Parkinson's Disease Flashcards
(22 cards)
What is Parkinson’s disease?
A chronic, progressive neurodegenerative condition due to the loss of dopamine-producing cells in the substantia nigra.
What is parkinsonism?
A clinical syndrome featuring bradykinesia plus at least one of the following: tremor, rigidity, or postural instability.
How does Parkinson’s disease usually begin in terms of symptom location?
Symptoms usually present unilaterally, but may become bilateral as the disease progresses.
What should be avoided when managing anti-parkinsonian medication?
Never stop suddenly, as it may cause acute akinesia or neuroleptic malignant syndrome.
What is the first-line drug treatment for early Parkinson’s with quality-of-life impact?
Levodopa (usually with a dopa decarboxylase inhibitor like co-careldopa or co-beneldopa).
What are the main advantages and disadvantages of levodopa?
✅ Greater motor symptom control
❌ Higher risk of dyskinesia and motor complications over time
Name other first-line options besides levodopa.
Oral MAO-B inhibitors (selegiline, rasagiline, safinamide)
Oral/transdermal dopamine agonists (pramipexole, ropinirole, rotigotine)
Which dopamine agonists should not be used first line and why?
Ergot-derived agonists (cabergoline, pergolide) due to the risk of cardiac fibrosis.
What adjuvant drugs can be added to levodopa to manage motor fluctuations?
COMT inhibitors (entacapone, opicapone)
Amantadine
Subcutaneous apomorphine (intermittent or continuous)
What are the side effects of amantadine?
Confusion, hallucinations, insomnia, nightmares, and dry mouth.
What should you avoid prescribing for nausea in Parkinson’s disease?
Metoclopramide and prochlorperazine (they worsen parkinsonism).
What antiemetic may be used cautiously?
Low-dose domperidone (monitor for cardiac side effects).
What sleep disorder in Parkinson’s may be treated with melatonin or clonazepam?
REM sleep behavior disorder
What class of antidepressants is most commonly used in Parkinson’s?
SSRIs, although they may worsen certain motor symptoms.
What may be more effective but limited by side effects in older adults?
Tricyclic antidepressants (e.g., amitriptyline).
What medications might worsen cognitive impairment in Parkinson’s?
Antimuscarinics, benzodiazepines, H2 blockers like ranitidine, amantadine, and dopamine agonists.
What drug classes might be used for Parkinson’s dementia (off-label)?
Acetylcholinesterase inhibitors (e.g., rivastigmine), and memantine second-line.
What medications are commonly associated with impulse control disorders in Parkinson’s?
Dopamine agonists.
What antipsychotic is preferred for severe psychosis in Parkinson’s (off-label)?
Quetiapine or, rarely, clozapine (requires monitoring).
What drug treatments may be used (off-label)?
Midodrine first-line, fludrocortisone second-line.
What specialist treatments may reduce excessive salivation?
Glycopyrronium bromide or botulinum toxin injections.
