Parkinson's Disease Medications

Flashcards about Dementia, Epilepsy, Mental Health, and Movement Disorders

What’s the Parkinson's Disease Pathophysiology

Progressive loss of dopaminergic neurones leading to dopamine deficiency in the nigrostriatal pathway, which regulates body movement.

What are the Motor Symptoms of Parkinson's Disease

Hypokinesia, bradykinesia, rigidity, rest tremor, postural instability.

What are the Non-Motor Symptoms of Parkinson's Disease

Dementia, depression, sleep disturbances, speech and language change, swallowing problems, and weight loss.

What are the Parkinson's Disease Driving Requirements

Notify DVLA and car insurer.

What are the Risks of Abruptly Withdrawing Parkinson's Medication

Acute akinesia and Neuroleptic Malignant Syndrome

What are the Treatment for Nausea and Vomiting in Parkinson's Disease

Domperidone, not Metoclopramide.

What are some examples of Dopaminergic Drugs

1.) Levodopa (dopamine precursor)

2.) Co-beneldopa (Levodopa with Benserazide)

3.) Co-careldopa (Levodopa with Carbidopa).

First-line treatment for motor symptoms decreasing quality of life

Levodopa with carbidopa/benserazide

Treatment choices for motor symptoms that do not affect quality of life

1.)Levodopa (with carbidopa/benserazide)

2.)Non-ergot derived dopamine-receptor agonists

3.) MAO-B inhibitors.

Adjuvant therapy choices for dyskinesia & motor fluctuations with levodopa

1.)Non-ergot derived dopamine-receptor agonists

2.) MAO-B inhibitors

3.) COMT inhibitors

4.) Ergot-derived dopamine receptor agonist (if inadequate response with non-ergot derived dopamine-receptor agonists)

5.) Amantadine (if dyskinesia not adequately managed by modifying therapy).

What’s the Use of Apomorphine in Advanced Parkinson's Disease

Refractory motor fluctuations "OFF" episodes

Side effects of Apomorphine

Nausea and vomiting, QT interval prolongation.

What’s the use of Levodopa-Carbidopa Intestinal Gel

Advanced levodopa-responsive Parkinson's disease with severe motor fluctuations, hyperkinesia or dyskinesia.

When to Consider Deep Brain Stimulation for Parkinson's Disease

Symptoms are not adequately controlled with the best drug treatment.

How Levodopa Works

Replenishing depleted dopamine levels in the brain

1st line treatment for PD

What are the 2 types of Levodopa

Co-carelodpa (Levodopa+Carbidopa)

Co-benelodpa (Levodopa+Benserazide)

What are the benefits of Peripheral dopa-decarboxylase inhibitors.

less N/V and CV effects

lower dose required for therapeutic effect

What is the key instructions for Levodopa

Take at specific times of the day to avoid "OFF" periods.

What are Impulse Control Disorders

Compulsive gambling, hypersexuality, binge eating, obsessive shopping.

What’s the treatment of End-of-Dose Deterioration

Modified-release preparations may help.

What are the side effects of Levodopa

1.) impulse control disorders

2.) excessive sleeping or sudden onset of sleepiness

3.) motor complications e.g. dyskinesia

4.) end of dose deterioration with shorter length of benefit

How Dopamine-Receptor Agonists Work

Direct action on dopamine D2 receptors in striatum

associated with more hallucinations, impulse controls and excessive sleepiness than Levodopa

What are examples of non ergot derived Dopamine receptor agonists

1.) Pramipexole

2.) Ropinirole

3.) Rotigotine

What are examples of ergot derived Dopamine receptor agonists

1.) Bromocriptine

2.) Cabergoline

3.) Pergolide

What are the Fibrotic side effects of Ergot-Derived Medications

Pulmonary (dyspnoea, persistent cough), Retroperitoneal (abdominal pain and tenderness), Pericardial (cardiac failure).

What drug class does Apomorphine and Amantadine belong to

Dopamine receptor agonists

What are the side effects of Dopamine receptor agonists

1.) Impulse control disorders e.g. gambling, binge eating, hyper sexuality, obessive shopping

2.) excessive sleepiness and sudden onset of sleep

3.) psychotic symptoms

4.) hypotensive reaction in the first few days

What’s the function of MAO-B Inhibitors

Inhibits monoamine oxidase B enzymes which are responsible for the breakdown of monoamines; dopamine.

What are the two types of MAO-B inhibitors

1.) Rasagiline

2.) Selegiline (metabolises to Amfetimine which’s a driving offence)

When do you use MAO-B inhibitors

Used alone in PD in patients with motor symptoms that don’t affect quality of life or as combo with Levodopa

What are the Over-the-counter Interactions of MAO-B Inhibitors

Nasal decongestants such as:

pseudophrine

phenylephrine

Xylometazoline

Oxymetazoline

What’s the MOA of COMT Inhibitors

Prevents the peripheral breakdown of levodopa, by inhibiting catechol-O-methyltransferase, allowing more levodopa to reach the brain.

What are the two types of COMT Inhibitors

1.) entacapone- colours urine red/brown

2.) Tolcapone causes hepatotoxcity

What’s the use of COMT inhibitors

adjunct to levodopa in end dose of motor fluctuations

What are the interactions of COMT inhibitors

increased CV effects with adrenaline/noradrenaline or MAOIs