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10 Cards in this Set
- Front
- Back
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PARKINSON'S MEDS
- early disease: from time of symptom onset --> symptoms become troublesome |
1. Rasagiline (Azilect): MAO-B inhib.
- Treats symptoms mainly - Slows DA breakdown in striatum - MAY slow down progression of dz (but no evidenc) 2. Amantadine (Symmetrel): Anti-viral agent - Mild benefit in early dz - Helps with dyskinesias - Augments DA release & blocks reuptake 3. Anticholinergic (musc antags) - Blocks ACh in the striatum - helps with TREMORS - MANY side effects (similar to anti-depressants) ex// Trihexyphenydyl (artane) & Benztropine (cogentin) |
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Reasons for delaying DA (l-dopa) therapy
*in pts >70 yo w/ cognitive difficulties, give L-dopa |
DA "primes" patients for dyskinesias,
especially in early onset patients *Levodopa may also accelerate the loss of dopaminergic neurons through oxidative stress* *Pts younger than 60yo & symptoms not super severe = give DA agonists* |
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Parkinson's MEDS
- mild disease + symptoms start to interfere with activities |
DA-RECEPTOR AGONISTS:
- best symptomatic relief after L-dopa - don't require enzymatic conversion in striatum --> not dependent on intact nigrostriatal neurons - more selective & longer half-lives (good for pts w/ motor fluctuations) 1. Pramipexole (mirapex): D2/3 agnoists, little axn at D1 2. Ropinirole (Requip) " " *these two also used for restless legs syn* 3. Bromocriptine (Parlodel): D2-R agonist, D1-R partial agonist - MORE side effects; used less - used for PROLACTINOMAS |
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SIDE EFFECTS OF DA-R AGONISTS
- esp pramipexole & ropinirole - L-DOPA has similar side effects excpet for #1 & 2. |
mech: d2, d3 agonists (not D1)
*Prami & ropin used for side effect profile & potency side effects: unique to prami & ropin = 1. Sudden attacks of sleep (pass out) 2. Gambling, compulsive behavior 3. Nausea 4. Hallucinations 5. Confusion 6. Vivid dreams 7. Hypotension 8. Dyskinesias: > L-dopa |
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PARKINSON'S MEDS:
- Moderate-severe disease; sufficient disability |
1. levodopa (sinemet = carbidopa & l-dopa)
- Precursor to DA - Carbidopa inhibits peripheral decarboxylation 2 DA --> less nausea & hypoTN *at least 75 mg needed to prevent nausea* L-DOPA = DOC - most effective - if non-responsive, might NOT be P.D. - big therapeutic window early on 2. COMT Inhibitors - Prolongs effects of L-dopa - never given alone (not useful) - used for "wearing off" effects *Tolcapone (tasmar) assc'd w/ fulminant hepatic fail so it's not used *Entacapone (comtan): 2 hr duration *Stalevo: Entacapone + levodopa 3. DA AGONISTS - used w/ L-dopa to smooth out motor flucts. 4. Low protein diet 5. Surgery |
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LOW PROTEIN DIET & P.D.
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Protein competes w/ absorption of L-dopa @ duodenum & BBB
- in severe disease w/ rapid motor fluctuations, best to take sinemet 1 hr before or 2 hr after meals |
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SURGERY & P.D.
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Severe or Refractory PD
Pallidotommy: internal segment of GP - Non-adjustable Thalamotomy: more helpful for trmor DEEP BRAIN STIMULATION: brain pacemaker in GP or STN - adjustable + memory loss - pts with dyskinesias |
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HEREDODEGENERATIVE PARKINSONISM
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Huntington's
- early symptoms are likely hyperkinetic w/ choreiform movements - LATE: dystonia & features of parkinsonism & Wilson's: usually < 40yo (20-40) - Tremor, dystonia, dysarthria, rigid - Cu metabolism problem *wrong deposition --> symptoms - Deposit in cornea (KF rings), liver, basal gang - 24 hr urine & low serum ceruloplasmin |
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SECONDARY PARKINSONISM
causes |
1. Vascular (multi-infarct, binswanger dz)
- hx of multiple subcoritcal strokes 2. Normal Pressure Hydrocephalus (NPH) - TRIAD: Gait instability, dementia, & urinary incontinence 3. Drugs: Metoclopramide & Haldol 4. Infectious: AIDS & Cretuzfeldt-Jakob 5. Toxins: MPTP (home drug labs, young ts) *responds to L-DOPA 6. Head trauma |
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DYSTONIAS
- TX - EXAMPLES |
TREATED W/ BOTOX EVERY 3 MO
- Blepharospasm - Spasmodic dysphonia: constricted vs. breathy - Torticollis - Writer's Cramp: hand is normal doing other things *trickier to tx w/ botox bc many mm in hand *sensory tricks* |
