This document provides an overview of Parkinson's disease (PD), including its symptoms, pathogenesis, treatment, and progression. PD is a progressive neurodegenerative movement disorder caused by the loss of dopamine-producing neurons in the substantia nigra. Its characteristic motor symptoms include bradykinesia, resting tremor, rigidity, and postural instability. Treatment involves pharmacological management with dopamine replacement therapy like levodopa, though medications must be adjusted as the disease progresses and complications emerge. PD progresses through several stages as its symptoms worsen and become more treatment-resistant over time.
complete and detail study on the topic of anti epileptic drugs . the topic contain drugs of epilepsy with their uses, side effect, mechanism of action, classification of epileptic drugs.
basic information of receptors
A short presentation looking at the various definitions of hypoglycaemia
(clinical, biochemical and symptomatic).
It goes through the modes of acute treatment and the options for disabling
hypos.
Provides information on hypoglycemia; every diabetic should know the symptoms, diagnosing test and treatment of hypoglycemia or low blood glucose. Knowledge of hypoglycemia helps to prevent low blood sugar complications.
This presentation provides information about parkinsonism or Parkinson disease and pathophysiology, classification, pharmacological action and side effects of Anti Parkinson drugs.
complete and detail study on the topic of anti epileptic drugs . the topic contain drugs of epilepsy with their uses, side effect, mechanism of action, classification of epileptic drugs.
basic information of receptors
A short presentation looking at the various definitions of hypoglycaemia
(clinical, biochemical and symptomatic).
It goes through the modes of acute treatment and the options for disabling
hypos.
Provides information on hypoglycemia; every diabetic should know the symptoms, diagnosing test and treatment of hypoglycemia or low blood glucose. Knowledge of hypoglycemia helps to prevent low blood sugar complications.
This presentation provides information about parkinsonism or Parkinson disease and pathophysiology, classification, pharmacological action and side effects of Anti Parkinson drugs.
Semana de prevenção e combate à aids é aberta com programação ampla no DF.Ministério da Saúde
O teste para diagnosticar o vírus da Aids pode ser feito
às quartas e quintas-feiras, das 19h às 23h, no Conic;
e às quintas-feiras, das 19h às 23h, no
Estacionamento 11 do Parque da Cidade. Duas vezes
por mês,o teste rápido segue para cidades satélites do
DF.
Lecture slides for Medical Undergraduate teaching in Pharmacology. Study material is based on Essentials of medical pharmacology by KD tripathi and Katzung. Figures are obtained from google image search and above mentioned textbooks.
It may contain a brief intoduction of disease, etiology, types of parkinson disease, clinical findings, dignosis, pathophysiology, treatment, drug classification and their mechanisms of actions.
Parkinsons Disease Psychosis (PDP) is a multifactorial, progressive disease that presents in the late stages of Parkinsons Disease. Its hallmark features include visual hallucinations and delusions. There are factors related to Parkinsons medications (i.e. L-DOPA, anticholinergics) as well as intrinsic disease-related factors that contribute to the psychosis.
Parkinson's disease is a progressive nervous system disorder that affects movement. Symptoms start gradually, sometimes starting with a barely noticeable tremor in just one hand. Tremors are common, but the disorder also commonly causes stiffness or slowing of movement
2. Introduction
Diagnosis
Brief Pathology
Treatment and Prognosis
Other symptoms/complications
Phases
Other Neurodegenerative diseases
Quiz
3. PD is a movement disorder
› Prevalence: 100 – 180/100,000 in UK
› Incidence: 4 – 20/100,000 in UK
› M > F
Parkinsonism – syndrome of:
› Bradykinesia (poverty of movement)
› Resting tremor
› Rigidity
› Varying degrees of postural instability
4. Asymmetrical onset
Slow progression
Good response to L-dopa therapy
N.B. only 60% develop tremor!
5. Clinical – structural imaging normal
Helpful signs:
› Micrographia
› Loss of arm swing
› Facial hypomimia (mask like)
› Cogwheel stiffness
› 4 – 7 Hz resting tremor
6. Symmetrical onset
Early falling
Early cognitive impairment
Prominent autonomic disturbance (sphincter
involvement)
Pyramidal tract or cerebellar signs
Classic MCQ trick innit!
7. Loss of dopamine producing cells in the
substantia nigra
Also involves Serotonin, Acetylcholine and
Noradrenaline neurotransmitters
Lewy bodies (intraneuronal protein inclusions)
Most not genetic unless present < 30
› Parkin gene
8. PD is progressive
Pharmacological intervention changes as the
condition advances
No universal first line treatment
› Patient choice and all that jazz!
9. Drug Group Examples Side Effects
Dopamine
Agonists
Bromocriptine
Pergolide
Cabergoline
Apomorphine
Pramipexole
Ropinorole
• Neuropsychiatric
• Ergots fibrosis
• Give Domperidone with
Apomorphine
• Hypotensive reactions
• SOOS and day sleepiness
Levodopa
Give with dopa-
decarboxylase
inhibitors
Co-careldopa (Sinemet)
(Ldopa + Carbidopa)
Co-benyldopa (Madopar)
(Ldopa + Benserazide)
• Response fluctuations ‘on-
off’
• Dyskinesias
• Anticholinergic
• Post. Hypotension
• Psychiatric
• N,V
MAOIs Selegiline
• Postural Hypotension
• Anticholinergic type
• Sleep disorders
• Confusion
• Nausea
10. Drug Group Example Side Effects
COMT Inhibitors
- Prevent peripheral
breakdown of Ldopa
- Can be used 1st line
according to NICE
Entacapone
Tolcapone
N,V
Diarrhoea, Constipation
Abdo pain
Urine goes red-brown
Dry mouth
Confusion
Insomnia etc
Amantidine
- Weak dopamine
agonist
- Antiviral
Amantadine
Hydrochloride
Anorexia
Nervousness
Insomnia
Reduced concentration
12. Diagnosis Refer to Specialists
› Medication may not be necessary
Maintenance Medication prescribed
› Medications increase over time, monitor
› Essentially stable
Complex Motor fluctuations: on-off/dyskinesia
› Other meds added: Amantadine, ? agonist, ? add anti-psychotics
› Provide information support and advice, monitor regularly, prevent
psychotic symptoms! Avoid hospital admission
Palliative
› Medications less effective, may be no observable benefit. ?PEG – early.
› Symptom control, specialist services, end of life choices
13. Parkinson Plus Syndromes:
› Multiple System Atrophy
› Progressive Supranuclear Palsy
› Dementia with Lewy Bodies
› Corticobasal degeneration
Drug induced Parkinsonism:
› Neuroleptics
› Antiemetics – which one?
› Lithium
Vascular Parkinsonism :
› Marked sparing of upper limbs
› Check vascular RF
14. Parksinson’s Disease:
Is usually inherited
Presents with early falling
Should show a good response to L-dopa
Can be treated with Deep Brain Stimulation
Usually presents with symmetrical onset
Constipation is a symptom
15. NICE guidelines
COMP2 presentations from blackboard…
grr!
Medicine At a Glance.
www.wikipedia.org
www.meducation.net
Editor's Notes
Serotonin – mood and behaviour
Acetylcholine – cognition and memory
Noradrenalin – Autonomic function - BP
Ergot derived dopamine agonists have been associated with pericardial, pulmonary and retroperitoneal fibrotic reactions. Before starting treatment it may be appropriate to measure ESR and serum creatinine and. Monitor for dyspnoea, persistent cough or chest pain, cardiac failure and abdominal tenderness.
Start dose small and increase slowly. Do not stop abruptly
Giving ldopa with decarboxylase inhibitors limits peripheral conversion to dopamine which would cause nausea and cardiovascular side effects. Avoud abrupt withdrawal because neuroleptic syndrome and rhabdomyolysis can occur.
COMT = Catechol O methyltransferase inhibitors. Use as adjunct to Ldopa in PD and end of dose motor fluctuations.