Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

CNS > PD > Flashcards

PD Flashcards

1
Q

Cardinal Signs of PD

A

TRAP: need 2/3 signs (TRA)

Tremor: resting tremor, incr with stress

Rigidity: muscle rigidity (cogwheel or lead pipe)

Akinesia/Bradykinesia: slowed movement, loss of weakness

Postural instability: gait and posture issues

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Clinical Presentations of Idiopathic PD (initial and progression)

A

Initial:

  1. Asymmetric
  2. Postural instability usually after 3 years
  3. Positive response to levodopa and apomorphine
  4. Less rapid progression
  5. Impaired olfaction (?)

Progressive:
1. Unable to perform ADLs
2. Choking
3. Pneumonia (aspiration common due to choking)
4. Falls

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

How to measure disease progression in PD? Mention about Tools & Staging

A

H&Y staging (1-5)
1. Asymmetric symptoms
2. Bilateral symptoms, no balance impairment
3. Impaired postural reflex, physically I dependent
4. Severe disability but can walk, stand unassisted
5. Wheelchair or bed ridden

MDS UPDRS
1. Mentation, Behaviour, Mood
2. ADL
3. Motor examination
4. Complications of therapy
5. Non motor experiences of daily living (dementia, psychosis, depression, GI motility issues, fatigue, siarllorhea, constipation)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Pharmacologicals for Non Motor Symptoms (Cognitive Impairment)

A

Dementia: Rivastigmine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Pharmacologicals for Non Motor Symptoms (Depression & Psychosis)

A

Dopamine Agonist: Premipexole

SSRI: Citalopram

TCA (metabolites): desipramine, nortriptyline

Atypical antipsychotic: quetiapine, clozapine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Pharmacologicals for Non Motor Symptoms (REM Sleep Behaviour Disorder)

A

BZD: Clonazepam

Melatonin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Pharmacologicals for Non Motor Symptoms (Constipation)

A

Osmotic laxative

Lubiprostone

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Pharmacologicals for Non Motor Symptoms (OH)

A

Domperidone

Fludrocortidone

Midodrine

Pyridostigmine

Droxidopa

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Pharmacologicals for Non Motor Symptoms (GI motility)

A

Domperidone

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Pharmacologicals for Non Motor Symptoms (Siallorhoea)

A

Atropine drops, glycopyrrolate

Botox (A & B)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Pharmacologicals for Non Motor Symptoms (Fatigue)

A

Methylphenidate, Modafinil

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Non Pharm for PD management

A

PT: stretch, transfers, posture, walking

OT: mobility aids, workplace safety

Speech and swallowing: able to swallow up to what extent (thicken? Tablet size they can swallow? Can crush?)

Surgery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Goals of PD treatment

A

Manage symptoms

Maintain function and autonomy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Pharmacologicals for PD treatment

A
  1. Levodopa + DCI (carbidopa/benserazide)
  2. Dopamine Agonist:
    - Pramipexole, Ropi, Roti, Apomorphine
    - bromocriptine, carbegoline, pergolide
  3. MAO-B Inhibitor: Selegiline, Rasagiline
  4. COMT-I: entacapone
  5. Anticholinergics: Benzhexol
  6. NMDA Antagonist: Amantadine (memantine not useful here)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Explain about Levodopa (MOA, S/E, Monitoring Parameters, PK, DDI, Important Counselling Points)

A

Levodopa is the most effective for motor symptoms (bradykinesia and rigidity) but try to not use in early onset PD

MOA: Metabolised by DOPA decarboxylase, MAO and COMT to dopamine

Dose:
- B 25mg/ L 100mg OD or BD
- C 50/ L 100mg BD or TDS
- Max L: 2g/ day

S/E: nausea, vomiting, hypotension, hallucinations, motor complications (dyskinesias, wearing off, on off effect), psychosis, drowsiness and sudden sleep onset

PK: Absorbed in proximal part of SI
- BA increases with DCI (Carbidopa/Benserazide) in a ratio of 1:4 or 1:10 (levodopa usually higher dose)
- CR has a lower BA than IR: increase dose when changing from IR to CR and decrease dose when CR to IR

DDI:
- Pyridoxine (Vit B6): no issues if administer with DCI but high dose B6 for haematological problems
- Protein / Fe: space administration
- Dopamine antagonist: Metoclopramide, Prochlorperazine, FGA, Risperidone

Counsel:
- Do not crush or open capsule for SR forms
- Counsel on to space apart HIGH fat and protein meals from levodopa

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Explain the Motor Complications when using Levodopa and how to manage (On Off, Wearing off, Dyskinesia)

A

On-off:
- mechanism unclear but it has unpredictable response

Wearing off:
- slowly lose effect before end of dosing interval
- associated with disease progression
- mgmt: Modify time of administration or use SR preparation or add COMT

Dyskinesia
- involuntary movements and peak dose dyskinesias and dystonia
- mgmt: add amantadine or replace with MR/SR levodopa

17
Q

Explain about Dopamine Agonist (MOA, S/E, Monitoring Parameters, PK, DDI, Important Counselling Points)

A

Preferred in early onset PD (<40 years) and adjunct to levodopa for moderate to severe PD. Can also manage motor complications caused by levodopa

Ergot:
- Bromocriptine: 1.25mg BD (max: 100mg)
- Pergolide, Cabergoline

Non Ergot:
- Pramipexole: IR 0.125mg TDS (max: 4.5mg) or XR 0.375 OD
- Ropinirole: IR 0.25mg TDS (max: 24mg/ day) or XR 2mg OD
- Rotigotine, Apomorphine

MOA: act on dopamine (d2) receptors and mimics dopamine

PK:
- ergot derived has lower F due to extensive FPE
- Ropi: liver metabolism (check DDI)
- Prami: renal clearance (check DDI)

S/E:
- peripheral: N&V, OH, Leg edema
- central: hallucinations, Somnolence, day time sleepiness, compulsive behaviours (gambling, shopping, eating, hyper sexuality)
- fibrosis and valvular heart disease more for ergot derived

18
Q

Explain about MAOI - B (MOA, S/E, Monitoring Parameters, PK, DDI, Important Counselling Points)

A

Usually for mono therapy in early stage (more for early onset PD) and adjunct in later. Improvement in the UPDRS scores not as good as levodopa and DA

MOA: Inhibit MAO B (irreversible)

Selegiline: 5mg OM to BD
- Second dose before 4pm
- Metabolized to amphetamines (stimulating)

Rasagiline: 0.5mg to 2mg OD
- not metabolised to Amphetamine

S/E: heartburn, LOA, hallucinations, insomnia, nightmares, palpitations, anxiety

DDI:
- SSRI, TCA, SNRI
- Pethidine , Tramadol
- Dextro
- Dopamine
- Linezolid
- Decongestants
- Another MAO I

Counsel:
- avoid tyramine rich food (fermented, aged cheese, wine)

19
Q

Explain about COMT (MOA, S/E, Monitoring Parameters, PK, DDI, Important Counselling Points)

A

Adjunct therapy only for managing motor complications in those on levodopa. Reduce levo dose if dyskinesia appear

MOA: selective, reversible COMT-I

S/E: Diarrhea, urine discolouration (orange), nausea, vomiting, OH (Potentiate dopaminergic effects)

DDI:
- Fe, CA
- MAOI
- Warfarin
- Catecholamine

Caution: hepatic impairment

Counsel:
- take at same time with levodopa

20
Q

Explain about Anticholinergics (MOA, S/E, Monitoring Parameters, PK, DDI, Important Counselling Points)

A

Benzhexol, Benztropine, Trihexyphenidyl - more for symptomatic control of PD

S/E: drying effects, hypotension, cognitive impairment

21
Q

Explain about Amantadine (MOA, S/E, Monitoring Parameters, PK, DDI, Important Counselling Points)

A

Adjunctive, usually for levodopa indicted dyskinesia

MOA: NMDA receptor antagonist

S/E: nausea, lightheadedness, insomnia, confusion, hallucinations, livedo reticularis

PK:
- Second dose in afternoon (can be stimulating)
- Renally excreted

Do not use with memantine

22
Q

What drugs causes Drug Induced Parkinsonism?

A

Usually Bilateral compared to idiopathic PD

High risk:
- FGA
- SGA at higher doses (ROA)
- Tetrabenazine, Reserpine
- a-methyldopa
- Flunarizine, Cinnarizine (CCB- P Channel)

Intermediate:
- Ziprasidone
- Diltiazem, Verapamil
- ASM: Valproate, CBZ and Levatiracetam
- Lithium
- Prochlorperazine, Metoclopramide, Substituted Benzamide

CNS (2 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions