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PR3136 PT IV > Parkinsonism Part 2 > Flashcards

Parkinsonism Part 2 Flashcards

1
Q

what is the difference between vascular parkinsonism and idiopathic PD?

A

vascular parkinsonism:
- usually bilateral vs asymmetric (unilateral) in IPD

  • usually no resting tremor vs resting tremor in IPD
  • usually stepwise in progression (stepwise = every time there is a CNS insult) vs continuous progression in IPD
  • vascular risk factors are usually present (factors affecting heart disease, DM)
  • increasing age is a risk factor
  • -> those w VP tend to be older than those w PD
  • mostly NOT caused by infarct/lesions in the basal ganglia (not at the dopaminergic neurons at the basal ganglia)
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2
Q

vascular parkinsonism is also known as

A

vascular Parkinson’s disease

  • PD due to vasculature in the brain
  • cerebrovascular disease
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3
Q

are drug-induced parkinsonism reversible?

A

depends
may not be completely reversible

response to the drug withdrawal is variable - may or may not be reversible

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4
Q

do drug-induced parkinsonism respond to levodopa?

A

no

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5
Q

how do we distinguish between drug-induced parkinsonism from idiopathic PD?

A

usually difficult to distinguish from PD but:

  • symptoms tend to occur bilaterally
  • withdrawal of the drug usually leads to improvement in symptoms in 80% of patients in 8 weeks (but also depends on how long the drug was used)
  • treatment should be withdrawal of offending drug
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6
Q

in which gender drug-induced parkinsonism can be observed greatly?

A

female/ women

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7
Q

in which gender all types of parkinsonism (including idiopathic PD) can be observed greatly

A

male

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8
Q

which drugs are most likely to cause drug-induced parkinsonism?

A

high risk:

  1. dopamine D2 receptor blockers
which:
typical antipsychotics (haloperidol, *prochlorperazine*, thioxanthene, amisulpride, flupentixol, fluphenazine, sulpride, zuclopenthixol)

atypical antipsychotics at higher doses (risperidone, olanzapine, aripiprazole)

  1. Calcium channel antagonist:
    - flunarizine, cinnarizine
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9
Q

which drugs are least likely to cause drug-induced parkinsonism?

A
  • SSRIs (fluoxetine, sertraline)
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10
Q

how can drug-induced parkinsonism be treated?

A
  • not always reversible
  • best ‘treatment’ = prevention
  • anticholinergics and amantadine may be used (but not as effective compared in use in idiopathic PD) (levodopa not effective)
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11
Q

DIP can unmask

A

existing PD; as bring PD sx earlier, prodromal

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12
Q

when does the drug-induced parkinsonism appears?

A

course is variable - onset ~3months within exposure to the offending agent

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13
Q

what can cause Parkinson hyperpyrexia syndrome (PHS)

A
  1. changes in dopaminergic treatment
  2. provoked by trauma, surgery, and pulmonary, GI, and UTI
  3. may have no apparent trigger
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14
Q

what can be a severe case seen in parkinson hyperpyrexia syndrome (PHS)

A
  • no response to dopaminergic rescue medications –> sx deteriorate rapidly, patient becomes progressively more immobile and rigid
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15
Q

what are the systemic complications of PHS?

A
  1. decrease consciousness –> aspiration pneumonia
  2. rhabdomyolysis –> acute renal failure
  3. immobility –> DVT, PE
  4. DIVC (disseminated intravascular coagulation)
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16
Q

what is the management of PHS?

A
  1. if cause of PHS is due to the decrease of dopaminergic meds, reinstate prev treatment (increase back the dose) and increase dose of levodopa gradually
  2. if PO route cannot be used, options are:
    - rotigotine patch
    - amantadine injection (but not available in SG)
  • dantrolene (injectable/PO), bromocriptine
17
Q

What are the usual reason PD patients are admitted into acute care?

A
  1. chest infection (due to pneumonia; dysphagia - prone to aspiration –> risk of chest/lung infection)
  2. general medical problems (activities of daily living (ADL) is affected/reduced)
18
Q

who are the different HC professionals that need to care for people with PD

A
  1. physiotherapist = as skeletal muscles prone to atrophy with little movement - help maintain balance
  2. OT: help them work around their disability, to ensure their environment at home and at work is safe
  3. speech therapist: to help project voice - maintain social connection
  4. medical social worker: direct them to services
  5. nutritionist: changes in diet to avoid muscle loss
19
Q

what should be done to patients being admitted with Parkinsonian features but without known PD (i.e. new diagnosis)

A
  1. accurate diagnosis impt but may be difficult to do so in acute care due to concurrent illness
  2. differential diagnoses: drug-induced Parkinsonism, essential tremor
  3. Specialist advice recommended
20
Q

what should be done for patients with known PD, admitted for an unrelated problem

A
  1. Most of these pts not admitted to a neurological or geriatric unit
  2. thus, review meds
    - AVOID anti-dopaminergics
    - AVOID anticholinergics
    - to avoid SE such as confusion
3. screen for possibly related problems
(problems from PD that are that look like unrelated problem?)
- drooling
- aspiration
- constipation
- faecal loading
  1. arrange for specialist input
21
Q

what should be done for patients who are admitted for specific complications of PD?

A
  1. aspiration pneumonia
  2. dopamine agonist withdrawal
  3. psychosis (excess dopamine)
  4. dyskinesias (from the drug levodopa)
22
Q

why do patients not get their medications on time?

A
  • serving of medication in hospitals are different from what they did when they were at home
  • international patients
  • formulary may not have that preparation/not stocked
  • is there support from the family to give med on time
23
Q

what are the different levodopa preparations that need to be looked at when doing medication review?

A
  • controlled vs regular release
  • sinemet 1:10 (10/100 or 25/250) vs 1:4
  • Madopar vs Madopar HBS vs Madopar dispersible
    (1: 4)
24
Q

what is the role of pharmacists in the management of PD?

A
  1. ensure correct levodopa preparation
  2. can patients swallow the pills whole
    - e.g. madopar HBS has to be swallowed whole
    drugs to be swallowed whole as well:

a. Alpha blockers (CR) for PD man with BPH
b. dysphagia
c. bisphosphonate
d. nifedipine LA for HTN

  1. Drug interactions
    - dopamine antagonists
    - common anti-emetics
    - SSRIs
  2. drug-food interactions
    - Madopar with protein diet
  3. Comorbidities
  4. Drug-disease interactions
    e. g. depression - SSRIs

e. g. BPH - alpha blockers (hypotension)
- increased hypotension developed due to autonomic dysfunction in PD patients + alpha blockers

  1. timing
    - entacapone must be taken at the same time as levodopa
25
Q

what was the important points from the community pharmacy PD project?

A

objective: aim was to help patients patient a greater understanding of their conditions and how to manage it more effectively
- many believed their medication to be working
- after the project more patients knew more about their treatment

26
Q

what is ISMP recommendation to ensure hospitalised PD patients are not at risk?

A
  • dont delay adminstration; allow creation of administration schedules
  • prevent CI drugs to be used; avoid non-formulary drugs
  • manage nil by mouth (NBM) status
  • report adverse events
  • ensure other meds don’t worsen PD symptoms
27
Q

when are PD patients not compliant with their medications?

A
  • no access to med
  • med are not updated
  • the adminstration timing not followed
28
Q

what is the pharmacist’s impact on PD-related care in the emergency department (ED)

A
  • they can prevent any anti-PD medication omission in the ED

- this ensure patients dont have a deterioration related to the PD sx

29
Q

what is so bad about missing doses of PD meds?

A
  1. prolong length of stay in hospitalised PD patients

- could due to increased aspiration risk, or minor accidents

PR3136 PT IV (17 decks)

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