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PHA333 > parkinson's disease in practice > Flashcards

parkinson's disease in practice Flashcards

1
Q

What is PD?

A

chronic, progressive, neurodegenerative condition

loss of DA cells in the substantia nigra

bradykinesia with one of: rigidity, tremor, postural instabiility

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2
Q

motor complications of PD

A 
deteriorating fxn
loss of drug effect
motor fluctuations
dyskinesia
freezing of gait
falls
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3
Q

non-motor complications of PD

A

mental health conditions
autonomic dysfunction
other complications

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4
Q

mental health conditions associated with PD

A 
depression
anxiety
dementia
cognitive impairment
impulse control disorders
psychotic symptoms
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5
Q

autonomic dysfunction associated with PD

A 
constipation
orthostatic hypotension
dysphagia
weight loss
excessive salavation
excesive sweating
bladder problems
sexual problems
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6
Q

other complications associated with PD

A 
n&v
pain
sleep disturbances
daytime sleepiness
aspiration pneumonia
pressure sores
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7
Q

What is neuroleptic malignant syndrome (NMS)?

A

rare, life-threatening idiosyncratic reaction

occours if DA drugs stopped abruptly

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8
Q

symptoms of neuroleptic malignant syndrome

A 
fever
altered mental state
muscle rigidity
raised creatinine kinase
autonomic dysfunction
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9
Q

management of NMS

A 
IV fluids
correct metabolic abnormalities
cooling blankets
IV dantrolene
restart PD meds
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10
Q

Why give IV dantrolene for NMS?

A

it acts on skeletal muscle
interferes with Ca influx
stops muscle contraction and muscle rigidity
reduces hyperthermia

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11
Q

When is levodopa given?

A

first line in early PD stage

when motor symptoms impact QoL

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12
Q

MOA of levodopa

A

converted/decarboxylated to DA in brain

DA acts on DA receptors

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13
Q

formulations of levodopa

A

can be formulated with benserazide (co-beneldopa) or carbidopa (co-careldopa)

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14
Q

Why combine levodopa with benserazide/caridopa?

A

they are DOPA-decarboxylate inhibitors
inhibit peripheral decarboxylation of levodopa before it crosses BBB
inc the amount of DA that reaches the brain

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15
Q

disadvantages with levodopa

A

becomes less effective over time
can get ‘wearing off’
LT use can result in dyskinesia
WD symptoms

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16
Q

s/e with levodopa

A 
N&V
hypotension
reduced apetite
hallucinations
sleep disturbances
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17
Q

How to take levodopa?

A
  • absorption reduced with iron, take separately
  • absorption reduced with protein, separate
  • take 30-60mins before meal
  • N&V on empty stomach, can take with low protein snack like crackers
  • could eat most of your protein in evening to improve daytime symptoms
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18
Q

2 brands of combined levodopa

A

Madopar - co-beneldopa

Sinemet - co-careldopa

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19
Q

When are DA agonists used?

A

early stages of PD in patients whose motor symptoms don’t impact on QoL

can use in combination with levodopa when get wearing off symptoms/fluctuations

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20
Q

MOA of DA agonists

A

act directly on DA receptors to mimic effects of DA

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21
Q

2 classes of DA agonists

A
  1. ergot derived

2. non-ergot derived

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22
Q

examples of non-ergot derived DA agonists (these onse are used, not ergot anymore)

A

pramipexole
ropinirole
rotigotine
apomorphine

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23
Q

s/e with DA agonists

A 
nausea
constipation
hypotension
headaches
anxiety
depression
movement problems
24
Q

problems with DA agonists

A 
fainting/dizziness
sudden onset of sleep
impulsive/compulsive behaviours
hallucinations/dellusions
withdrawal
25
Q

caution when dispensing pramipexole

A

dose/strength in terms of pramipexole base

but can be in salt form

26
Q

ropinirole and smoking

A

might need dose adjustments if stopping/starting smoking during Tx

27
Q

What happens if missed one day’s dose of ropinirole?

A

might need dose titration

28
Q

rotigotine form and advantage

A

24hr patch

useful if swallowing difficulties

29
Q

problems with rotigotine patch

A

skin irriation - different site every day

contains aluminium - take off for MRI scam or cardioversion

30
Q

apomorphine form

A

SC via disposable pen/cartridge/infusion pump

31
Q

When is apomorphine useful?

A

continuous infusion to reduce ‘off’ periods

injections can be used as rescue Tx

works in 5-10mins

32
Q

problems with apomorphine

A

causes N&V
highly emetic
give domperidone 2 days before start of Tx

33
Q

When are MAO-B inhibitors used?

A

patients in early PD whose motor symptoms don’t impact QoL

34
Q

MOA of MAO-B inhibitors

A

inhibit breakdown of DA by MAO-B

35
Q

examples of MAO-B inhibitors

A

selegiline
rasagiline
safinamide

36
Q

problems with MAO-B inhibitors

A

interact with antidepressants

worsen s/e of levodopa - dyskinesia

impulsive/compulsive disorders

withdrawal

risk of hypertension when taken with tyramine rich foods

37
Q

s/e of MAO-B inhibitors

A 
headaches
constipation
dry mouth
aching joints
indigestion
urinary urgency
38
Q

selegiline oral lyophilizate

A

if swallowing difficulties
tablet on tongue and disperses in 10 seconds
can’t drink/eat/rinse mouth 5 mins after taking

39
Q

When are COMT inhibitors used?

A

with levodopa for patients who have developed dyskinesia or motor fluctuations on levodopa

to reduce ‘off’ periods

improve motor symptoms and daily activities

40
Q

MOA of COMT inhibitors

A

inhibit peripheral methylation of levodopa to 3-O-methyldopa

allow more levodopa to reach the brain

41
Q

Are COMT inhibitors used alone?

A

NO
in combination with levodopa
-> reduce levodopa dose by 10-30% whan stating COMT inhibitor

42
Q

examples of COMT inhibitors

A

entacapone
opicapone
tolcapone

43
Q

problems with COMT inhibitors

A 
colour urine bright red/orange
diarrhoea
risk of fatal liver damage - tolcapone
worsen s/e of levodopa - dyskinesia, N&V
impulsive/compulsive behaviours
44
Q

s/e of COMT inhibitors

A 
confusion
diziness
falls
dry mouth
hallucinations
sleep disorders
chest pain
fatigue
45
Q

How to take entacapone?

A

take at same time as levodopa

don’t take at same time as IRON supplements - reduced absorption

46
Q

combination product of levodopa and entacapone

A

co-careldopa + entacapone = Stalevo

47
Q

How to take opicapone

A

at bed time

1hr before/after levodopa

48
Q

When is amantadine used?

A

adjunct if dyskinesia not managed

49
Q

What type of drug is amantadine?

A

glutamate antagonist

50
Q

importance of PD meds on time

A

can impact patinet’s health

  • reduced movement
  • unable to get out of bed
  • unable to swallow
  • unable to talk
  • unable to walk

delay of 30mins can have bad effects

51
Q

accurate drug Hx for PD

A

med name
formulation
exact timing

52
Q

if PD patient is nil my mouth

A

need to convert crirital oral meds to non-oral route and calculate equivalent doses

  • via NG tube
  • topical pach
53
Q

What PD drugs can be left out in acute nil my mouth situation?

A

amantadine
selegiline
rasagiline

54
Q

What to convert levodopa to if NG not available?

A

equivalent rotigotine patch

55
Q

max dose of rotigotine patch

A

16mg

56
Q

What can happen if patient is DA agonist naive and converting their levodopa to rotigotine patch in acute situation?

A

specialist review required

risk of s/e

  • voiting
  • skin rxns
  • hallucinations
  • inc confusion

start at lower dose (2-4mg) and inc gradually over a few days

57
Q

meds to avoid in PD

A 
metoclopramide
prochlorperazine (Stemetil)
haloperidol
chlorpromazine
St John's Wort
decongestants - phenylephrine
anticholinergics

PHA333 (27 decks)

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