Windsor Parkinson Meeting April 22, 2014

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== Cut- A - Thon For Parkinson's Sunday April 27, 2014 ==
== Cut- A - Thon For Parkinson's Sunday April 27, 2014 ==
[[file:Parkinson_Society_Southwestern_Ontario.png|link=http://www.parkinsonsociety.ca/windsor-support-services.html]] [[ File:Parkinson SW rgb EN.jpg|90px|]]
[[file:Parkinson_Society_Southwestern_Ontario.png|link=http://www.parkinsonsociety.ca/windsor-support-services.html]] [[ File:Parkinson SW rgb EN.jpg|90px|]]
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Welcomes Guest Speaker : <span style="color:crimson"> Mr. Peter Dumo, a Pharmacist  </span>with Nova Care Pharmacy </div><br/>
Welcomes Guest Speaker : <span style="color:crimson"> Mr. Peter Dumo, a Pharmacist  </span>with Nova Care Pharmacy </div><br/>
:'''"is also President of the Essex County Pharmacist Association."''' <br/><br/>
:'''"is also President of the Essex County Pharmacist Association."''' <br/><br/>
 +
 +
Parkinson's Support Group
 +
 +
Medications for people living with Parkinson’s Disease
 +
 +
General Principles
 +
* treafinent is individualized
 +
* focus is on quality of life, benefit risk
 +
Dopamine Agonists (pramipexole. ropinirole )
 +
* often used first line because less movement disorders than levodopa-based treatments
 +
* may not be as effective but better benefit risk ratio
 +
* preferred in younger patients
 +
* dosed three times daily, slowly titrated
 +
* most common side effects: swelling, sleepiness (sudden dramatic), constipation, dizziness, hallucinations, and nausea
 +
* impulse control disorder
 +
Levodopa
 +
* most effective treatment, especially for severe rigidity or "frozen" patients * always combined with carbidopa or benserazide to allow brain lievels (Sinemet or Prolopa) to prevent nausea, dizziness, and vomiting
 +
*common approach is to start low and gradually titrate up - then switch to slow release version
 +
*nausea common with initial low doses because of low amounts of carbidopa
 +
* initially take with a snack, but with advanced disease empty stomach may better for absorption
 +
* common early side effects: Nausea, somnolence, dizziness, and  headache
 +
* more advanced disease/elderly: confusion, hallucinations, delusions, agitation, and psychosis
 +
* prolonged use = movement disorders (dyskinesia, dystonias and complex motor fluctuations) develop
 +
* wearing-off phenomenon also happens
 +
Selegiline and Rasagiline
 +
* modest effect, especially in early disease (? neuroprotective)
 +
* selegiline dosed once or twice (AM and Lunch) whereas Rasagiline dosed once daily
 +
* do not combine with certain  antidepressants, pain medicines without close MD supervision
 +
Entacapone
 +
* only works in combination with Levodopa
 +
* added to deal with "weaning-off phenomenon, provides more "on-time" boost Levodopa effect
 +
* patients often need a DECREASE in Levodopa dose
 +
* side effects related to increase Levodopa effect plus orange discoloration of urine and rare diarrhea
 +
Benztropine and trihexyphenidyl
 +
* useful in < 70 with significant tremor or those with advanced disease despite max Levodopa
 +
* causes confusion and hallucinations (more so in the elderly)
 +
* dry mouth, blurry vision, difficulty urinating and prostate problems
 +
 +
<--Page_2 
 +
Timing of Medications
 +
* Timing matters, especially with levodopa-based treatment
 +
* cleared quickly from the body so missed doses or delayed doses can cause severe worsening
 +
* stopping dopamine-based drug can precipitate severe rigidity (Parkinsonism-Hyperpyrexiui )
 +
* seligiline and rasagiline should be taken in the AM (less insomnia)
 +
Side effect management
 +
 +
Constipation
 +
* look at medication(s) that may cause (benztropine)
 +
* may be due to dysautonomia, decreased walking around nutritional intake
 +
* optimize fluid and fiber intake
 +
* may add PEG powder, then stool softener, then laxative, then suppository then enema
 +
* 1-2 week between each stage
 +
*increasing Levodopa may help
 +
Dementia
 +
* typically  occurs late in the course of PD, may be related to "Lewey Bodies “, different than AD
 +
* Rivastigamine and Donezipil have been found helpful in PD -Dementia
 +
* discontinue amantadine and benztropine if possible
 +
Sleep Disturbance
 +
* difficulty turning over, nocturnia, neck/back pain, restless legs, wild dreams, tremor
 +
* Restless legs - adjust dopaminergics, add opioids
 +
* Hallucinations/Psychosis - adjust Levodopa, add Seroquel or Clozaril
 +
* Nocturia - OAB medications
 +
* RBD - Rapid-Eye Movement Behavior Disorder- Clonazepam melatonin
 +
Daytime Sleepiness
 +
* Sleep Hygiene, address depression, review medications
 +
* adjust dopaminergics and add modafinil
 +
Urinary Disorders
 +
* related to disease progression, general aging or PD_drugs
 +
* need proper diagnosis to determine best treatment – usually  anticholinergics
 +
Swelling
 +
usually due to dopamingeric agents, responds to dose decrease or stopping  using diuretics may help, but may contribute to other problems (falls, urinary issues, constipation )
 +
 +
 +
 +
 +
 +
:'''Some information links below'''.
:'''Some information links below'''.
:<div style="font-size:140%"> Meeting Followup </div><br/>
:<div style="font-size:140%"> Meeting Followup </div><br/>

Revision as of 03:00, 6 May 2014

Cut- A - Thon For Parkinson's Sunday April 27, 2014

Parkinson Society Southwestern Ontario.png Parkinson SW rgb EN.jpg

Parkinson home.jpg . . Welcomes Guest Speaker : Mr. Peter Dumo, a Pharmacist with Nova Care Pharmacy

"is also President of the Essex County Pharmacist Association."

Parkinson's Support Group

Medications for people living with Parkinson’s Disease

General Principles

  • treafinent is individualized
  • focus is on quality of life, benefit risk

Dopamine Agonists (pramipexole. ropinirole )

  • often used first line because less movement disorders than levodopa-based treatments
  • may not be as effective but better benefit risk ratio
  • preferred in younger patients
  • dosed three times daily, slowly titrated
  • most common side effects: swelling, sleepiness (sudden dramatic), constipation, dizziness, hallucinations, and nausea
  • impulse control disorder

Levodopa

  • most effective treatment, especially for severe rigidity or "frozen" patients * always combined with carbidopa or benserazide to allow brain lievels (Sinemet or Prolopa) to prevent nausea, dizziness, and vomiting
  • common approach is to start low and gradually titrate up - then switch to slow release version
  • nausea common with initial low doses because of low amounts of carbidopa
  • initially take with a snack, but with advanced disease empty stomach may better for absorption
  • common early side effects: Nausea, somnolence, dizziness, and headache
  • more advanced disease/elderly: confusion, hallucinations, delusions, agitation, and psychosis
  • prolonged use = movement disorders (dyskinesia, dystonias and complex motor fluctuations) develop
  • wearing-off phenomenon also happens

Selegiline and Rasagiline

  • modest effect, especially in early disease (? neuroprotective)
  • selegiline dosed once or twice (AM and Lunch) whereas Rasagiline dosed once daily
  • do not combine with certain antidepressants, pain medicines without close MD supervision

Entacapone

  • only works in combination with Levodopa
  • added to deal with "weaning-off phenomenon, provides more "on-time" boost Levodopa effect
  • patients often need a DECREASE in Levodopa dose
  • side effects related to increase Levodopa effect plus orange discoloration of urine and rare diarrhea

Benztropine and trihexyphenidyl

  • useful in < 70 with significant tremor or those with advanced disease despite max Levodopa
  • causes confusion and hallucinations (more so in the elderly)
  • dry mouth, blurry vision, difficulty urinating and prostate problems

<--Page_2  Timing of Medications

  • Timing matters, especially with levodopa-based treatment
  • cleared quickly from the body so missed doses or delayed doses can cause severe worsening
  • stopping dopamine-based drug can precipitate severe rigidity (Parkinsonism-Hyperpyrexiui )
  • seligiline and rasagiline should be taken in the AM (less insomnia)

Side effect management

Constipation

  • look at medication(s) that may cause (benztropine)
  • may be due to dysautonomia, decreased walking around nutritional intake
  • optimize fluid and fiber intake
  • may add PEG powder, then stool softener, then laxative, then suppository then enema
  • 1-2 week between each stage
  • increasing Levodopa may help

Dementia

  • typically occurs late in the course of PD, may be related to "Lewey Bodies “, different than AD
  • Rivastigamine and Donezipil have been found helpful in PD -Dementia
  • discontinue amantadine and benztropine if possible

Sleep Disturbance

  • difficulty turning over, nocturnia, neck/back pain, restless legs, wild dreams, tremor
  • Restless legs - adjust dopaminergics, add opioids
  • Hallucinations/Psychosis - adjust Levodopa, add Seroquel or Clozaril
  • Nocturia - OAB medications
  • RBD - Rapid-Eye Movement Behavior Disorder- Clonazepam melatonin

Daytime Sleepiness

  • Sleep Hygiene, address depression, review medications
  • adjust dopaminergics and add modafinil

Urinary Disorders

  • related to disease progression, general aging or PD_drugs
  • need proper diagnosis to determine best treatment – usually anticholinergics

Swelling usually due to dopamingeric agents, responds to dose decrease or stopping using diuretics may help, but may contribute to other problems (falls, urinary issues, constipation )




Some information links below.
Meeting Followup

You may direct your questions and comments about his page to Rick's Clicks
Use Rick's online contact form HERE.


Windsor Parkinson’s Support Group



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