Parkinson's + Movement Disorders Flashcards
Parkinson’s disease px
- resting tremor
- shuffling gait
- cogwheeling
- micrographia
- orthostatic (due to autonomic instability)
-dec dopamine, inc ACh
Parkinson’s dx
no diagnostic tests
Shy-Drager syndrome px, tx
Parkinsonism + prominent orthostatic hypotension
-autonomic dysfunction (postural hypotension, abnormal sweating, bladder/bowel disturbance, salivation, lacrimation, impotence, gastroparesis)
- tx: intravascular volume expansion (fludrocortisone, salt supplementation, alpha agonists, stockings)
- dopamine agonists do NOT work
Supranuclear palsy px
Parkinsonism + vertical gaze palsy
-cannot voluntarily look downwards
Olivopontocerebellar atrophy px
Parkinsonism + prominent ataxia
Parkinson’s tx: class options
- dopamine agonists
- anticholinergics
dopamine agonist drugs
- carbidopa/levodopa
- pramiprexole, bromocriptine, pergolide, ropinirole
- COMT inhibitors (tolcapsone, entacapone)
- selegiline, amantadine
anticholinergic drugs
- benztropine
- trihexyphenidyl
tx for: <60 YO + mild functional impairment
- anticholinergics: benztropine
- SE: urinary retention, constipation, dry mouth
tx for: >60 YO Parkinson’s + mild impairment
- amantadine
- don’t use anticholinergics —due to SLUDGE loss side effects
tx, SE for: severe Parkinson’s
- levodopa/carbidopa = strongest choice –bc directly replaces dopamine
- SE: on/off phenomenon = drug is never a smooth even level of dopamine (sometimes too much or too little)
- carbidopa prevents peripheral conversion of levodopa, so that it can reach brain
ropinorole & pramipexole MOA, SE
-directly stimulates dopamine receptors
- less adverse effects (less on/off)
- less potency –> good initial tx
amantadine MOA
inc dopamine release from substantia nigra
bromocriptine & pergilide SE
-cause vasoconstriction
COMT inhibitors MOA
- tolcapone, entacapone
- prevents degradation of dopamine
- adjunct: must be combined with levidopa/carbidopa
