Parkinsons Disease Flashcards
What are the risk factors
age, genetics, pesidicies, well water, trauma
Patho of PD
Injury to dopaminergic projections from teh substantia nigra pars compacta to the caudate neucleus and putamen. Lewy bodies present
How is PD confirmed
Resonce to levodopa in motor manifestations
Primary featues, resing tremor, bradykinesia, rigidity, asymetric onset PLUS responsiveness to levodopa
Supportive features of PD
Mask like face, loss of fine motor skills, droooling, speach and swallong problems, shuffing gain, reduced arm swing, reduced upwards gaze, decreased bliniking
Non motor features
autonomic dysfunction, dementia, depression, sensory symptoms, disturbed sleep.
Define essential tremor
most common, tends to be familiarl. Typically noted first when eating. Tens to be absent at rest and bilateral
Drugs in PD
Levodopa, then dopamine, COMT inhibitors increased levodopa half life
What is the issue with dopamine agonists
Moto sideeffects. Newer ones are better (ropinirole or pramipexole)
How is the tx of younger people different
Often start with dopamine agonist. Will still use anticolinergiecs
Why is carbidopa mixed with levodopa
prevent conversin to dopamine reducing nausia, vominting, and orthostatic htn
What is starting dose and how should it be taken
start 1/2 tab 25/100 TID and titrate to 25/100 TID. On empty stomach. If nausia take with snack or manage with antiemitcs onsansatron
Which antiemetics can cause drug enduced parkinsosim
metocolpramize & phenothiazine (prochlorperazine)
Management of autonomic dysfunction
orthostatic htn - drug reduction, salt diet, fluid intake, fludrocortisone or midodrine.
Aggressive constipation management, fluid, fibre, stool softeners, enimers
urinary urgency - oxybutynin and (peripheral anticologenic)
Management of depression
40% of patients - use ssris to tx. Citalopram & venlafazine. If ESP symptoms use sertraline.
Sleep disturbances
Melatonin
