Parkinson Disease Concept Map: An Overview

Parkinson Disease Concept Map Download the whole map

What is Parkinson Disease (PD)?

Part of Parkinson Disease (PD) Concept Map - definition, epidemiology, etiology, and signs and symptoms

1. Smaller handwriting (micrographia)
2. Infrequent blink
3. Excessive drooling (sialorrhea) may contribute to disability
4. Soft voice trails off
5. Speech becomes hypophonic, ... etc.

Parkinson Disease Differential Diagnosis

• Common features of atypical parkinsonism that differentiate it from PD.
• Forms of atypical parkinsonism and associated conditions.

Parkinson disease vs atypical parkinsonism - PD differential diagnosis Zoom-out-pharmacotherapy

Part of Parkinson Disease Concept Map - Pathophysiology and Treatment of Parkinson Disease

Parkinson's Treatment

Dopamine metabolism and Antiparkinson drugs mechanisms of actions Download the whole map

This part of the map links between dopamine metabolism in presynaptic neurons and antiparkinson drugs mechanisms of actions. Pharmacological treatment of PD aims to restore dopaminergic function in the brain using one or more of the following:

• Carbidopa/L-Dopa
• COMT Inhibitors
• MAO-B Inhibitors
• DA Agonists
• Anticholinergic Medications
• Amantadine

For each drug or drug class, its mechanism of action, efficacy against PD symptoms, adverse effects, precautions or drug interactions if present are explained.

It is important to state that treatment of PD doesn't prevent progression of the disease and drug choice is based on symptoms. For example, Levodopa is most effective at relieving bradykinesia and rigidity, although it often substantially reduces tremor. On the other hand, anticholinergic medications are effective against IPD tremor in about 50% of patients; not bradykinesia or rigidity.

Antiparkinson Drugs Table Comparisons

Beside using the way of concept mapping to build information upon each other (information about drugs mechanisms of action and indications are built upon dopamine metabolism), there are also table comparisons for antiparkinson drugs. There are three tables that compares:

1. Catechol-O-methyl transferase inhibitors (COMT inhibitors): Tolcapone and Entacapone.
2. Monoamine oxidase B inhibitors (MAO-B inhibitors): Selegiline and Rasagiline
3. Nonergot dopamine agonists: Apomorphine, Pramipexole, Ropinirole, and Rotigotine transdermal.

Antiparkinson drugs table comparisons

L-dopa motor complications

Despite its efficacy as a symptomatic treatment of Parkinson disease, long-term L-dopa therapy is associated with disabling motor complications. These complications includes:

1. End-of-dose wearing off (motor fluctuation)
2. "Delayed-on" and "no-on" response
3. Freezing
4. Dyskinesias
5. "Off-period" dystonia

These complications are represented in the map through a table that contains clinical features, mechanism, and management approach for each of l-dopa motor complications.

Levodopa motor complications table - clinical features, mechanism, and management

Surgical Management of Parkinson Disease

Surgical Management of Parkinson Disease

Surgery should be considered as an adjunct to pharmacotherapy in case of PD symptoms are not adequately controlled with optimized medical therapy. The map briefly states surgical procedures for the treatment of PD, including the most common procedure which is Deep brain stimulation (Thalamic Stimulation) and its patient selection criteria.

Management of Special Situations

Hallucination and  cognitive disorders associated with PD

Parkinson disease is associated with nonmotor symptoms that may be caused by either the disease itself or the antiparkinson drugs. These nonmotor symptoms can be hallucinations/psychosis, cognitive disorders, sleep disorders, depression, agitation, anxiety, constipation, orthostatic hypotension, seborrhea, and blepharitis. The goal in the management of Parkinson disease is to improve motor and nonmotor symptoms

in order to improve the quality of life. This part of the map gives an overview of medications that can be used in the management of nonmotor complications and those that should be avoided in order not to worsen Parkinson symptoms.

We hope you find Parkinson Disease (PD) Concept Map helpful.  And if you've any inquiries or suggestions, please don't hesitate to contact us or comment below.

Download the whole map now.

Parkinson Disease (PD) Concept Map by Maha Atef, B Pharm, PGDip (ClinPharm), PGDip (TQM).

Last updated on:  26 October 2014

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Otitis Media Concept Map

• Symptomatic treatment using analgesics and antipyretics.
• Observation versus antibiotic use. This is should be determined according to “Criteria for Initial Antibacterial Treatment” table on the right of the map.
• Follow-up after at least 3 months.
• Management of recurrent AOM.

• Clinical reevaluation at 3 month intervals.
• Referral to otolaryngology for persistent abnormal findings or complications like: hearing loss or language delay. Children with an asymptomatic middle ear effusion (no developmental or behavioral problems) can be followed without referral.
• Parental education regarding approaches to maximizing language.

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Click on the image to enlarge Free Map

Acne vulgaris Mind Map: An Overview

Acne vulgaris large picture consists of four interlinked mind maps ® explaining its pharmacotherapy.

We hope you find Acne vulgaris mind map helpful and we are looking forward to hearing your opinion. The whole map is available for free on this page. It is also available in two forms: printable version and folded poster. You can order below.

Acne Vulgaris Mind Map by Maha Atef, B Pharm

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Click the image to enlarge Free Map

• Renin-Angiotensin Aldosterone System,
•  Increased sympathetic discharge,
•  Increased sodium  and chloride concentrations in extracellular fluid volume, and
•  Vasodilators deficiency

Hypertension pathophysiology

Pharmacological treatment of hypertension

We hope you find Hypertension Pathophysiology and Treatment Concept Map helpful and we are looking forward to hearing your opinion. This map is available in the following formats:

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Rheumatoid Arthritis Concept Map - Click to enlarge image

Rheumatoid Arthritis Concept Map: An Overview

Etiology and Pathophysiology of Rheumatoid Arthritis

Most of rheumatoid arthritis extra-articular manifestations are collected in this image:

Rheumatoid arthritis extra-articular manifestations

Diagnosis

This part of the map includes: History and Examination - Laboratory tests - Radiographic test
(x-ray) - ACR Rheumatoid Arthritis Diagnostic Criteria (2010). In addition, a comparison between rheumatoid arthritis and osteoarthritis is included.

Rheumatoid Arthritis vs Osteoarthritis

Treatment

- adverse effects: GI toxicity, headache, confusion and other CNS symptoms, increased BP, worsening of hypertension, edema, and decreased platelet function. NSAIDs increase cardiovascular risk. 
Non-steroidal anti-inflammatory drug drugs mechanism of action is shown in this diagram:

Non-steroidal Anti-inflammatory Drugs - Mechanism of Action

• adjunctive therapy      
• decrease inflammation and other symptoms rapidly and efficiently
• slow bone erosion

• In early RA, low-dose oral prednisone (<10 mg/day) in combination with DMARDs for up to 6 months, as symptomatic effects ↓ with time
• In established RA, CS may be used as 'bridging' therapy when DMARDs are initiated, and should be withdrawn once DMARDs have controlled the disease
• May be used for severe joint or systemic manifestations of RA (eg, vasculitis, pleurisy, pericarditis)

• Relative contraindications include PUD, HTN, untreated infections, DM, and glaucoma
• The risk of latent TB should be considered before CS therapy is begun

• Early treatment of RA (< 6 months after the onset of symptoms) with DMARDs retard disease progression more efficiently and induce more remissions.
• Until the full action of DMARDs takes effect, anti-inflammatory or analgesic medications may be required as bridging therapy to reduce pain and swelling.
• They differ from each other chemically and pharmacologically.
• Patients should be informed about the risks of DMARDs and monitored closely for evidence of toxicity.
• Combinations of DMARDs may be more effective than single drugs. Also, combining a DMARD with another drug, such as methotrexate plus a TNF-α antagonist or an IL-1 receptor antagonist or a rapidly tapered corticosteroid, may be more effective than using DMARDs alone.

A comparison between DMARDs is available in the map. The comparison is showing: mechanisms of actions, indications, doses, adverse effects, monitoring parameters, and contraindications.

Disease Modifying Anti-Rheumatic Drugs (DMARDs) - Table Comparison

• Also called "biologic DMARDs"
• They are not given in combination with each other due to increased frequency of infections.
• Approved by the FDA to treat moderate to severe RA not responded to an one or more of the traditional DMARDs
• They may be used alone, but are often in combination with other DMARDs, to increase the efficacy and decrease AE
• Start biologic agents while patients remain on NSAID and/or corticosteroid

A comparison between biologic agents is available in the map. The comparison is showing: mechanisms of actions, indications, doses, onset of action, adverse effects, contraindications, and warnings/cautions.

Biologic DMARDs - Table Comparison

• Efficacy is similar to DMARDs but more toxic.
• Used in case of treatment failure with DMARDs or to ↓ the need for CSs.
• Used infrequently unless there are extra-articular complications.

And here is a comparison between them:

Other immunomodulatory, cytotoxic, and immunosuppressive drugs - Table Comparison

We hope you find Rheumatoid Arthritis Concept Map helpful.  Please let us  know your opinion in a comment below. You can access this map for free. But if you want it as printable version or a folded poster please order below.

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