Parkinsons Disease Flashcards
How is parkinsons disease caused?
by the degeneration of neurons in the substantia nirgra which leaves a deficiency in the neurotransmitter dopamine
How does the treatment help with parkinsons disease?
it doesn’t prevent the disease progression, its used to help the quality of life for the patient
What drugs are used in parkinsons?
dopaminergic drugs, ergot-derived such as bromocriptine (less used and can be associated with fibrotic reactions so monitor for chest pain, persistent coughing and any cardiac function).
What are the main drugs used?
dopamine receptor agonists (ole’s) ropinerole, pramipexole etc. FIRST LINE
What are the side effects of dopamine receptor agonists (DRA)?
more psychological S/E than levodopa
associated with impulse control disorders (binge eating)
What is a BIG S/E of DRA? like co-careldopa etc
sudden onset of sleep
so if a patient is driving they must be cautious with driving
When can pramipexole and ropinerole be used?
can be used as an adjunct to co-careldopa
When is apomorphine used?
for pts with severe parkinsons disease and for those with ‘off’ periods (when pts are feeling weak/restricted mobility)
What’s levodopa?
precursor of dopamine
What is levodopa usually given with and why?
A dopa-decarboxylase inhibitor. By inhibiting dopa-decarboxylase means that less levodopa will convert to dopamine in the bloodstream so more levodopa can cross the BBB and thus be converted to dopamine in the brain, decreasing side effects like N/V.
What’s an example of dopa-decarboxylase inhibitor?
benserazide
What else can levodopa be given with? Why?
a COMT inhibitor (catechol-O-methyltransferase inhibitor)
This will prevent levodopa being broken down allowing more L-dopa in the brain.
Whats an example of an COMT inhibitor?
Entacapone. This can be given in combination with a dopa-decarboxylase and levodopa - called stalevo.
What are monoamineoxidase-B inhibitors? Why are they used?
Rasaligine, sligiline - prevents dopamine being broken down which prolongs its action.
Which drugs are used in tremor and ticks?
Tetrabenazine - can be used for huntington’s disease (also haloperidol too unlicensed)
propranolol - can be used for tremor
botox can be used for any facial spasticity.
