Parkinsons disease Flashcards
How is parkinsons disease alleviated?
By increasing the amounts of dopamine
How do you treat patients with PD whose motor symptoms decrease their quality of life?
Levodopa and Cardidopa/Benserazide
e.g. Co-careldopa or Co-beneldopa
How do you treat patients with PD whose motor symptoms don’t affect their quality of life?
Non-ergot derived dopamine receptor
Monoamine oxidase B inhibitors
Levodopa and Cardidopa/benserazide usually withheld for pt’s with severe symptoms
What are side effects of levodopa?
Impulsive disorder e.g. pathological gambling, binge eating, hyper sexuality
Sudden onset of sleep (treat with modafinil)
Red urine - not to worry
What are the side effects of non-ergot dervied dopamine receptors?
e.g. Pramipexole, Ropinirole, Rotigotine
Impulsive diorders (more so than levodopa)
Sudden onset of sleep
Hypoetnsion - treat with midodrine
What are the side effects of MAOB-I?
e.g. Rasagiline or selegiline
Causes hypertensive crisis if given with Phenylephrine
Interacts with tyramine rich foods:
-mouldy and rich stuff
Whats the side effects of COMT inhibitors?
Entacapone: Red-brown urine
Tolcapone: Hepatotoxic
increases sympathetic side effects - increase in CVD events e.g. tachycardia, fast breathing etc.
What are the side effects of ergot derived dopamine receptor agonists?
Pulomary reactions: SOB, cough
Pericardial reactions: Chest pain
if patients are having ‘off’ periods at the end of the dose deterioration what should you do?
Use MR prep
How would you treat hypotension?
Midodrine
What does motor symptoms mean?
Movement and muscles
What does non motor symptoms mean?
Not movement related
What does impulse control disorders mean
Urges and behaviours that are excessive and or harmful to you and other that can cause specific impairment in social and occupational functioning
Why is Levodopa prescribed alongside a decarboxylase inhibitor?
Stops levodopa being broken down peripherally and allows more to get into the brain.
Why is levodopa preferred for the treatment of motor symptoms in Parkinson’s?
Overall better improvement
Less likely to cause sleepiness, hallucinations and improve control disorders
What dopaminergic drugs have potential to cause impulse control disorders?
All of them
Treatment for nausea and vomiting in patients with PD
NOT metocopramide.
Best one is domperidone because it does not cross the BBB
What’s the greatest for sleepiness in PD?
Review therapy
If not resolved the modafinil
How do you treat depression in PD?
- Non pharmacological
- SSRI’s
How do you treat dementia in PD patients
Same as normal so acetylcholinesterase inhibitors e.g. donepezil, rivastigme, galantamine
Glutamate receptor antagonist e.g. galantamine
How do you manage psychosis in PD patients
- Review meds
- 2nd gen antipsychotics e.g. Quetta pine or clozapine
What PD medication is most likely to cause dyskinesias?
Levodopa
What kind of medications are Parkinson’s disease meds
Critical time medications
Why is PD mediation a CTM?
To avoid response fluctuations between on and off periods
Reduce risk of akinesia and neuroleptic malignant syndrome. Abrupt withdrawal
If you have PD who must you inform
The DVLA and car insurer
What can you use in severe off periods in Parkinsons disease?
Apomorphine
Levodopa transdermal gel if responsive to levodopa
