PD Flashcards
What are examples of dopamine agonists?
Ropinirole
Pramipexole
Rotigotine
What dopamine agonists should be avoided? Why?
Cabergoline, bromocriptine
Risk cardiac valve fibrosis and other fibrotic sx
When is apomorphine used in PD?
Crises
Self-administered in severe cases
What are the main problems with PD treatments?
Loss of efficacy Dyskinesias Fluctuations in response Neuropsychiatric problems Impulse control disorders Sleep attacks- DA agonisrts
First line mx of PD in young patients who are biologically fit?
MAO-is e.g. selegiline DA agonists (non-ergot)
Later LDOPA and COMT inhibitors e.g. entacapone
What is the mx of PD in patients who are biologically frail, co-morbs or CI
LDOPA (sine met, madopar)
Later MAOi and COMT i
What is DBS?
Deep brain stimulation
Electrode in subthlamic nuclei
When is DBS used?
Advanced disease with severe fluctuations, dyskinesias and reduced drug responsiveness
How do you mx acute dystonia including oculogyric crises?
Anticholinergics
How do you manage akathisia (restlessness)
B-blockers may help
Mx tardive dyskinesia?
Switch to atypical antipsychotic
How do you treat neuroleptic malignant sx?
Dantrolene
DA agonists
What are the sx of neuroleptic malignant sx?
Muscle rigidity
Hyperthermia
Fluctuating consciousness
Autonomic instability
Potentially fatal
