Treatment of Parkinson's Disease Flashcards
What is used to stage parkinson’s disease?
Hoehn and Yahr staging
Stage 0
No clinical signs or symptoms
Stage 1
One-sided involvement
Stage 2
Bilateral involvement
Stage 3
Bilateral involvement with mild postural abnormalities or history of poor balance and falls
Stage 4
Bilateral involvement with postural instability
Tremor is eclipsed by advancing bradykinesia and rigidity
Stage 5
Severe, advanced
Cannot stand or walk
Cognitive impairment
GI motility is affected
Primary Symptoms
Bradykinesia
Postural abnormalities
Tremor
Muscle rigidity
Functional Scales for Evaluation
ADL and IADLs
Gait and balance assessment
Tinetti
- Gait is observed through 10 foot walk (swinging, step pattern, etc)
- Balance is score through a series of commands (sit/stand, etc)
Movement Disorder Assessment
AIMS- can also be used for drug-induced PD side effects
Cognitive, Mood and Behavior Assessment
GDS, Cornell, Neuropschiatry inventory
Overall PD assessment
UPDRS (unified PD risk scale)
- GOLD standard
Selegiline use, dose, class, titration
Neuroprotective and prevent early symptoms MOAB inhibitor 5 mg BID (RR, disintegrating tablets, patch) Tablet is titrated after 6 weeks
Selegiline side effects, CI, precautions, drug/food interactions
All CI with meperidine, methadone and MAOI
Patch and tablet: muscle relaxants (end in zaprine)
Patch: antidepressants, decongestants, tyramine food
SE: hypertensive crisis
Selegiline Monitoring
PD symptoms
BP
Mood
Rasagiline use, dose, class, titration
Prevention
MAOi
Mono (1 mg QD) or adjunct (0.5 mg QD)
No real titration
Rasagiline CI, precautions, side effects, drug/food interactions
CI: muscle relaxants, dextromethorphan, meperidine, methadone, tramadol MAOIs
Caution: antidepressants, melanoma, hepatic disease, 1A2 substrates
SE: orthostatic hypotension, HTN, GI, RASH, headache, vivid dreams
Food: Tyramine
Rasagiline Monitoring
Parkinson’s symptoms
BP
Skin
Alpha tocopherol dosing and MOA
Vitamin E
1000 IU BID
Antioxidant - decrease ROS on DA neurons
DATATOP Results
Selegiline is not neuroprotective, but it does allow delay in levodopa therapy (good for early symptoms)
Vitamin E had no effect
Early Treatment: Monotherapy Options
- MAOB inhibitors (selegiline/rasagiline)
- Dopamine replacement (levodopa/carbidopa)
- DA agonists (ropinerole, pramipexole, rotigotine patch)
Minimum Daily Dose of Carbidopa
75 mg
Levodopa/Carbidopa
Sinemet or Sinemet CR - extended release
Daily dose of Levodopa A) 300-400 B) 500-600 C) 700-800 D) 900-1000
Sinemet CR Regimen
A) 50/200 mg 1 tablet BID
B) 50/200 mg 1 tab TID
C) 50/200 mg 4 tablets TID or in combo with 25/100 mg form
D)50/200 mg 5 tablets TID or in combo with 25/100 mg form
Sinemet dose, titration
25/100 BID or TID with 4 hours between CR doses
Max 200/2000 mg/day
Sinemet CI, precautions and drug/food interaction
CI: narrow angle glaucoma, malignant melanoma, skin conditions
Caution: MI, arrhythmias, asthma, wide angle glaucoma, PUD
Drug: Pheytoin, BZD, TCA, Haldol, methyldopa, antacids, MAOI
Food- PROTEIN***
Sinement SE
Orhtostatic hypotension, arrhythmias, anxiety, confusion, N/V, blurred vision