Flashcards in Chapter 4 - Movement Disorders Deck (86)
How is pain managed in cerebral palsy?
Pain related to spasticity or muscle spasm:
Other causes of pain
Usual analgesic ladder
How is drooling managed in cerebral palsy?
Give an antimuscarinic e.g.
If this doesn’t work
Botulinum toxin type A can be administered into the salivary glands
What should patients with cerebral palsy be given to protect their bones?
Vitamin D and calcium
What symptoms should patients be warned of when taking Botulinum toxin type A?
Swallowing or breathing difficulties
What is motor neurone disease?
A neurodegenerative condition affecting the brains and spinal chord
List some symptoms of motor neurone disease
Decline in respiratory function
What is amyotrophic lateral sclerosis and what can be used to extend life?
The most common form of motor neurone disease
Riluzole can be used to extend life
What is the aim of drug therapy in motor neurone disease?
To manage symptoms (MND is incurable)
What can be given to manage the muscular symptoms in motor neurone disease?
First line - quinine
Second line - baclofen
Alternatives - gabapentin, tizanidine, dantrolene
What are the options for saliva problems in motor neurone disease?
Botulinium toxin type A
If saliva is this
Can glycopyronium be given to patients with motor neurone disease and cognitive impairment?
Glycopyronium bromide has the advantage of having few CNS side effects
What can be used to manage respiratory symptoms in motor neurone disease?
Benzodiazepines if there is co-existing anxiety
When do patients need to inform the DVLA about having Parkinson’s disease?
At the point of diagnosis
What are some motor symptoms associated with Parkinson’s disease?
Postural instability (increased falls)
What are some non-motor symptoms associated with Parkinson’s disease?
Speech and language changes
Which analgesic shouldn’t be used in Parkinson’s disease?
Tramadol - may exacerbate symptoms
How should dementia associated with Parkinson’s disease be managed?
Don’t use antipsychotics - can cause EPSEs and worsen Parkinson’s symptoms
What is off time in Parkinson’s disease?
Amount of time in the day the patient experiences symptoms of Parkinson’s
What is on time in Parkinson’s disease?
Amount of time in the day the patient does not experience the symptoms of Parkinson’s
What are the 3 main mechanisms of anti-Parkinson’s drugs?
Give a dopamine precursor
Give a dopamine receptor agonist
Reduce the breakdown of dopamine
What is the first line option if symptoms of Parkinson’s are affecting QoL in the elderly?
What can levodopa be combined with and what is the brand name of these combinations?
Dopa decarboxylase inhibitors
Levodopa + carbidopa (co-careldopa)
Levodopa + benserazide (co-benledopa)
Why are dopa decarboxylase inhibitors given alongside levodopa?
Then don’t cross the BBB
So they block the conversion of levodopa in the periphery, but not in the brain
Therefore there are less peripheral side effects e.g. nausea, arrhythmia, BP changes
And levodopa can be initiated at a lower dose
What is the first line option if symptoms of Parkinson’s are not affecting QoL in the elderly?
Non ergot derived dopamine receptor agonist
What is the mechanism of levodopa?
Gets converted into dopamine
What is the mechanism of rasagiline?
Inhibits the breakdown of dopamine
What is the mechanism of pramiprexole?
Dopamine receptor agonist
Why aren’t ergot derived dopamine receptor agonists used?
Risk of cardiac and pulmonary fibrosis
Give examples of non-ergot derived dopamine receptor agonists