Pharmacotherapy of Parkinson disease

1. PHARMACOTHERAPY
OF PARKINSON’S
DISEASE
17-03-2015
Dr. T.S. Mohamed Saleem , ANCP, RJP
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2. DEFINITION
• Progressive disorder of the nervous system that affects
your movement.
• Tremor in just one hand.
• Stiffness or slowing of movement.
• 1 million patients inn USA
• 10:100000 patients of 6th decade
• 120:100000 patients of 9th decade
• Genetic constitution and toxin
17-03-2015
Dr. T.S. Mohamed Saleem , ANCP, RJP
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3. PATHOPHYSIOLOGY
• Substantia nigra
• Loss of neurons (70-80%)
• Presence of lewy bodies
• Nigrostriatal dopamine loss and severity of motor
symptoms
• Reduced activation of dopamine-1 and dopamine-2
receptors
• Increase of striatal cholinergic activity
17-03-2015
Dr. T.S. Mohamed Saleem , ANCP, RJP
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4. CLINICAL
PRESENTATION
• Resting tremor, rigidity, bradykinesia, postural instability
• Pill-rolling tremor, Cogwheel rigidity
• Speech changes
• Writing changes
17-03-2015
Dr. T.S. Mohamed Saleem , ANCP, RJP
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5. PD PRESENTATION
• General features
• Motor symptoms
• Dysarthria
• Dysphagia
• Hypomimia
• Hypophonia
• Micrographia
• Autonomic and sensory symptoms
• Mental status changes
17-03-2015
Dr. T.S. Mohamed Saleem , ANCP, RJP
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6. DESIRED OUTCOME
• Minimize symptoms
• Disability
• Improved quality of life.
• Education of patients and caregivers
• Exercise and proper nutrition are essential
17-03-2015
Dr. T.S. Mohamed Saleem , ANCP, RJP
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7. TREATMENT
• Pharmacological therapy
• Anticholinergic drugs
• Dopamine agonist
• COMT inhibitors
• MAO-B inhibitors
• Carbidopa and levodopa
• Amantadine
• Nonpharmacological therapy
• Education
• Support
• Exercise
• Nutrition
17-03-2015
Dr. T.S. Mohamed Saleem , ANCP, RJP
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8. 17-03-2015
Dr. T.S. Mohamed Saleem , ANCP, RJP
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9. 17-03-2015
Dr. T.S. Mohamed Saleem , ANCP, RJP
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10. PHARMACOLOGICAL
THERAPY
• Monotherapy – MAO-B inhibitors
• Dopamine agonist – Physiologically young
• Motor fluctuations – COMT inhibitors
• L-Dopa induced dyskinesia's – Amantadine
• Tremor and dystonic features – anticholinergic drugs
17-03-2015
Dr. T.S. Mohamed Saleem , ANCP, RJP
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11. COMMON MOTOR
COMPLICATIONS AND
TREATMENT
17-03-2015
Dr. T.S. Mohamed Saleem , ANCP, RJP
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12. EVALUATION
• Patient education
• Individualization of drug therapy
• Discontinuation of drug therapy – Worsening the
psychosis
17-03-2015
Dr. T.S. Mohamed Saleem , ANCP, RJP
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13. 17-03-2015
Dr. T.S. Mohamed Saleem , ANCP, RJP
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