Parkinson Disease Flashcards
(17 cards)
What would you prescribe a patient who’s motor symptoms affects their QUALITY OF LIFE
Levodopa + carbidopa / Benserazide
Don’t give levodopa on its own because only a small percentage goes to the BBB
What would you prescribe a patient who motor symptoms DOESNT AFFECT their QUALITY OF LIFE
Levodopa
Non-ergot derived dopamine receptor
Monoamine-oxidase-B inhibitors
What is levodopa
Carbidopa/ benserazide is added in order to prevent the breakdown of levodopa before it crosses the brain
What are the side effects of levodopa
-Impulse disorders such as shopping
-Pathological gambling
-Binge eating
-Hypersexuality
Sudden onset of sleep (treated with modafinil)
Red urine counselling point just tell pt side effect no worries
What drugs are non-ergot derived dopamine receptors
Pramipexole
Ropinirole
Rotigotine
What are the side effects of non-ergot derived dopamine receptors
Impulse disorder (more than levodopa)
Sudden onset of sleep
Hypotension (treated with midodrine)
What are monoamine-oxidase-B inhibitors
Rasagiline and selegiline
What drug can cause a hypertensive crisis when given with a monoamine-oxidase-B inhibitor
Phenylephrine or pseudoephedrine (sudafed) - MAJOR INTERACTION
What interacts with mono amine-oxidase-B inhibitors
Interacts with thyramine rich foods such as
Mature cheese
Salami
Marmite
Yeast
Tofu
What do you do if a patient develops dyskinesia or motor fluctuation despite optimal levodopa therapy
Add another therapy either
non-ergot dopamine receptor antragonists
Monamine-oxidase-B inhibitors
COMT inhibitors
What drugs fall under COMPT inhibitors
Entacapone or talcapone
What side effects does entacapone give
Red-brown urine
Increases sympathetic side effects- increase in CVD events
What side effects does tolcapone give
Hepatotoxic side effects
Increases sympathetic side effects- increase in CVD events
What do you do if symptoms are not controlled with non-ergot derived dopamine receptor agonist as an adjunct to levodopa
Give ergot-derived dopamine receptor agonist
What drugs are ergot-derived dopamine receptor agonist
Bromocriptine
Cabergoline
What are the side effects associated with ergot-derived dopamine agonist
Pulmonary reactions: Report SOB, chest pain or cough
Pericardial reactions: chest pains
What are some counselling points to patients who are on treatment for Parkinson’s
Do NOT WITHDRAW medication abruptly
If person has ‘off periods ‘ due to end of dose deterioration- Use MR preparations
- off periods is when the medication is wearing off
Treat nocturnal akinesia with levodopa or oral dopamine- receptor agonist as first line option then rotigotine as second line
Treat hypo tension with midodrine
