Parkinsons disease Flashcards
(28 cards)
How to alleviate Parkinson’s disease?
increasing amount of dopamine
Patients whose motor symptoms DO affect QOL.
What do we treat with?
Levodopa + carbidopa or benserazide
Patients whose motor symptoms DO NOT affect QOL. what do we treat with? (3)
Dopamine agonist - non ergot derived
Levodopa
Monoamine oxodase B inhibitor
For patients with motor fluctuations deapite optimal levodopa. What do we add in adjunct?
Dopamine agonists - non ergot derived
Monoamine oxodase B inhibs
COMT inhibs
When do we consider using ergot derived dopamine agonists?
When symptoms are uncontrolled with levodopa AND non ergot derived dopamine agonist
What are the side effects with ergot derived dopamine agonists?
Increased risk of HF
Pulmonary and peritoneal fibrosis
Cardiac valvular
What is the main difference between non ergot and ergot derived dopamine agonists?
Non-ergot is more selective so less side effects so less monitoring
Ergot is less selective so more side effects
All antiparkinsons medication can cause what?
And this can be triggered by what?
Neuroleptic malignant syndrome
Can be triggered by withdrawal of dopame agonists
What are the symptoms of neuroleptic malignant syndrome?
Fevers
Muscle rigidity
Confusion
Agitation
Delirium
Autonomic instability
Why do we give levodopa with carbidopa or benserazide?
Levodopa cannot cross BBB
Car and ben allows this and prevents breakdown of levo before it reaches target
What are 3 side effects of levodopa?
Impulse disorders
Sudden sleep onset
Red urine
3 examples of non ergot derived dopamine agonists
Pramipexole
Ropinirole
Rotigotine
What are the side effects of non ergot compared to levodopa? (3)
Increased risk of impulse disorders
Increased risk of hallucinations
Increased risk of HYPOtension
2 ergot derived dopamine receptor agonists
Bromocriptine
Cabergoline
What is MHRA warning for ergot derived
Risk of fibrosis particularly cardiac
What is a contraindication for ergot derived
MHRA
Previous fibrosis in heart, lungs or abdomen
What is an alternative use of cabergoline
Inhibits lactation
For women that no longer need to BF but still producing
3 monoamine oxidase B inhibitora
Rasagiline
Selegiline
Sulfinamide
What can happen if MAOBi is given with phenylephrine
Hypertensive crisis
3 COMT inhibitors
Entecapone
Opicapone
Tolcapone
Which COMTi is hepatotoxic
Tolcapone
What medication is used to aid daytime sleepiness?
Modafinil
What medication is used to aid rapid eye movement or sleep behaviour disorders (2)
Clonazepam
Melatonin
What is used to treat nocturnal akinesia (2)
Levodopa
Oral dopamine agonists
