Parkinson's Disease Overview and Treatment

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Questions and Answers

What is a primary advantage of dopaminergic therapy?

Less risk of dyskinesias (correct)

Requires dietary protein restrictions

Prevents hallucinations

Requires conversion before use

What condition may occur if levodopa is taken with non-selective MAOIs?

Hypertensive crisis (correct)

Increased drowsiness

Cognitive decline

Malignant melanoma activation

Which of the following is NOT an adverse effect of anticholinergic therapy?

Urinary retention

Drowsiness

Blurred vision

Rigidity (correct)

What implication should be communicated to clients when starting dopaminergic agents?

Monitor for dizziness and assist with walking Signup and view all the answers

Which of the following medications is classified as an anticholinergic drug?

Benztropine Signup and view all the answers

What is a critical client care implication for patients on levodopa?

Regular skin assessments for melanoma Signup and view all the answers

Anticholinergic agents are primarily used to treat which symptoms associated with Parkinson's disease?

Muscle tremors and rigidity Signup and view all the answers

Which of the following does NOT represent a common side effect of anticholinergic drugs?

Increased sweating Signup and view all the answers

Which motor symptom is characterized by a slowing of movement in Parkinson's disease?

Bradykinesia Signup and view all the answers

What is the primary purpose of levodopa in the treatment of Parkinson's disease?

To increase dopamine release Signup and view all the answers

Which drug combination helps to prevent the peripheral metabolism of levodopa?

Benserazide and carbidopa Signup and view all the answers

What adverse effect is commonly associated with levodopa therapy?

Dizziness and confusion Signup and view all the answers

Which of the following drugs can cause an increased release of dopamine from nerve endings?

Amantadine Signup and view all the answers

What mechanism does selegiline follow to assist in the management of Parkinson's disease?

Inhibits MAO-B to prevent dopamine breakdown Signup and view all the answers

What is the 'on-off' phenomenon in relation to levodopa treatment?

An abrupt loss of drug effect Signup and view all the answers

Which additional therapy is often considered for patients with drug-resistant Parkinson's disease?

Deep brain stimulation Signup and view all the answers

What role does carbidopa play in the therapy for Parkinson's disease?

Reduces peripheral metabolism of levodopa Signup and view all the answers

Which of the following is characterized by involuntary muscle movements as an adverse effect of levodopa therapy?

Dyskinesia Signup and view all the answers

Which agent is used to inhibit the enzyme COMT in combination therapies for Parkinson's disease?

Entacapone Signup and view all the answers

When is a dopamine receptor agonist typically recommended in the treatment of Parkinson's disease?

As a first-line treatment for younger patients Signup and view all the answers

Which of the following is a potential effect of using a monoamine oxidase inhibitor (MAOI) in Parkinson's disease treatment?

Enhanced dopaminergic stimulation Signup and view all the answers

Study Notes

Parkinson's Disease (PD) Overview

Chronic, progressive, degenerative neurological disorder
Affects control of body movements and other functions
Characterized by motor symptoms including bradykinesia (hypokinesia), rigidity, tremor, postural instability, gait disturbances, mask-like face, and dystonias
Other symptoms: sleep disturbances, depression, psychosis, dementia, loss of smell, apathy, and autonomic dysfunction (e.g., orthostatic hypotension, urinary urgency, constipation)
Affects dopamine-producing neurons in the brain
Symptoms caused by an imbalance of two neurotransmitters: dopamine (DA) and acetylcholine (ACh)
Symptoms occur when ~70-80% of dopamine neurons in the substantia nigra (SN) of the basal ganglia are lost
DA is inhibitory and ACh is excitatory; Imbalance leads to disturbed movement

Parkinson's Disease (PD) Treatment and Interventions

Treatments and interventions focus on managing movement abnormalities and include medications, deep brain stimulation (DBS), exercise, and socialization programs
Drug therapy mainly targets the DA pathway by:
- Replacing dopamine precursors (e.g., levodopa/carbidopa)
- Preventing dopamine metabolism (e.g., MAO-B inhibitors like selegiline, rasagiline)
- Using dopamine receptor agonists (e.g., pramipexole, ropinirole, rotigotine)
Anticholinergic agents (e.g., benztropine, trihexyphenidyl, diphenhydramine) are also used to treat muscle tremors and rigidity

Levodopa Therapy

Levodopa is a dopamine precursor that crosses the blood-brain barrier while dopamine cannot
After transport to the dopaminergic terminal neurons it is converted to dopamine and then released
Combination therapy with carbidopa or benserazide is common to prevent peripheral breakdown of levodopa, leading to lower doses, reduced nausea, and vomiting
COMT inhibitors (e.g., entacapone, opicapone) further increase the amount of levodopa available to the brain
Therapy usually maintains functional mobility for years, prolongs quality of life, and life expectancy
Response may take several months to fully develop
As PD progresses, levodopa becomes less effective in controlling symptoms, and alternative treatments like DBS may be considered
"Wearing-off" effect and "on-off" phenomenon are common issues with levodopa therapy

Levodopa Therapy Adverse Effects

Common adverse effects include nausea, vomiting, dyskinesias (involuntary movements), cardiovascular effects (hypotension, dysrhythmias), and psychosis (hallucinations, paranoid ideation)

Other Dopaminergic Therapies (Selegiline and Amantadine)

Selegiline: Selectively inhibits MAO-B, preventing dopamine breakdown, useful in milder cases or for managing fluctuations
Amantadine: Promotes dopamine release and blocks reuptake, effective as an adjunctive agent; useful in managing "on-off' fluctuations
Selegiline doesn't have the "cheese effect" of other MAOIs.

Dopamine Receptor Agonists

Direct-acting drugs such as bromocriptine (older), pramipexole, ropinirole, and rotigotine (transdermal patch) directly stimulate dopamine receptors. They are often the first-line treatment for younger patients with mild-to-moderate symptoms, used to reduce the "wearing-off" effect of levodopa, and tend to cause less dyskinesia but still can have serious side effects. These include hallucinations, postural hypotension, drowsiness, and impulse-control disorders (e.g., gambling, shopping, hypersexuality).

Client Care Implications

Clients should inform the prescriber about all medications
Patients taking dopaminergic agents may experience dizziness upon initiation; assistance with ambulation might to be required
Patients on levodopa should avoid high-protein diets
Combination of levodopa or levodopa-carbidopa with other drugs should be avoided or checked with a physician before using it
Careful skin assessment during levodopa therapy may be needed to monitor for malignant melanoma activation.

Anticholinergic Therapy

Anticholinergics block the effects of acetylcholine (ACh), which helps reduce tremor and rigidity in Parkinson's Disease. Although these drugs are helpful they are not used to alleviate issues like bradykinesia.
Adverse effects can be similar to atropine, including drowsiness, confusion, disorientation, constipation, nausea, vomiting, urinary retention, blurred vision, dilated pupils, photophobia, dry mouth, dry skin, and fever

Additional Notes

Deep brain stimulation (DBS) can be an alternative therapy for patients with drug-resistant PD.
Non-pharmacological approaches to manage symptoms such as exercise, occupational therapy, and speech therapy can improve the overall quality of life.

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Description

Explore the key aspects of Parkinson's Disease, a chronic and progressive neurological disorder. This quiz covers symptoms, affected brain areas, and the imbalance of neurotransmitters. Additionally, it delves into treatment strategies aimed at managing movement abnormalities.