Dystonia and Parkinson's Disease Flashcards
(24 cards)
What are the treatment options for muscle cramps?
1st: quinine
2nd: baclofen
Which anti-emetic can and cannot be used in Parkinson’s disease?
CAN - domperidone
CANNOT - metoclopramide, prochlorperazine
What are the treatment options for PD?
1st: levodopa as co-beneldopa (benserazide) and co-careldopa (carbidopa)
DA agonists
- non-ergot: pramipexole, ropinirole, rotigotine
- ergot: bromocriptine, cabergoline, pergolide
MAObI: selegiline, rasagiline
COMTi: entacapone, tolcapone
amantadine: weak DA agonist
apomorphine
What medications are used for the motor symptoms of PD?
POT: anti-muscarinic
procyclidine
orphenadrine
trihexyphenidyl
How is treatment decided for PD?
motor symptoms decrease quality of life: give levodopa
motor symptoms do not affect quality of life: give levodopa, DA agonists or MAObI
Why are ergot derived DA agonists not recommended?
bromocriptine, cabergoline, pergolide
- can cause fibrotic and serosal reactions
1 - pulmonary: SOB, persistent cough
2 - retroperitoneal: abdominal pain and tenderness
3 - pericardial: cardiac failure
What is a major side effect of apomorphine?
highly emetogenic
- needs anti-emetic: domperidone to be started 2 days before treatment
risk of QT prolongation when used together
- asses cardiac risk factos, monitor ECG
Why is levodopa taken at specific times of days?
to avoid ‘OFF’ periods
What are the side effects of levodopa?
impulse control disorders: compulsive gambling, hyper sexuality, binge eating, obsessive shopping
excessive sleepiness and sudden onset of sleep
motor complications: greatest risk of EPSE
end of dose deterioration with shorter length of benefit: MR may help
How do side effect affected levodopa and DA agonists differently?
levodopa > DA agonists: motor side effects, end of dose deterioration
levodopa < DA agonists: all other S/E like impulse control disorders, hallucinations, excessive sleepiness
What are the main side effects for all PD medications?
impulse control disorders
excessive sleepiness and sudden onset of sleep
psychotic symptoms
hypotensive reaction in first few days
What are the main drug interactions for MAObI?
hypertensive crises: pseudoephedrine, phenylephrine, xylometazoline, adrenalinem methylphenidate, beta 2 agonist
What is a major side effect of tolcapone?
liver toxicity: report anorexia, nausea, vomiting, abdominal pain, dark urine, pruritus
What is the treatment for PD medication induced excessive sleepiness and sudden onset of sleep?
modafinil
What is the treatment for PD medication induced nocturnal akinesia?
1st - levodopa or DA agonist
2nd - rotigotine
What is the treatment for PD medication induced postural hypotension?
1st - midodrine hydrochloride
2nd - fludrocortisone
What is the treatment for PD medication induced depression?
anti-depressants
What is the treatment for PD medication induced psychosis?
quetiapine, clozapine
What is the treatment for PD medication induced rapid eye movement/sleep behaviour disorder?
clonazepam or melatonin: both unlicensed
What is the treatment for PD medication induced drooling saliva/siallorrhoea?
1st - glycopyrronium bromide
2nd - botulinum toxic type A
What is the treatment for PD medication induced dementia?
donepezil
rivastigmine
galantamine
memantine
What is the treatment for advanced PD?
apomorphine + domperidone
What is the risk associated with abrupt PD treatment cessation?
neuroleptic malignant syndrome
Which PD medications colour urine?
levodopa: red
entacapone: reddish-brown
