Autonomic dysfunction medications used to treat Parkinsons disease PD also have

Autonomic dysfunction medications used to treat

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E. Autonomic dysfunction (medications used to treat Parkinson’s disease [PD] also have autonomic side effects)1. Urinary incontinence2. Sexual dysfunction3. Constipation4. Orthostatic hypotension5. Impaired thermoregulation6. Sensory abnormalities (pain and paresthesia)F. Craniofacial abnormalities1. Masked face: expressionless, fixed, and immobile face; staring eyes with mouth slightly open2. Dysphagia3. Involuntary closure of the eye lid4. Impaired sense of smell
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5. Excessive drooling6. DysarthriaIV. Laboratory findings/diagnosticsA. History and physical exam are the basis for diagnosis1. Physical exam findings of tremor, rigidity, impaired balance, and gait alterations are the central findings that suggest PD.B. CT scan and MRI .are usually normal in PD but may be useful in assessing a differential diagnosisC. Positron emission tomography scans are used primarily in research and are not specific for diagnosisD. Clinical ratings scales, such as the Unified Parkinson’s Disease Rating Scale, provide a standard evaluation and measure of the diseaseand its progression.V. Treatment (see Table 9.1)A. Referral to neurologistB. Pharmacological intervention provides symptom relief and can improve functioning1. Carbidopa-levodopa combination (Sinemet) isthe standard treatment2. Dopamine agonists (ropinirole and pramipexole) may reduce the risk of developingmotor complications and alleviate symptoms3. Anticholinergics (trihexyphenidyl and benztropine mesylate) are helpful in treating tremors, but may cause confusion; use cautiously4. Amantadine (Symmetrel) is used early in the disease, helpful with dyskinesias5. MAO-B inhibitors (rasagiline and selegiline) may be helpful in the treatment of motor symptomsC. “On-off’ phenomena described when the medication is working, then stops working. This is characterized by motor function fluctuations. The addition of catechol-O-methyltransferase prevents the breakdown of dopamine and helpswith these phenomena.D. Neuroprotective agents have been investigated to prevent degeneration of neurons. The findings have been conflicting andmore research is progressing in this area.PHARMACOLOGIC AGENTSDOPAMINERGIC AGENTSCarbidopa/Levodopa (Sinemet):10 mg/100 mg, 25 mg/100 mg, 25 mg/250 mgIR: 25/100 PO TID• Most effective drug for the symptomatic treatment of PD• Use with COMT/MAO-B inhibitors prolongs duration of effect• Sinemet is available as immediate release andsustained releaseS/E: GI upset, arrhythmias, dyskinesias, on-off and wearing-off phenomena, confusion, dizziness, headache, hallucinationsDOPAMINE AGONISTSBromocriptine (Parlodel)1.25 mg PO BID• Can be used as monotherapy (mild disease) or in combination with levodopa/carbidopa• Reduce the frequency of “off periods” and may allow reduction of levodopa/carbidopa dosePramipexole (Mirapex, Mirapex ER)IR: 0.125 mg PO TID ER: 0.375 mg PO daily• Requires slow titration• Adjust dose for renal dysfunctionRopinirole (Requip, Requip XL)IR: 0.25 mg PO TIDRequip XL: 2 mg PO dailyRopinirole:• Many drug-drug interactions
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