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Special considerations: Parkinson’s disease
Published in Hemanshu Prabhakar, Charu Mahajan, Indu Kapoor, Essentials of Geriatric Neuroanesthesia, 2019
The choice of anesthesia should take into consideration many factors, such as the procedure scheduled, preferences of the patient, and risk factors for complications. When appropriate, regional anesthesia has advantages over general anesthesia as it avoids the side effects of general anesthetics and muscle relaxants. Regional anesthesia also allows monitoring of Parkinson's symptoms during surgery and dosing of antiparkinson agents if needed. Lastly, regional anesthesia avoids postoperative nausea and vomiting (PONV), which is particularly beneficial in this group of patients since they have contraindications to multiple antiemetic drugs. At the same time, tremor will not be eliminated with regional anesthesia, and it can make surgery and electrocardiographic monitoring difficult. PD is associated with impaired swallowing and excessive salivation. Sialorrhea may worsen with sedation and can result in aspiration. Anesthesiologists should assess the risk of aspiration, particularly if there is significant dysphagia and sialorrhea, and should proceed with intubation when safer. Glycopyrrolate by mouth and ipratropium spray have been found to be effective for short-term treatment of sialorrhea (26).
Anticholinergic and Neuroleptic Drugs
Published in Frank A. Barile, Barile’s Clinical Toxicology, 2019
In contrast, the anticholinergic properties of antiparkinson agents are therapeutically desirable. They are indicated for the adjunctive treatment of all forms of Parkinsonism and are used to ameliorate the extrapyramidal symptoms (EPS) associated with traditional neuroleptic drugs.
Antipsychotics: Predicting Response/Maximizing Efficacy
Published in Mark S. Gold, R. Bruce Lydiard, John S. Carman, Advances in Psychopharmacology: Predicting and Improving Treatment Response, 2018
R. Bruce Lydiard, John S. Carman, Mark S. Gold
When they occur, acute dystonias can be dramatic, painful, and frightening to the patient. In a hospital setting, intravenous injection of 1 to 2 mg (2 mg i.m.) benztropine or 25 to 50 mg (50 mg i.m.) diphenhydramine will readily reverse dystonia. There is considerable disagreement about whether to use antiparkinson medication prophylactically to prevent the emergence of EPS. Proponents suggest that they enhance compliance in patients who are distressed by undertreated EPS, especially akathisia and akinesia. 197,198 Others, however, suggest that symptoms should be treated only as they emerge.199 Anticholinergic drugs lower blood levels and may slow GI motility and decrease intestinal absorption.200 There is some concern that they may antagonize the therapeutic effects of antipsychotic agents within the CNS201 and may also interfere with memory.202 Additionally, there is evidence that anticholinergic drugs have abuse liability.203 It seems prudent to avoid routine prophylaxis for hospitalized patients being treated with antipsychotic medication and to provide an as-needed (prn) order for treating any acute dystonia which occurs. Subsequently, treatment may be continued for a few weeks and the antiparkinson medication can usually be tapered as tolerance to extrapyramidal effects develops. There are some instances where initial prophylaxis may be advisable. For extremely paranoid hospitalized patients or outpatients with whom a good therapeutic alliance is essential, initial prophylaxis may be warranted. In any case, antiparkinson medication should be thoughtfully prescribed on an individualized basis.
Influence of chitosan thioglycolic acid conjugate in improving bioavailability of an antiparkinson drug; Rasagiline Mesylate from transdermal patch
Published in Drug Development and Industrial Pharmacy, 2021
G. Rohith, B. K. Satheesha Babu
The drug RM was belonging to BCS class III drug having high solubility and low permeability. In the present research study the RM, antiparkinson drug was included in the transdermal patch to treat chronic disorder. But during the study as it belongs to BCS class III drug, the flux obtained from chitosan films was very poor. To enhance the flux in the formulation, previously screened IPM was added at 2 different concentrations as permeation enhancer unable to achieve the desired flux. The new strategy was adopted to include a prepared CTC, as it possess a pore forming property to enhance permeation capability of IPM. The proportion of CTC and IPM in the formulation were optimized by design of expert software. The optimized transdermal patch was further evaluated with respect to responses of the study to achieve desired response that is desired flux. The relative bioavailability study was conducted and optimized transdermal patch has improved bioavailability.
Novel drug delivery systems of β2 adrenoreceptor agonists to suppress SNCA gene expression and mitochondrial oxidative stress in Parkinson’s disease management
Published in Expert Opinion on Drug Delivery, 2020
Piyong Sola, Praveen Krishnamurthy, Pavan Kumar Chintamaneni, Sai Kiran S.S Pindiprolu, Mamta Kumari
Epidemiological studies were conducted in Norwegian and Israeli populations to evaluate the risk of β2-adrenergic agonists and antagonists in PD The results reveal that the agonists lower the risk of PD, while antagonists increase the risk [23,49,51]. A meta-analysis of β2-agonist treatment in obstructive airway disease reveals a significant increase in the risk of adverse cardiovascular events such as sinus tachycardia, ventricular tachycardia, syncope, atrial fibrillation, congestive heart failure, myocardial infarction, cardiac arrest, or sudden death as compared to placebo. The above adverse effects are reported to be related to peripheral activation of β-AR [52–56]. One of the criteria, therefore, for repurposing β2AR agonists as antiparkinson agents is to prevent peripheral side effects by brain-specific drug delivery.
The efficacy and safety of riluzole for neurodegenerative movement disorders: a systematic review with meta-analysis
Published in Drug Delivery, 2018
Traditionally, antiparkinson medications e.g. levidopa and dopamine agonists are used to treat hypokinesia, while dopamine antagonists can release hyperkinesia. However, these therapies are not always effective in controlling symptoms (Connolly & Lang, 2014; Jankovic, 2016; Coppen & Roos, 2017). For instance, levodopa-induced dyskinesias and motor fluctuations can be seen in the advanced stage of PD patients (Aquino & Fox, 2015). Riluzole, an antiglutamatergic agent, is the only drug approved by the US Food and Drug Administration for therapy in amyotrophic lateral sclerosis (ALS). The neuroprotective effects of riluzole have been observed in experimental models of PD, MSA, and HD (Douhou et al., 2002; Schiefer et al., 2002, 2005). Concerning the motor improvement, riluzole reduces motor disturbance in MSA animal models, and may prevent levodopa-induced dyskinesias in PD patients (Merims et al., 1999; Scherfler et al., 2005). In HD patients, riluzole can improve the symptoms and reduce chorea scores with protecting gray matter volume loss and increasing the production of neurotrophins (Bonelli & Hofmann, 2007; Squitieri et al., 2009).