Treatment of parkinson's

Question 1

general aim

Answer 1

increase dopamine
agonists
increase secretion
decrease enzyme activity, lengthening time in the synaptic cleft

Question 2

levadopa

Answer 2

most effective and improves motor symptoms significantly
converted by body into dopamine

some SE:
nausea and vomitting
confusion
postural hypotension
somnolence
long term:
dyskinesia

end of dose fluctuations where the drug starts to wear off
freezing
confusion and hallucinations

Question 3

management of motor complications

Answer 3

fractionate dose
adjuvant treatment
cont.

Question 4

dopamine agonist

Answer 4

act directly on post synaptic dopamine receptors
oral, sub cut or transdermal
similar side effects to l-dopa and also impulse control disorders - eg gambling, hypersexuality, compulsive buying, binge eating

Question 5

mono-amine oxidase inhibitors

Answer 5

decrease breakdown of dopamine so increase the levels in the cleft
possible neuroprotective effect
same side effects as l-dopa
potential interaction with antidepressants such as SSRI’s leading to serotonin syndrome

Question 6

catechol-O-methyltransferase inhibitors

Answer 6

inhibit COMT inhibitors to increase the amount of l-dopa available to cross the BBB to produce prolonged effect

SE
as l-dopa
also can cause diarrhoea, discolouration of body fluids

Question 7

amantadine

Answer 7

not commonly used, sometimes used in the later stages

increases dopamine release at the synaptic cleft

Question 8

anticholinergics

Answer 8

occasionally in younger patients with early symptoms

decrease the relative central ACh excess that occurs due to dopamine insufficiency