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PR3136 > treatment of parkinson's disease > Flashcards

treatment of parkinson's disease Flashcards

1
Q

Cardinal features of Parkinson’s

A

Tremors
Rigidity
Akinesia/Bradykinesia

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2
Q

Idiopathic PD initial presentations

A

Asymmetric
Positive response to levodopa or apomorphine
Postural instability and falls not present
Less rapid progression
Autonomic dysfunction not present

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3
Q

Morbidity in PD

A

Unable to perform basic ADLs
Dysphagia
Falls due to postural imbalance

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4
Q

Pathology

A 
Significant loss of dopaminergic neurons in the substantia niagra 
Age-related
Environmental toxins 
Genetics 
- Predisposition to toxins/insults 
- Genetic abnormalities
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5
Q

Non-movement symptoms

A

Cognitive impairment
Sleep disorders
Psychiatric disorders
Autonomic dysfunction

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6
Q

Goal of treatment

A

Manage symptoms

Maintain function and autonomy

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7
Q

Non-pharmacological treatment

A

PT
OT
Speech and swallowing
Surgery

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8
Q

Levodopa

A

Most effective for bradykinesia and rigidity

Causes N/V, hypotension

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9
Q

Levodopa PK

A

A: proximal part in small intestines
Increased F with benserazide/carbidopa
Decreased absorption with high fat/protein meals

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10
Q

DOPA decarboxylase inhibitors

A

Do not cross BBB
75-100mg daily for saturation of dopa decarboxylase (1:1 action)
1:4 – Sinemet, Madopar
1:10 – Sinemet

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11
Q

Levodopa AE

A 
N/V
Orthostatic hypotension 
Drowsiness, sudden sleep onset
Hallucinations, psychosis
Dyskinesia within 3-5y
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12
Q

Levodopa DI

A 
Pyridoxine (Vit B6) - cofactor for dopa decarboxylase 
Iron 
Protein
Antidopaminergic drugs 
- Metoclopramide, prochlorperazine
- 1st gen antipsychotics 
- Risperidone
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13
Q

Dopamine agonists MOA

A

Act on D2 receptors in the basal ganglia

Mimic action of dopamine

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14
Q

Dopamine agonists PK

A

Longer half-life and duration of action than levodopa
Ropinirole metabolised in liver to inactive metabolites, DA in hepatic impairment
Pramipexole excreted largely unchanged in urine, DA in renal impairment

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15
Q

Dopaminergic agonists AE

A 
N/V
Orthostatic hypotension
Hallucinations 
Somnolence, daytime sleepiness
Compulsive behaviours
Fibrosis
Valvular heart disease
Leg edema
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16
Q

MAO B Inhibitors

A

Selegiline and rasagiline both irreversible inhibitors
Effective as monotherapy
Selegiline metabolised to amphetamines

17
Q

MAO B inhibitors dosing

A

Selegiline 5mg OM to BD

Rasagiline 0.5-2mg OD

18
Q

MAO B inhibitors DI

A 
SSRI, SNRI, TCA
Dopamine
Sympathomimetics
Another MAOi 
Penthidine, tramadol 
Linezolid
Dextromethorphan
19
Q

COMT inhibitors

A

Decreases “off” time, useful in wearing off phase

Not effective without concurrent levodopa

20
Q

Entacapone

A 
Selective, reversible COMT inhibitor
Must be taken at the same time as levodopa 
DI: 
- Iron, calcium 
- Catecholamine drugs 
- Enhances warfarin 
Diarrhoea, urine discolouration
May cause dyskinesia upon initiation 
May potentiate other dopaminergic effects
21
Q

Anticholinergics

A

Primarily used to control tremor
Ipatropium
Hyoscine
Tolterodine

22
Q

Anticholinergics SE

A

Dry mouth
Sedation
Constipation
Urinary retention

23
Q

NMDA Antagonists

A

Amantadine
Glutamate activates NMDA receptor activity which activates processes that encourage cell death
Improvement in levodopa-induced dyskinesia – used for management

24
Q

NMDA Antagonist PK

A

Renally excreted
Can be stimulating
AE: N, light-headedness, insomnia, confusion, hallucinations, livedo reticularis

25
Q

Alternative medicines

A 
Co-enzyme Q10
Creatinine 
Vit E 
Glutathione 
Riboflavin 
Lipoic acid 
Acetyl carnitine 
Curcumin
26
Q

Vascular Parkinsonism

A

Pathology due to vasculature in the brain
Usually bilateral
No resting tremor
Stepwise in progression
Vascular risk factors present
Increasing age is risk factor
Mostly not caused by infarct/lesions in basal ganglia

27
Q

Drug-induced parkinsonism

A 
Improvement with drug withdrawal in 80% of patients in 8w
No improvement with levodopa 
Occurs bilaterally
Women at higher risk
May unmask existing PD 
onset ~3m
28
Q

Drugs that may cause drug induced parkinsonism

A

1st gen antipsychotics
Antiepileptics
Metoclopramide

29
Q

Parkinsons Hyperpyrexia Syndrome

A 
Caused by changes in dopaminergic treatment 
Provoked by trauma and infections 
Loss of consciousness 
Rhabdomyolysis 
Immobility 
Disseminated intravascular coagulation
30
Q

PHS management

A

Reinstate previous treatment and increase dose of levodopa gradually
Rotigotine patch
Dantrolene PO/IV
Bromocriptine

PR3136 (5 decks)

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