Pharmaceutical Care of Parkinson's Disease Flashcards
What are the main symptoms?
Bradykinesia
Rigidity
Tremor
What are the other symptoms?
Postural instability
Sleep problems
Freezing of gait - inability to continue locomotion
Speech problems
Swallowing problems
Mental health
What is postural hypotension?
Fall in blood pressure of at least 20 systolic + 10 diastolic
What symptoms are associated with postural hypotension?
Light-headedness
Visual blurring
Dizziness
Fatigue
Weakness
What is PD diagnosis?
Many other conditions mimic PD
= refer to specialist
What are the complications with PD?
Communication
Attitudes to drug therapy
Family/carer needs
Non-motor symptoms
What is the disease complication?
Deterioration of quality of speech
= difficult to express emotion
What is the attitudes to drug therapy complication?
Medication can take time to work
What is the family/carer needs complication?
Difficult watching their family struggle
Changes in lifestyle for carer
What is the non-motor symptoms complication?
Distracted, diminished attention
What does the choice of drug depend on?
Effectiveness + adverse effects of drugs
Patient comorbidities
Patient response to the drug
Clinical experience
Patient preference
What are you managing in the early disease?
Functional disability
What are you managing in the later disease?
Motor complications
What increases the availability of dopamine to brain?
Decarboxylase inhibitor
COMT inhibitors
What decreases the breakdown of dopamine?
MAOb inhibitors
COMT inhibitors
What replaces the post-synaptic dopamine stimulation?
DR2 agonists
What is the 1st line (1) treatment of early PD?
Levodopa + dopa decarboxylase inhibitor
What is the side effect of Levodopa + dopa decarboxylase inhibitor?
Nausea + vomiting
What is nausea + vomiting managed by?
Domperidone
= DA receptor antagonist BUT doesn’t cross BBB
= decreased side effects
What is the 1st line (2) treatment for early PD?
Oral/transdermal dopamine agonist
How do the oral/transdermal dopamine agonist work?
Bind directly post-synaptic dopamine receptor
Combined with Levodopa
Mimic effect of dopamine
Improve motor symptoms
What can oral/transdermal dopamine agonists be classified?
Ergot derived = older generation
Non-ergot derived
What is an example of ergot derived?
Cabergoline
What is the risk with ergot?
Cardiac valvulopathy
Pleural fibrosis - thickening of membrane
What is an example of non-ergot derived?
Ropinirole
Rotigotine
What are the side effects of dopamine agonists?
Impulse control disorders - eg. gambling
Daytime drowsiness
Peripheral oedema
Nausea, dizziness, hallucinations + constipation
What is the 1st line (3) treatment of early PD?
MAOb
What is an example of MAOb?
Rasagiline
Selegiline
What is safer out of Rasagiline + Selegiline?
Rasagiline
= Selegiline is converted to amphetamine derivatives = sleeping disorders
What is NOT used as 1st line for treatment of PD?
Anticholinergic drugs
Beta-blockers
Amantadine
How does anticholinergic drugs work for PD?
Reduce effects of cholinergic excess
= some relief of tremor + rigidity
What is the example of anticholinergic drug?
Benztropine
Biperiden
What are the side effects of anticholinergics?
Dry mouth
Blurred vision
Constipation
Confusion
Hallucinations
What is Amantadine?
Weak dopamine agonist of NMDA-type glutamate receptor
How can Amantadine be used?
With Levodopa
= improve muscle control + reduce stiffness
How are beta-blockers used?
Treatment of tremor
What is an example of beta blocker?
Propranolol
What are the treatment for non-motor symptoms of PD?
Antidepressants for depression
Laxatives
NSAIDs for pain-frozen shoulders
Benzodiazepines for REM-sleep disorder
Fludrocortisone for postural hypotension
What are the symptoms of later PD?
Physical symptoms NOT controlled by medication
Medication side effects
End of dose deterioration function
Dyskinesia
Freezing
What drugs are used to manage later PD?
Levodopa + dopa decarboxylase inhibitor
Oral/transdermal dopamine agonist
MAOb inhibitor
COMT inhibitors
Amantadine
Apomorphine
What is Levodopa used to treat?
Later
Postural
Freezing
What is Apomorphine?
Later
Dopamine agonist = non-ergot
How is Apomorphine delivered?
Injections
What are the side effects of Apomorphine?
Confusion
Hallucinations
What are MAOb inhibitors used for?
Later
Reduce motor fluctuations
What should COMT inhibitors be combined with?
Levodopa
Carbidopa
What is an example of COMT inhibitors?
Tolcapone
Entacapone
What is Tolcapone associated with?
Fatal hepatic toxicity
= mandatory liver function tests
What should be done with PD drugs?
Do NOT withdraw them suddenly
= avoid potential acute akinesia (loss of voluntary movement)
