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
How is nocturnal akinesia treated?
- Levodopa
- Dopamine-receptor agonist e.g. Rotigotine
How is postural hypotension treated?
- Midrodine
How is Rapid eye movement sleep behaviour disorder treated?
Clonazepam [unlicensed]
Melatonin [unlicensed]
How is Psychotic symptoms treated?
- Quetiapine [unlicensed]
- Clozapine
For hallucination and delusion
Other antipsychotics such as phenothiazines and butyrophenones can worsen motor features of PD
How is drooling of saliva treated?
Glycoyyronium bromide
Bromocriptine, apomorphine SE
impulse control
How is dementia treated?
Rivastigmine caps and oral solution
Memantine
