帕金森英文概要1.pptVIP

Levodopa-relatedlong-term complications Dyskinesias or abnomal involuntary movement Fluctuations in motor performance “Wearing off” phenomenon, end-of-dose deterioration “On-off” phenomenon Drug-Associated Side Effectsof Parkinson’s Disease “Off”-period dystonia “Wearing-off” response “On-off” response Peak-effect dyskinesia or dystonia Diphasic dyskinesia Drug-failure response Beginning-of-dose deterioration Myoclonus Freezing Imbalance Psychosis (hallucinations, confusion) Sleep disturbances Orthostatic hypotension Bradyphrenia Sweating episodes Motor Abnormalities Non-Motor Disorders Drug-Associated Side Effectsof Parkinson’s Disease “Off”- delayed stomach empty/decreased absorption increase dose or freq or take only with lots of water “Wearing-off” response – loss of neuronal storage capacity increase frequency or change to CR (decrease bioavailability may require adding IR in morning) or add DA agg. Or MAOi or COMT or Amantadine “On-off” response – extension of “off” add DA agg or change to CR or add COMT or add MAOi Peak-effect dyskinesia decrease dose and increase frequency or change to CR or add DA agg, decrease anticholinergics, or add propranolol Dystonia – early morn (improve w/ 1st dose) use CR at HS or add DA agg, or add baclofen, or add Botox Freezing increase dose or add DA agg or refer for gait modification Delay onset take on empty stomach with water and avoid protein Drug-Induced Psychosis in PD 1. Evaluate hypoxemia, infection, electrolyte disturbance 2. Simplify regimen – Discontinue medications with highest risk:benefit Anticholinergics Taper and Discontinue Amantadine (withdrawal can cause delirium) Selegiline/MAOi Taper and Discontinue DA agg. Consider decreasing L-Dopa (end of day) and discontinue COMT 3. Consider atypical antipsychotics (quetipine 12.5-50mg HS, increase weekly; clozapine 12.5-50 mg, increase weekly, monitor neutrophils). * * * * * * * * Carbidopa/Levodopa (Sinemet) Maintain carbidopa doses at least 70—100 mg/day