Parkinsons Flashcards
Basic neurotransmitter and protein pathology of DEMENTIA
- Ach defect
- Amyloid plaques, tau tangles in cortex
Basic neurotransmitter and protein pathology of PARKINSON’S
- Nigrostriatal dopamine defect
- Lewy bodies in substantia nigra
Side effects of non-ergot dopamine agonists
- Impulse disorders (gambling, binge eating, hypersexuality)
- Somnolence, hallucinations, nausea,
- peripheral oedema
Donezepil,
Rivastigmine,
Galantamine
Pharmacodynamics
Ach-esterase inhibitor
Memantine
- Blocks NMDA receptor
- Blocks glutamate excitotoxicity
L-DOPA
Pharmacodynamics + clinical use + side effects
DA precursor
Clinical use: Parkinson’s
Side effects of L-DOPA
-NnV
-Postural hypotension,
-Hallucinations
-Mania
-Anxiety
Dyskinesia during peak dose
Note: wears off after 4-6 years (needs more frequent dosing, leads to more frequent dyskinesia)
Apomorphine,
Pramiprexole,
Ropinirole,
Rotigotine
Pharmacodynamics
Non-ergot derived dopamine agonist
Bromocriptine, Pergolide, Cabergoline
Pharmacodynamics
Ergot-derived dopamine agonist
Side effects of ergot dopamine agonists
- cardiac valve problems
2. pleural, pericardial, retroperitoneal fibrosis
Selegiline
Pharmacodynamics
MAO-B inhibitor
Less dyskinesia compared to L-DOPA but only slight efficacy compared to L-DOPA
Benztropine, Benzhexol
Pharmacodynamics
Anticholinergic
First line drug class for old pt with Parkinsons.
1st line
L-DOPA
First line drug class for young pt with Parkinsons.
1st line
MAO-B inhibitor
DA
How to change medication regime with dyskinesia
- Reduce L-DOPA dose
- Add amantadine
