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Antiparkinson Agents (Drugs (Levodopa (Early side effects (NV, Cardiac…

- - - - Decreased efficacy
      - Motor fluctuations and dyskinesia
    - - NV
      - Cardiac arrhythmia
      - Postdural hypotension
    - - Wearing off syndrome
        
        Decreased efficacy before the next dose (drugs drop below TI)
        
        Combine with MAO/COMT - Carbidopa sustained release
        
        Switch to amantadine
      - Dyskinesia
        
        Involuntary 'wriggling'
        
        Use amantadine
        
        Combine with MAO-B
  - - - Ropinirole, apomorphine
    - - Early stage
        
        NV
        
        Somnolence
        
        hallucination
        
        leg edema
      - Late stage
        
        Dyskinesia
        
        Hypotension
        
        insomnia
    - - Rescue therapy for hypomobility
      - NV, somnolence, dizziness
      - Give with antiemetic
      - Do not give with serotonergic
        
        Causes severe hypotension
      - Requires test dose and titration
    - - younger patients
      - depressive disorder
      - May need modification to dopaminergic therapy
  - - - Delays the need but not the long term symptoms
      - Should not be given in the evening
        
        Causes insomnia
      - Less risk of cheese effect
        
        counsel patient nevertheless
    - - More potent than selegiline
      - High doses show disease modifying effect but also associated with dyskinesia
      - No amphetamine metabolites
      - 1mg as monotherapy, 0.5mg with levodopa
      - If long term effects - reduce levodopa dose
    - - Effective in preventing wearing-off syndrome
      - Urine discoloration
      - Abdominal pain
      - Lowers UPDRS score and decreases levodopa dose
  - - - Adjunct to treating such complication
- - - - but all CI in pregnancy
  - - - Associated with onset of disease and age
      - Goal: Discontinue drugs that may cause dementia, prevent infections
      - Use of anticholinergics (rivastigmine) improve scales
        
        Side effects however are not as ideal: incontinence, lacrimation, NV
    - - Poorly diagnosed
      - Goal: restore mobility and reinforce independence
      - Give antidepressants where required
      - Benzodiazepines are a good starting drug
    - - Associated with high doses of dopamine agonists and levodopa
      - More pronounced at night
      - Reduce dose, or give antipsychotic that does not act on dopamine receptor