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PHAM01 - term 2 > Wk 28 - Parkinson's disease > Flashcards

Wk 28 - Parkinson's disease Flashcards

1
Q

Which genes + toxins cause PD?

A
  • Genes: parkin + DJ-1
  • Toxins: MPTP
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2
Q

Which drugs cause parkinsonian syndrome + for how long?

A

Recover w/in 2 months:

  • Neuroleptics
  • Anti-psychotics: haloperidol
  • Anti-depressant
  • Anti-emetics: metoclopramide
  • CCB
  • Lithium
  • Donepezil
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3
Q

What are the motor symptoms of PD?

A
  • Tremor
  • Rigidity
  • Hypokinesia
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4
Q

What are the autonomic symptoms of PD?

A
  • Constipation
  • Saliva pooling
  • Dysphasia
  • Aphasia
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5
Q

What is given alongside levodopa + why?

A
  • Dopa decarboxylase inhibitor (benserazide or carbidopa)
  • Red peripheral conversion of levodopa to dopamine
  • Limits s/e
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6
Q

When would you be cautious of using levodopa?

A
  • Severe pulmonary + CVD
  • Psychiatric illness
  • Dyskinesia
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7
Q

What are the side effects of levodopa?

A
  • Impulse control disorder (gambling, shopping)
  • N+V
  • Taste disturbance
  • Dry mouth
  • Postural hypotension
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8
Q

What are the counselling points for levodopa?

A
  • Discolour urine
  • Take w/ or after food
  • Driving: can cause sudden onset of sleep
  • MR: swallow whole + don’t take indigestion tabs 2 hrs before/after
  • Dispersible: in water or squash
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9
Q

What are the types of dopamine agonists?

A
  • Ergot derived: bromocriptine, pergolide (not 1st line)
  • Non-ergot derived: ropinirole, rotigotine
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10
Q

What are the adverse effects of ergot derived dopamine agonists?

A
  • Fibrotic reactions
  • Exclude cardiac valvuopathy
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11
Q

What are the side effects of dopamine agonists?

A
  • Psychiatric
  • Impulse control disorders
  • Sudden sleep onset
  • Hypotensive
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12
Q

When would you be cautious of using non-ergot derived dopamine agonists?

A
  • Psychiatric disorders
  • Regular eye tests
  • CVD
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13
Q

What are the counselling points for dopamine agonists?

A
  • Impulse control disorder
  • Driving
  • Take w/ or after food
  • Patch: don’t cut, apply to torso, thigh/upper arm, put replacement on diff. area
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14
Q

What is the MOA of MAO-B inhibitors + give examples

A
  • Prevent breakdown of dopamine
  • Rasagiline (neuroprotective) + selegiline
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15
Q

When would you be cautious of using selegiline?

A
  • Gastric + duodenal ulcers
  • Uncontrolled HPT
  • Inc s/e of levodopa
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16
Q

What are the side effects of MAO-B inhibitors?

A
  • Nausea
  • Constipation
  • Dry mouth
  • Selegiline: mouth ulcer, psychosis, sedation
  • Rasagiline: headache
17
Q

What are the counselling points of MAO-B inhibitors?

A
  • Avoid food high in tyramine (aged cheese, dry meat)
  • Selegiline: place on tongue + dissolve, don’t drink
18
Q

Give examples of COMT inhibitors + their MOA

A
  • Entacapone, tolcapone, opicapone
  • Prevent peripheral breakdown of levodopa by inhibiting catechol-o-methyltransferase
19
Q

When would you be cautious of entacapone + what are the side effects?

A
  • Caution: IHD
  • Avoid: hepatic impairment
  • S/e: urine brown, constipation, ab pain
  • Avoid iron same day
20
Q

When would you be cautious of using tolcapone + what are the side effects?

A
  • Caution: hepatotoxicity (anorexia, ab pain, dark urine)
  • S/e: dyspepsia, N+V, constipation
21
Q

When would you be cautious of using opicapone + what are the side effects?

A
  • Caution: hepatic impairment, >85
  • S/e: constipation, dizzy, dry mouth
  • Take bedtime 1 hr before/after levodopa
22
Q

When would you be cautious of using amantadine, CI, s/e + what is it used for?

A
  • Dyskinesia
  • Caution: CHF
  • CI: epilepsy, gastric ulceration
  • S/e: GI disturbance, dry mouth, confusion
23
Q

When would you be cautious of using anticholinergics, s/e + what is it used for?

A
  • Red symptoms of antipsychotics
  • Cautions: CVD, HPT + psychiatric disorders
  • S/e: confusion, dry mouth, constipation
24
Q

What are general counselling points?

A
  • Avoid abrupt w/drawal: risk of NMS
  • Protein may interfere, take levodopa 30 mins before meal w/ cracker
  • Contact if experiencing impulse control disorder
  • Don’t drive/inform DVLA
25
Q

What is first line for early PD where motor symptoms impact QoL?

A

Levodopa

26
Q

What is first line for early PD where motor symptoms don’t impact QoL?

A
  • Levodopa
  • Dopamine agonist
  • MAO-B inhibitors
27
Q

What is given for postural hypotension in PD?

A
  • Midodrine: last dose 4 hrs before bed
  • Fludrocortisone: s/e: weight gain, oedema + headache
28
Q

What is given for hallucinations in PD?

A
  • Quetiapine if no cognitive impairment
  • Clozapine if treatment fail
29
Q

What is given for severe N+V in PD?

A

Domperidone

30
Q

What is given for daytime sleepiness in PD?

A

Modafinil

PHAM01 - term 2 (21 decks)

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