Parkinson's Disease
- Created by: Melissaloughlin
- Created on: 19-05-23 14:15
View mindmap
- Parkinson's Disease
- Progressive bradykinesia
- Slowness in movement and amplitude of repetitive actions
- Progressive hypokinesia
- Reduced facial expression, difficulty with fine movements, slow shuffling
- Stiffness, Rest tremor, Balance/gait disorders
- Differential diagnosis
- Drug-induced
- Anti-psychotics (1st gen)
- Anti-emetics
- If Parkinson's is suspected but pt. is also taking a drug known to induce parkinsonism, reduce/stop drug if possible and refer
- Medical conditions
- Cerebro-vascular disease
- Non-parkinson's dementis
- Repeated head injury
- Drug-induced
- Treatment
- 1st line
- Co-careldopa/ Co-beneldopa
- Levodopa with dopa de-carboxylase inhibitor
- The inhibitor prevents levodopa from converting to dopamine before it reaches the brain
- Therefore, reduced levodopa dose needed- reducing N&V side effects
- The inhibitor prevents levodopa from converting to dopamine before it reaches the brain
- Levodopa with dopa de-carboxylase inhibitor
- Monoamine-oxidase-B inhibitors (MAO-Bi)
- Selegiline, Rasagiline, Safinamide
- MAO-B enzyme hoovers up unused dopamine - inhibiting this enzyme will free up dopamine
- Oral dopamine agonists
- Pramipexole, Ropinirole
- Transdermal Rotigotine (Neupro 24hr patch)
- Pros: swallowing difficulties, bypasses stomach
- Cons: skin irritation, sleep issues
- Ergot-derived (cabergoline, pergolide) should not be used 1st line - risk of cardiac fibrosis with long term use
- Co-careldopa/ Co-beneldopa
- Adjuvant treatments
- COMT inhibitors
- Entacapone (combo with levodopa, carbidopa - Stalevo)
- Dyskinesia/ motor fluctuations despite optimal therapy
- Reduces metabolism of levodopa - increase bioavailability
- Amantadine
- Increases dopamine levels
- SC Apomorphine
- Dopamine Agonist
- DBS
- COMT inhibitors
- 1st line
- Neuro-degenerative disorder affecting predominantly dopaminergic neurons in the substantia nigra
- Complications
- Constipation, N&V
- Pain
- Sleep disturbance/ Daytime sleepiness
- Depression & Anxiety
- Dementia & Cognitive impairment
- Impulse control disorders & Psychotic symptoms
- Dysphagia & Weight loss
- Excessive salivation & Sweating
- Bladder and sexual problems
- Progressive bradykinesia
Comments
No comments have yet been made