Parkinsons disease Flashcards
Clinical characteristics of parkinson’s disease
-neurodegenerative disorder caused by reduced dopamine secretion by the substania nigra
–> this results in a gradual loss of muscle control –> tremor, akinesia/bradykinesia, rigidness, postural instability
non-motor skill symptoms
- insomnia
- mental/behavioural issues
- pain
- GI issues
- sweating and melanoma
levodopa/dopa-decarboxylase inhibitors - MOA, AE, RPP
levodopa/carbidopa
levodopa/benserazide
AE - well tolerated compared to other drugs
- nausea, vomitting, postural HT, constipation, sleep episode, confusion, hallucinations
MOA - replaces missing dopamine in brain
- given with inhibitor to decrease peripheral metabolism of levodopa to dopamine –> reduced adverse effects
RPP - first choice for most
- preferred for pt over 70
Drug interactions:
- dopamine agonists - increase adverse effects
- dopamine antagonists - reduce therapeutic effect
- antihypertensives - can worsen HT
dopamine agonists - MOA, AE, RPP
E.g. - cabergoline, bromocriptine, pergolide, peamipexole
AE - more significant adverse effect profile
MOA - mimic dopamine –> improve bradykinesia and rigidness
RPP - preferred in younger pt
- dont stop abruptly
- can lead to impulse control disorders - inform pts and monitor behaviour closely
monoamine oxidase type B inhibitors - MOA, AE, RPP
selegiline, rasagiline
AE - orthostatin HT, dyskinesia, headache, insomnia, nausea, vomitting, rash
MOA - conserve dopamine by blocking MOA-B enzyme
RPP - less effective than levodopa combination
- increases AE if combined with levodopa
anticholinergics - MOA, AE, RPP
Benzhexol, benztropine, biperiden
Common adverse effects and poor efficiacy
MOA - Reduce excess of cholinergic activity
RPP - avoid use in parkinson’s disease
medications to avoid in parkinson’s disease
antinausea medications - mtoclopramide
antiopsyhcotic medications e.g. risperidone (switch to quetiapine or clozapine)
