PD and MS Flashcards
NTs for Alzheimer’s
acetylcholine, excitatory
glutamate, excitatory
NT for PD
dopamine
NT for epilepsy and Huntington’s
GABA, inhibitory
NTs for depression
norepinephrine, serotonin
non motor symptoms of PD
SOAP
sleep disturbance
other: nausea, fatigue, speech, pain, dysesthesias, vision problems, seborrhea)
A: autonomic (drool, constipation, sexual dysfunction, urinary problems, sweating, OH, dysphagia)
P: psych: anxiety, psychosis, cognitive impairment, depression
response fluctuations in PD
MAD
motor fluctuations
akathisia
dyskinesias
drugs causing drug induced parkinsonism
dopamine blockers:
chlorpromazine
haloperidol
risperidone
droperidol
metoclopramide
levodopa carbidopa: fx of carbidopa
prevents metabolism of L-Dopa until it crosses the blood brain barrier
allows L-DOPA to act as a dopamine replacement
almost 100% metabolized by GI absorption without carbidopa
carbidopa MOA
inhibit dopa decarboxylase enzyme
levodopa side effects
GI irritation
nausea
anorexia
hypotension
psychotropic
dyskinesias
decreased response to therapy after 4-5 years
drug holiday from PD medication indication
sudden increase in adverse effects
decrease dose over 1 week to allow body to recover from toxicity
then resume at lower dose
common drugs used to treat PD
dopamine agonists
dopamine precursors
monoamine oxidase inhibitors
catechol-o-methyl-transferase inhibitors
amantadine
PT considerations for PD
schedule therapy at peak effectiveness of meds (on phase)
adjust intensity as disease progresses
med side effects
reduce fall risk
monitor for dyskinesias
neurospychiatric side effects
treat while on drug holiday
educate on med adherence
PT + drugs have better effect than either alone
multiple sclerosis
inflammatory CNS disease of white matter
T cells activated against myelin, disrupting signal transmission
+ antibodies from B cells attack myelin sheath
forms of MS
relapsing remitting
primary progressive
secondary progressive
progressive relapsing
relapsing remitting MS
defined flare ups and remissions
most common
better prognosis
blocky graph
secondary progressive MS
relapse frequency will decrease but disability increases
steady progressive disability with less recovery
2nd most common
primary progressive MS
steady worsening of symptoms without relapse or remission
worse prognosis, 3rd most common
progressive relapsing MS
from onset steadily worsening disease with clear relapses with or without recovery
least common
symptoms of MS
N/T
cog dysfunction
depression
fatigue
muscle spasm
weakness
walking difficulty
dizziness
vision problems
pain
bladder dysfunction
bowel dysfunction
treatment of acute MS flare up includes
injection of high dose corticosteroids
oral predinisone
ACTH hormone
MS drugs to modify treatment progression
interferons and monoclonal antibody injections
fubdilimod/dimethyl fumarate oral
infused: mitoxantrone, ocrelizumab, natalizumab
treatment for primary progressive MS
ocrelizumab
immunoglobin antibody to reduce disease progression
indications for dalfampridine in MS
to improve walking speed
dalfampridine MOA
K+ channel blocker to prolong AP and improve nerve conduction
adverse effects of dalfampridine
UTI
insomnia
dizziness
headache
nausea
asthenia
back pain
balance disorder
seizures
PT considerations for MS
impact of meds on therapy
side effects
adjust to symptomatic days and side effects
MS drugs can affect motor performance
monitor changes in pt condition
shorter more frequent sessions if necessary for fatigue
cog dysfx or dizziness
