PARKINSONS: GENERAL INFO Flashcards
Pathophysiology of Parkinson’s
Chronic, progressive neurodegenerative condition due to the loss of dopaminergic neurons in the substantia nigra.
Dopamine deficiency in the basal ganglia leads to a movement disorder with parkinsonian motor symptoms
Motor symptoms of Parkinson’s Disease
o Hypokinesia
o Bradykinesia
o Rigidity
o Rest tremor
o Postural instability
Non-motor symptoms of Parkinson’s Disease
o Bladder and bowel dysfunction
o Dementia
o Depression
o Dysphagia/ speech + language change
o Sleep disturbances
o Weight loss
DVLA/insurance
Must notify the DVLA + car insurer
Withdrawal
Never abruptly withdraw
Can cause acute akinesia + neuroleptic malignant syndrome
Nausea + vomiting
Low dose domperidone (CI <35kg)
DO NOT give metoclopramide or prochlorperazine
Non-drug treatment
- Physiotherapy
- For balance and motor function problems - Speech and language therapy
- communication, swallowing or saliva problems - Occupational therapy
- Dietician
- if problems with diet
Motor symptoms that decrease QoL
1st line = Levodopa (with carbidopa/benserazide)
Motor symptoms that do not affect QoL
- Levodopa (with carbidopa/benserazide)
- Dopamine agonist
o Pramipexole
o Ropinirole
o Rotigotine - Monoamine-oxidase B inhibitors
o Seligiline
o Rasagiline
o Safinamide
Adjuvant therapy for patients who have developed dyskinesia & motor fluctuations with levodopa
Non-ergot derived dopamine agonists
MAO-B inhibitors
COMT inhibitors
Amantadine
If dyskinesia not adequately managed by modifying therapy
Ergot-derived dopamine agonists
Inadequate response with non-ergot derived dopamine receptor agonists
Advanced parkinsons disease
Apomorphine (SC intermittent injections/continuous infusion)
Levodopa-carbidopa (intestinal gel)
Deep brain stimulation
Apomorphine (SC intermittent injections/continuous infusion)
Advanced levodopa-responsive PD with severe motor fluctuations, hyperkinesia or dyskinesia)
Deep brain simulation
Symptoms are not adequately controlled with best drug treatment
