Parkinson's Disease Flashcards
(34 cards)
True or False: Parkinson’s Disease is characterized as a syndrome of motor and non-motor symptoms
True
What does diagnosis of PD rely on?
Signs/symptoms and ruling out other causes
-no lab testing available for diagnosis
What are the risk factors of PD?
- Age (60 or older)
- heredity (close relative)
- Sex (M>F)
- Toxin exposure
Describe the Dopamine imbalance in PD
Progressive loss of Dopamine in nigrostriatal tracts of brain; acetylcholine increased–> imbalance
Clinical presentation (symptoms) can be separated into what 3 categories?
- Motor symptoms
- autonomic symptoms
- cognitive and psychiatric symptoms
What are the motor symptoms of PD?
- abnormal gait, posture, impaired fine movements (buttoning shirt), masked facies, micrograph
- dysphagia, drooling, less blinking
What are the autonomic symptoms of PD?
- Orthostatic hypotension
- impaired GI motility and constipation
- bladder dysfunction and sexual dysfunction
What are the cognitive and psychiatric symptoms of PD?
- Cognitive decline
- hallucinations
- anxiety, depression, sleep disorders
- behavioral symptoms and agitation
What are the cardinal features of PD?
Resting tremor (pill rolling), rigidity, bradykinesia
What resources are used to diagnose a patient with PD?
- medical history and physical exam
- Neurologic Exam (cardinal features): one cardinal feature (possible), at least two (probable), at least two and positive response to levodopa (Definite)
- Neuroimaging to rule out other causes
What drug classes may be used in the treatment of PD?
- carbidopa/levodopa
- dopamine agonists
- anticholinergics
- MAO-B inhibitors
- COMT inhibitors
Which drug class is best for treatment of tremors? What if the patient is over the age of 65 with CC of tremors?
- anticholinergics
- use carbidopa/levodopa because anticholinergics increase fall risk
Which dopamine agonists are used in the treatment of PD?
Bromocriptine, Rotigotine, Ropinirole, Pramipexole, apomorphine
What are the benefits/downsides of Dopamine agonist use?
- Not as effective as levodopa
- fewer motor complications than levodopa
- longer half-life than levodopa (less daily dosing needed)
- non-ergot derivatives (pramipexole and ropinirole) preferred over ergot derivatives (bromocriptine) b/c of cardiac fibrosis and valve disease
Which dopamine agonist has renal dosing? What is its dosage form?
pramipexole (mirapex); IR or ER tablet
how is apomorphine administered
subcutaneous injection for intermittent freezing episodes
Ropinirole dosage form
IR tablet, XL tablet
Rotigotine Dosage form
transdermal patch; rotate app sites daily
Bromocriptine dosage form
Tablet or capsule; give with food; give within 2 hours of waking in the morning
What are the benefits and drawbacks of Levodopa for PD?
- most clinically effective therapy for PD symptoms
- 1st line in elderly
- long term use–> dyskinesia and motor complications
- effective for all cardinal symptoms
Why is carbidopa administered with levodopa?
carbidopa reduces levodopa dose requirements and improves tolerability
What is the difference between IR and CR carbidopa/levodopa (sinemet)
CR formulation is 30% less bioavailable compared to IR; must increase dose by 10% and titrate if switching from IR to CR
What are the motor complications caused by Levodopa?
Freezing, on/off effect, wearing off, drug holiday
Levodopa: Freezing
immobility in the morning b/c of short half life of levodopa
-take am dose upon waking, intermittent apomorphine, add DA or MAO-B, physiotherapy, assistive walking device, and sensory cues
