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S3 Case 2 - Mental Health > Pharmaceutical Care of Parkinson's Disease > Flashcards

Pharmaceutical Care of Parkinson's Disease Flashcards

1
Q

What are the main symptoms?

A

Bradykinesia
Rigidity
Tremor

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2
Q

What are the other symptoms?

A

Postural instability
Sleep problems
Freezing of gait - inability to continue locomotion
Speech problems
Swallowing problems
Mental health

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3
Q

What is postural hypotension?

A

Fall in blood pressure of at least 20 systolic + 10 diastolic

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4
Q

What symptoms are associated with postural hypotension?

A

Light-headedness
Visual blurring
Dizziness
Fatigue
Weakness

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5
Q

What is PD diagnosis?

A

Many other conditions mimic PD
= refer to specialist

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6
Q

What are the complications with PD?

A

Communication
Attitudes to drug therapy
Family/carer needs
Non-motor symptoms

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7
Q

What is the disease complication?

A

Deterioration of quality of speech
= difficult to express emotion

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8
Q

What is the attitudes to drug therapy complication?

A

Medication can take time to work

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9
Q

What is the family/carer needs complication?

A

Difficult watching their family struggle
Changes in lifestyle for carer

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10
Q

What is the non-motor symptoms complication?

A

Distracted, diminished attention

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11
Q

What does the choice of drug depend on?

A

Effectiveness + adverse effects of drugs
Patient comorbidities
Patient response to the drug
Clinical experience
Patient preference

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12
Q

What are you managing in the early disease?

A

Functional disability

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13
Q

What are you managing in the later disease?

A

Motor complications

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14
Q

What increases the availability of dopamine to brain?

A

Decarboxylase inhibitor
COMT inhibitors

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15
Q

What decreases the breakdown of dopamine?

A

MAOb inhibitors
COMT inhibitors

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16
Q

What replaces the post-synaptic dopamine stimulation?

A

DR2 agonists

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17
Q

What is the 1st line (1) treatment of early PD?

A

Levodopa + dopa decarboxylase inhibitor

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18
Q

What is the side effect of Levodopa + dopa decarboxylase inhibitor?

A

Nausea + vomiting

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19
Q

What is nausea + vomiting managed by?

A

Domperidone
= DA receptor antagonist BUT doesn’t cross BBB
= decreased side effects

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20
Q

What is the 1st line (2) treatment for early PD?

A

Oral/transdermal dopamine agonist

21
Q

How do the oral/transdermal dopamine agonist work?

A

Bind directly post-synaptic dopamine receptor
Combined with Levodopa
Mimic effect of dopamine
Improve motor symptoms

22
Q

What can oral/transdermal dopamine agonists be classified?

A

Ergot derived = older generation
Non-ergot derived

23
Q

What is an example of ergot derived?

A

Cabergoline

24
Q

What is the risk with ergot?

A

Cardiac valvulopathy
Pleural fibrosis - thickening of membrane

25
Q

What is an example of non-ergot derived?

A

Ropinirole
Rotigotine

26
Q

What are the side effects of dopamine agonists?

A

Impulse control disorders - eg. gambling
Daytime drowsiness
Peripheral oedema
Nausea, dizziness, hallucinations + constipation

27
Q

What is the 1st line (3) treatment of early PD?

A

MAOb

28
Q

What is an example of MAOb?

A

Rasagiline
Selegiline

29
Q

What is safer out of Rasagiline + Selegiline?

A

Rasagiline
= Selegiline is converted to amphetamine derivatives = sleeping disorders

30
Q

What is NOT used as 1st line for treatment of PD?

A

Anticholinergic drugs
Beta-blockers
Amantadine

31
Q

How does anticholinergic drugs work for PD?

A

Reduce effects of cholinergic excess
= some relief of tremor + rigidity

32
Q

What is the example of anticholinergic drug?

A

Benztropine
Biperiden

33
Q

What are the side effects of anticholinergics?

A

Dry mouth
Blurred vision
Constipation
Confusion
Hallucinations

34
Q

What is Amantadine?

A

Weak dopamine agonist of NMDA-type glutamate receptor

35
Q

How can Amantadine be used?

A

With Levodopa
= improve muscle control + reduce stiffness

36
Q

How are beta-blockers used?

A

Treatment of tremor

37
Q

What is an example of beta blocker?

A

Propranolol

38
Q

What are the treatment for non-motor symptoms of PD?

A

Antidepressants for depression
Laxatives
NSAIDs for pain-frozen shoulders
Benzodiazepines for REM-sleep disorder
Fludrocortisone for postural hypotension

39
Q

What are the symptoms of later PD?

A

Physical symptoms NOT controlled by medication
Medication side effects
End of dose deterioration function
Dyskinesia
Freezing

40
Q

What drugs are used to manage later PD?

A

Levodopa + dopa decarboxylase inhibitor
Oral/transdermal dopamine agonist
MAOb inhibitor
COMT inhibitors
Amantadine
Apomorphine

41
Q

What is Levodopa used to treat?
Later

A

Postural
Freezing

42
Q

What is Apomorphine?
Later

A

Dopamine agonist = non-ergot

43
Q

How is Apomorphine delivered?

A

Injections

44
Q

What are the side effects of Apomorphine?

A

Confusion
Hallucinations

45
Q

What are MAOb inhibitors used for?
Later

A

Reduce motor fluctuations

46
Q

What should COMT inhibitors be combined with?

A

Levodopa
Carbidopa

47
Q

What is an example of COMT inhibitors?

A

Tolcapone
Entacapone

48
Q

What is Tolcapone associated with?

A

Fatal hepatic toxicity
= mandatory liver function tests

49
Q

What should be done with PD drugs?

A

Do NOT withdraw them suddenly
= avoid potential acute akinesia (loss of voluntary movement)

S3 Case 2 - Mental Health (15 decks)

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