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timothy.pdlt
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GoT of PD Tx
- minimize s/s
- maintain QoL
- prolong survival
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Cardinal S/S of PD
- coarse tremor
- cogwheel rigidity (jerky resistance to passive movement)
- bradykinesia
- postural changes (usually later)
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Non-motor complications of PD and management
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S/E of DA Tx (LDOPA/carbidopa 100mg/25mg TID)
- confusion
- hallucination
- N/V
- orthostatic hypotension
- red urine
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Motor fluctuations with long-term Tx (3-5years)
- 1. wearing-off effect: breakthrough s/s near the end of dose interval
- 2. peak dose dyskinesia: involuntary movements after dose
- 3. on-off phenomenon: random breakthrough s/s (not related to dose timing)
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Management of LDOPA motor complications
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Strategies to delay LDOPA Tx
- 1. selegiline (selective irreversible MAO-B inhibitor): delays need for LDOPA, doesn't increase mortality
- 2. rasagiline (irreversible MAO-B>>MAO-A) inhibitor: improves s/s and slow progression
- 3. DA agonist:
- a. ropinirole: decreased dyskinesia complications when given as initial Tx
- b. pramipexole: decreased dyskinesia complications when given as initial Tx
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S/E of selegiline/rassagiline
- hallucinations
- insomnia
- somnolence
- parethesia
- N/V
- edema
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S/E of DA agonist (esp. pramipexole)
- more hallucinations
- more somnolence
- more edema
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