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PHA333 > Wk 29 - Parkinson's disease in practice > Flashcards

Wk 29 - Parkinson's disease in practice Flashcards

1
Q

What is Parkinson’s?

A

Chronic, progressive neurodegenerative condition - due to loss of dopamine-containing cells of substantia nigra

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2
Q

How does PD usually present as?

A

Bradykinesia w/:

  • Tremor
  • Rigidity
  • Postural instability

Unilateral initially then bilateral

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3
Q

What is Neuroleptic malignant syndrome?

A
  • Rare life-threatening idiosyncratic reaction

- Occurs if dopaminergic drugs are stopped abruptly

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4
Q

What are the symptoms of NMS?

A
  • Fever
  • Altered mental state
  • Muscle rigidity
  • Raised CK
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5
Q

How do you manage NMS?

A
  • IV fluids
  • Correct metabolic abnormalities
  • Cooling
  • IV dantrolene
  • Restart PD medications
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6
Q

What is the first line medication for people in early stages of PD whose motor symptoms impact their QoL?

A

Levodopa

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7
Q

What else does levodopa formulations contain?

A
  • Benserazide (co-beneldopa)

- Carbidopa (co-careldopa)

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8
Q

Why does levodopa contain co-beneldopa/co-careldopa?

A
  • No therapeutic on own
  • Dopamine can’t cross BBB
  • Inhibit peripheral decarboxylation of levodopa before crosses BBB
  • Inc dopamine in brain
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9
Q

What are the problems w/ levodopa?

A
  • Less effective over time
  • LT = dyskinesia
  • Impulsive + compulsive behaviours
  • W/drawal symptoms
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10
Q

How do you take levodopa?

A
  • Separate w/ iron bc red absorption
  • Take 30-60 mins before meal bc abs red w/ protein
  • N+V on empty stomach tf take w/ low protein snack
  • Take daily protein in evening to improve daytime symptoms
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11
Q

What is used for people in the early stages of PD whose motor symptoms don’t impact their QoL?

A

Dopamine agonists + MAO-B inhibitors

  • Used alone or combination w/ levodopa when wearing off/fluctuations
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12
Q

How do dopamine agonists work?

A

Act directly on dopamine receptors to mimic effect of dopamine

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13
Q

What are the 2 classes of dopamine agonists?

A
  • Ergot derived

- Non-ergot derived

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14
Q

Why are ergot derived no longer used?

A

Risk of: Pulmonary + pericardial fibrotic reactions

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15
Q

Give examples of ergot derived drugs

A

Pergolide

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16
Q

Give examples of non-ergot derived drugs

A
  • Pramipexole
  • Ropinirole
  • Rotigotine
  • Apomorphine
17
Q

What are the problems with dopamine agonists?

A
  • Fainting or dizziness
  • Sudden onset of sleep
  • Impulsive or compulsive behaviours
  • Hallucinations/delusions
  • W/drawal
18
Q

How do you take ropinirole?

A
  • Adjust dose if stopped/started smoking

- If dose missed, re-initiate by titrating dose

19
Q

How do you take rotiotine?

A
  • 24hr patch
  • Contains Al tf remove for MRI/cardioversion
  • For swallowing difficulties
  • Can cause skin irritation
20
Q

How do you take apomoephine?

A
  • SC via disposable pen, cartridge or infusion pump
  • Works w/in 5-10 mins: used as rescue treatment
  • Continuous infusion red off periods
  • Can cause N+V - domperidone given 2 days before treatment starts
21
Q

How do MAO-B inhibitors work?

A

Inhibit breakdown of dopamine by MAO-B

22
Q

Give examples of MOA-B inhibitors

A
  • Selegiline

- Rasagiline

23
Q

What are the problems with MAO-B inhibitors?

A
  • Interact dangerously w/ antidepressants
  • Worsens levodopa s/e: dyskinesia
  • Impulsive + compulsive disorders
  • W/drawal
  • HT in high dose selegiline w/ tyramine rich food
24
Q

How do you take MAO-B inhibitors?

A
  • Rasagiline: OD

- Selegiline: OD or oral lyophilisate if difficulty swallowing (tongue + disperse, can’t drink for 5 mins)

25
Q

What do you take in adjunct to levodopa for people who have developed dyskinesia or motor fluctuations despite optimal levodopa therapy?

A

COMT inhibitors

26
Q

How do COMT inhibitors work?

A
  • Inhibit peripheral methylation of levodopa to 3-o-methyldopa allowing more levodopa to reach brain
  • Used in combination w/ levodopa
27
Q

Give examples of COMT inhibitors

A
  • Entacapone
  • Opicapone
  • Tolcapone
28
Q

What are the problems w/ COMT inhibitors?

A
  • Urine bright red/orange
  • Diarrhoea
  • Hepatotoxic: talcopone
  • Worsens levodopa s/e: dyskinesia + N+V
  • Impulsive + compulsive behaviours
29
Q

How do you take entacapone?

A
  • Same time as levodopa

- Avoid taking same time as iron supplements: red abs

30
Q

How do you take opicapone?

A

At bedtime, 1hr before/after levodopa

31
Q

What is taken as an adjunct if dyskinesia is not adequately managed by modifying existing therapy

A

Amantadine: glutamate antagonist

32
Q

What needs to be ensured when giving PD medication?

A
  • Med name
  • Formulation
  • Timing
33
Q

What happens when a patient is nil by mouth?

A

Convert to non-oral route:

  • NG tube: dispersible co-beneldopa
  • Topical patch: rotigotine patch
34
Q

What can you omit during an acute situation?

A
  • Entacapone
  • Selegiline
  • Rasagiline
  • Amantadine
35
Q

What are the side effects of the rotigotine patch?

A
  • Vom
  • Hypotension
  • Skin reactions
  • Hallucinations
36
Q

Give examples of medications to avoid in PD

A
  • Metoclopramide
  • Prochlorperazine
  • Haloperidol
  • Chlorpromazine
  • St John’s Wort
  • Anticholinergics

PHA333 (35 decks)

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