Parkinson's Disease: Clinical Features and Therapeutics Flashcards Preview

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Flashcards in Parkinson's Disease: Clinical Features and Therapeutics Deck (17)
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Key features of PDD (instead of PD)

- visuospatial function

- hallucination

- aggression/anxiety

- amnestic, language deficits


How to image PD and what is observed?

Fluorodopa (18-F)

Bilateral loss of DA signal


Neurotransmitters involved in PD?

DA, ACh, excitatory amino acids (serotonin, NA, adenosine, opioids)


Motor symptoms of PD?

- tremor, rigidity, bradykinesia ]- responsive to medication

- loss of postural reflexes

- shuffling gait

- freezing episodes

- hypomimia (masked facies)


Non-motor symptoms of PD?

- neuropsychiatric: hallucinations, confusion, depression (50%)

- autonomic: bladder, bowel, hypotension

- sleep: restless legs, REM sleep behaviour disorders


Trend of PD symptoms over time?

Get worse

Early stages (motor) -> Late stages (non-motor)


PD management (NICE Guidelines)?

- physiotherapy
- occupational therapy
- speech and language therapist
- specialist nursing care
- exercise/movement (e.g. yoga, tai chi)
- pharmacological


Overview of TYPES of pharmacological management of PD?

- indirect agonists (L-DOPA, Amantadine)

- direct DA agonists (apomorphin, ropinirole)

- enzyme blockers (sinemet, selegiline, entacapone)

- anticholinergics
- cell therapy (foetal cell transplant)
- treat secondary symptoms


Indirect DA agonists in PD?

- L-DOPA]- gold standard, given w/ enzyme blockers

- amantadine (increased DA release with unknown MOA)


L-DOPA absorption features?

Protein load (in food) may interfere w/ absorption because L-DOPA also relies on amino acid tranporters


L-DOPA response features?

Benefits wear off.

Requires surviving neurons. As PD progresses, L-DOPA is less effective

Low dose: no response

High dose: diskinesia


Advice concerning L-DOPA and young pts?

Young onset PD: give DA agonist (keep L-DOPA for future use)


Side effects of DA agonists?

- N&V
- gambling
- hypotension
- somnolence and "sleep attacls"


When to use DA agonists?

Early stage PD, to delay the introduction of L-DOPA

Late stage: to reduce the dose of L-DOPA

(NB: if the effect wanes, add L-DOPA)


Examples and MOA of enzyme blockers for PD?

- Sinemet: DOPA-decarboxylase inhibitor

- Selegiline: MAO inhibitor

- Entacapone: COMT inhibitor


Overview of cell therapy for PD?

Foetal Cell Transplant: extract DA neurons from aborted foetuses and transplant into striatum


Overview of treating secondary symptoms in PD?

- ANS features: reduce BP (fluids/salt/fludrocortisone); bladder freq/urgency (desmopressin); drooling (anticholinergics)

- cognitive (ID triggers for depression/anxiety/dementia/hallucinations)

- sleep (avoid drugs, treat depression, sleep hygiene)

[NB: be aware of carer fatigue]