IC17 Parkinson's Disease Flashcards
(46 cards)
What are the 4 characterpstic features of PD (which ones are cardinal signs)?
- Tremors (resting)
- Rigidity (lead pipe or cogwheel)
- Akinesia (bradykinesia)
- Postural instability
How do tremors manifest and what should be excluded?
resting tremors that disappear with movement and increases with stress
exclude generalised anxiety that can be triggered by certain activities
What must be present for a PD diagnosis?
Clinical signs, physical exam and history
2/3 of the cardinal signs (T,R,A)
What are the characteristic features of idiopathic PD? Which ones manifest upon diagnosis and which ones show up later on?
Upon dx:
assymetry
Later on:
positive response to levodopa or apomorphine
less rapid progression
may present with impaired olfaction
What are the possible factors that could lead to loss of dopaminergic neurons in PD? (3)
age-related factors
environmental toxins or insults (MPTP-MPP+, pesticides, herbicides)
genetic factors (predisposition to toxins or insults and genetic abnormalities)
Which 2 scoring systems can be used used for PD staging?
Hoehn and Yahr (H&Y)
MDS-UPDRS
What are the 5 non-motor symptoms of PD?
- Cognitive impairment → dementia
- Psychiatric symptoms → depression, psychosis
- Sleep disorders → REM sleep behaviour disorder
- Autonomic dysfunction → constipation, GI motility, sialorrhea and orthostatic hypotension
- Other symptoms → fatigue
Differentiate between the features in early onset PD and typical PD? (3)
slower disease progression
less cognitive decline
earlier motor complications
What are the 2 goals of therapy for PD?
manage symptoms
maintain function and autonomy
no neuroprotective treatment yet
Which 2 symptoms of PD are levodopa good for managing?
rigidity and akinesia
What is an important counselling point for taking levodopa?
Space apart from heavy meal
If got n&v, can take w light snacks
What is the DCI dosing required to saturate DOPA?
75-100mg daily
What are the levodopa to DCI ratios?
Sinemet 1:4 or 1:10
Madopar 1:4
What are the side effects of levodopa (5)
- nausea, vomiting (especially in new treatment)
- orthostatic hypotension
- drowsiness and sudden sleep onset
- hallucinations, psychosis
- dyskinesias (usual onset 3-5 years of starting levodopa)
What is the “on-off” phenomenon in levodopa treatment?
ON refers to levodopa response
OFF refers to no levodopa response
unpredictable and not related to dose or dosing intervals
What is the “wearing off” phenomenon in levodopa treatment?
effect of levodopa wanes before the end of the dosing interval with a shortened ON time, associated with disease progression
How can “wearing off” be managed?
modifying times of administration or replacing with modified-release preparations
How can peak dose dyskinesia be managed?
manage by decreasing dose and increasing frequency
alternatively can be managed by adding amantadine or replacing levodopa with specific doses or MR-levodopa
How should dose of levodopa/DCI be adjusted with switching from IR to CR form?
Increase dose by 25-50%
What are the DDIs with levodopa?
- Pyridoxine (vitamin B) → cofactor for DOPA decarboxylase, possibility of interactions with high dose B6
- Iron → space out administration
- Protein → space out administration
- Dopamine antagonists → such as risperidone, FGA and metoclopramide/prochlorperazine (domperidone is antiemetic of choice in PD)
What dosage forms are rotigotine and apomorphine available in
rotigotine: transdermal patch
apomorphine: SC injection
What are the peripheral dopaminergic side effects of dopamine agonists?
Dopaminergic (peripehral) → nausea, vomiting, orthostatic hypotension, leg edema
What are the central dopaminergic side effects of dopamine agonists?
Dopaminergic (central) → hallucinations (visual > auditory), somnolence, day-time sleepiness, compulsive behaviours (gambling, shopping, eating, hypersexuality)
What are the non-dopaminergic side effects of dopamine agonists?
Non-dopaminergic → fibrosis, valvular heart disease
