Parkinsons Disease Flashcards
motor symptoms of parkinsons disease
hypokinesia, bradykinesia, rigidity, rest tremor, postural instability
Non-motor symptoms of Parkinsons disease
dementia, depression, sleep distrubance, bladder and bowel dysfunction, speech and language changes, swallowing problems, weight loss, hallucinations, REM sleep behaviour
If a patient who drives develops Parkinsons who do they need to inform?
DVLA and car insurance
First line treatment for Parkinsons patients who’s motor symptoms affect their quality of life
Levodopa combined with Carbidopa (co-careldopa) Or Benserazide (co-beneldopa)
First line treatment for Parkinsons patients who’s motor symptoms do NOT affect their quality of life
levodopa, non-ergot dervived dopamine agonists (e.g. Ropinorole, Pramipexole, Rotigotine) or MAOBi (rasagiline or Selegilline)
Why cant dopamine be used to treat parkinsons?
It does not cross the BBB but its precursor, Levodopa does
What enzyme converts Levodopa into Dopamine
Dopamine decarboxylase
Why is Levodopa given alongside Carbidopa / Benserazide?
Carbidopa and Benserazide are dopamine decarboxylase inhibitors that prevent the conversion to dopamine in the periphery (which woulod cause N&V, tacycardia etc)
Why do Dopamine decarboxylase inhibitors not prevent the coversion of Levodopa to dopamine in the brain but do in the periphery?
They do not cross the BBB but Levodopa does
For how many months does Levodopa improve symptoms for?
6-18 months, declines after 2 years
What are 3 main side effects of Levodopa?
- Dykinesias - develop in 30-40% of pt after 4-6 years
- Motor fluctatuins - on’off symptoms
- End of dose deterioration (weaning off)
What preparation of Levodopa can be used to prevent wearing off?
MR preparations (limited role) also used to manage night time akinesia and simplyfy dose regimes
What form of levodopa is usually used first thing in the morning for rapid effect?
Dispersible
Side effects of Levodopa treatment
Nausea (take with food initally) Postural hypotension Somnolence Urine discolouration IMPULSE CONTROL DISORERS
What is encompased by the term impulse control disorder
pathological gambling, binge eating, hypersexuality
If a patient develops motor fluctuations despite optimal levodopa therapy, what else can be trialled?
Non-ergot dopamine receptor agonists (pramipexole, ropinorole, rotigotine), MAOIB (selegelline, rasagiline) 0r COMT inhibitor (Entacapone or tolcapone)
examples of ergot derived dopamine receptor agonists
Carbergoline, pergolide, bromocriptine
When should an ergot derived dopamine receptor agonist be initiated?
Following failure of a non-ergot derived dopamine agonist + levodopa
If dyskinesia is not adequately controlled with ergot/levo/non ergot therpay, what can be tried?
Amantadine
What drug can be used to treat excessive sleepiness?
Modanifil
What drug can be used to manage postural hypotension?
Midrodrine or fludrocortisone
Which antipsychotic can be used to help treat delusions and hallucinations associated with parkinsons?
Quetiapine or Clozapine is also licensed
Can antipsychotics e.g. phenothiazines and butyrtphenones be used in parksinsons?
No - they can worsen motor symptoms
What drugs can help manage rapid eye movement in parksinson?
Clonazepam or melatonin
How can mild-moderate parkinsons dementia be treated?
Ach esterase inhibitor e.g. Rivastigmine, Galatamine and Donepezil OR memantine (NMDA antagonist)
When is apomorphine used in parksinsons?
In advanced parkisnons as intermitten injections or continuous SC infusion
Which antiemetic is given 2 days before apomorphine infusions?
Domperidone
What is used to treat the EPSE of parksonsons medications>
Procyclidine
What does Entacapone do?
COMT inhibitor - prevents breakdown of Levodopa (reduces end of dose motor flucuations)
What colour can Entacapone turn your urine?
Redish-brown (counsel patient)
What should patients be taught to recognise when starting Tolcapone?
Signs of liver disease due to its hepatotoxic potential
Why should abrupt withdrawal of Levodopa be avoided?
Risk of Neuroleptic malignant syndrome
when switcihg from MR to dispersible levodopa, how much should the dose be reduced by?
30%
What does Stalevo contain?
Levodopa, Carbidopa and Entacapone
What dopamine receptor agonist(s) has been associated with fibrotic reactions?
Bromocriptine, Cabergoline, pergolide
Other than parksinsons, what can Ropinorole be used for?
restless leg syndrome
which anti parksinsons drug requires ophthalmic testing?
Rotigotine
How should a rotigotine patch be applied
clean,dry intact healthy non irritated skin on torso, thigh,hip, shoulder or upper arm by pressing the patch down firmly for 30 seconds. Remove patches after 24 hours, replace in different area
How far apart from iron preparation do COMT inhibitors need to be taken?
2 - 3 hours apart
