Wen Li Flashcards
parkinsons in terms of neurones
- death or destruction (degeneration) of neurons in substansia niagra of brain
- these neurones usually dopaminergic
- hence have a lack of dopamine produced leading to involuntary movements
- dopamine usually transmits chem messages to corpus striatum which is responsible for muscle activity regulation
ropinirole indication and dose
parkinsons, 750mcg in 3 divided doses daily
ropinirole counselling / lifestyle
- will take a few weeks for effcets to be seen
- dose will be weekly changed most liekly
- If miss one day or more have to reinitiate the whole titration process
- Don’t abruptly stop taking (neuroleptic malignant syndrome – high fever, stiff muscles, quick breathing)
- may experience some gi discomfort or drowsiness
- sudden onset of sleep (so avoid driving or skilled activities, best to have someone around to help with this)
- Optimise sleep routine at night so this is prevented in the day (sleep hygiene – less naps, no caffeine before bed, 7-9 hours, bright lights)
- adapt home layout to make it easier for you to walk around or minimise risk of falls
common side effect with ALL dopamine receptor agonists
Impulse control behaviour
- doing an activity to an extreme
- overstimulation at dopamine reward centre
- eg binge eating, gambling addictions etc
co-careldopa what it is, indication and dose
- levodopa = dopamine precursor
- carbidopa = decarboxylase inhibitor, prevents breakdown of levodopa
used for parkinsons, 25/100 TDS initally and titrate up
co-careldopa counselling
- ropinirole will be titrated down which co-carel up so both will be taken
- can turn urine a reddish colour
- still may cause the impulse control behaviour so keep eye out
- dont abruptly stop taking as can cause neuroleptic malignant syndrome
- excessive daytime sleepiness is common hence try not to carry out any skilled tasks or driving, ladders etc
- Optimise sleep routine at night so this is prevented in the day (sleep hygiene – less naps, no caffeine before bed, 7-9 hours, bright lights)
- the aim is to bring your old med (ropin) up so we dont have too many SE’s and ur new med up to get effective management of PD symptoms
what antiemetics can be given in PD?
- domperidone –> 10mg tds prn
- cyclizine –> 50mg upto tds prn
NOT METOCLOPRAMIDE (WORSENS PARKINSON SYMPTOMS)
domperidone counselling / lifestyle points
- short term use only, dont use for longer than 7 days
- is prn so dont need to take it every 8 or so hours, just can only have a max of tds
- can cause se’s like dry mouth so sugar free gum to help with this
- eating smaller more frequent meals
- stay away form fatty, rich meals and foods
- dont lie down straight after a meal
- ginger teas and biscuits can help the nausea too
on and off symptoms and how these can be managed
on = when PD symptoms controlled, off = when symptoms not controlled
- off could be due to end-of-dose deteroiration as suggests levodopa levels not high enough
- give MR before bed so off periods in morning better controlled
- add MOAI or catecholamine transferase
how does parkinsons cause dementia?
- lewy body dementia
- as parkinsons progresses have biuldup of alpha synuclein which comes together as clumps known as lewy bodies
- these deposits lead to memory loss, hallucinations, impaired concentration
donezepil in PD dementia
NOT LICENCED CHEKC WITH CONSULTANT FIRST but is still used
urosepsis medication
- IV tazocin in over 65
- IV Cefuroxime under 65
medications commonly associated with c.diff
Cephalosporins and quinolones and PPI and clindamycin
covert administration
- when pt actively refuses medication and lacks capacity
- med essential to pt’s wellbeing
- wanna test capacity
- Consideration is made to reasoning for patient’s refusal of medication
• Reasons for refusal could be dislikes taste, anticipatory sickness or other side-effects
• A mental capacity assessment to be made for the patient
• Assessment identifies whether patient lacks capacity to decline medications
• Reference made to the importance of certain medications, e.g. critical medications
• Where patients are deemed to lack capacity, continuing covert administration is regularly reviewed as capacity can fluctuate
• BNF provides information on alternative preparations
• Medications to be reviewed for safety in covert administration
• Manufacturers Summary of Products and Characteristics may provide
information for drug compatibility in juices, crushing and dispersing etc.
• Refer to guidance available from Royal Pharmaceutical Society (RPS)/MEP/GPhC
wrong medication administered
- duty of candour so own up to mistake and be honest w patinet
- investigate how error occured
- document error and reflect so that doesnt happen again and prevent others doing it
- obs pt for side effects
- tell pharm and dr what happened
donepezil vs rivagastimine
- donep is off license for parkinsons induced dementia so give riva
- BUT when dementia gets moderate-severe then gice and AChE inhibitor so donep can be given then
- donep has fewer se’s than riva
how does entacapone work?
COMT enzymes normally metabolises levodopa before it reaches the brain
Entacapone is a COMT inhibitor, blocking the enzyme so more levodopa is available to the brain
Increased levodopa availability leads to smoother and steadier levels of dopamine, providing better symptom control for longer periods each day
Less ”off’ periods
