parkinsons

Question 1

cardinal symptoms

Answer 1

tremor, rigidity, bradykinesia

Question 2

non-cardinal symptom

Answer 2

postural instability

Question 3

pathophysio

Answer 3

Impaired clearing of abnormal INTRACELLULAR PROTEINS by ubiquitin-proteasomal system →

Leads to accumulation of aggressomes, known as Lewy bodies →

Degeneration of dopaminergic neurons with Lewy body inclusions in the substantia nigra →

Dysfunction of nigrostriatal pathway causing movement disorder

Question 4

direct pathway of loss of dopaminergic input

Answer 4

Hypoactivation of excitatory D1 receptors → weakens striatal inhibition of GPi (globus pallidus internal) → hypokinesia

Question 5

Indirect pathway of loss of dopaminergic input

Answer 5

Hypoactivation of excitatory D2 receptors → weakens striatal inhibition of GPe (globus pallidus external)→ hypokinesia

Question 6

medications associated with drug induced parkinsonism

Answer 6

antipsychs (haloperidol, CPZ)
alpha methyl dopa
metocloperamide
tetrabenazine

Question 7

dopamine agonists moa

Answer 7

Mimics action of dopamine by acting on D2 receptors in basal ganglia

Question 8

dopamine agonists space out with

Answer 8

iron, protein

Question 9

dopamine agonists avoid

Answer 9

dopamine antagonists (antipsych, metoclopramide)

Question 10

examples of ergot derivatives

Answer 10

bromocriptine, cabergoline

Question 11

examples of non ergot derivatives

Answer 11

ropinirole (IR/SR), pramipexole (IR/SR), rotigotine

Question 12

levodopa benefits

Answer 12

bradykinesia, rigidity.

less effective for speech and gait disturbances

Question 13

levodopa food interactions

Answer 13

high fat or protein meals. space 2h

Question 14

side effects of levodopa

Answer 14

Dyskinesias
Dystonia
NV (domperidone)
Orthostatic hypoT
Drowsiness
Hallucinations / Psychosis

Question 15

dopaminergic side effects of dopamine agonists

Answer 15

NV
Orthostatic hypoT
Led oedema
Compulsive behaviours
Hallucinations
Somnolence

Question 16

non-dopaminergic side effects (mostly ergot) of dopamine agonists

Answer 16

Fibrosis
Valvular heart disease

Question 17

ropinirole / pramipexole: renal or liver

Answer 17

Ropinirole: liver metabolism
Pramipexole: renal clearance

Question 18

maobi moa and examples

Answer 18

Irreversible MAOb inhibitors, inhibiting dopamine breakdown
selegiline
rasagiline

Question 19

which has hepatic metabolism to ampetamines, which is stimulating, hence must not be taken at night

Answer 19

selegiline

Question 20

maobi or comti preferred for early stage PD

Answer 20

maob-i

Question 21

foods to avoid with maobi

Answer 21

tyramine, soy sauce, aged cheese, fermented food, beer

Question 22

se of maobi

Answer 22

gi: heartburn, loss of appetite
CNS: Anxiety, palpitations, insomnia, nightmares, visual hallucinations

Question 23

comti moa

Answer 23

Selective, reversible catechol-o-methyltransferase (COMT) inhibitor, preventing COMT conversion of L-DOPA into inactive form.

Question 24

comti administration requirement

Answer 24

Requires concurrent levodopa

Question 25

comti drugs to avoid

Answer 25

iron/calcium, concurrent non-selective maobi, warfarin, catecholamine drugs

Question 26

comti side effects

Answer 26

dyskinesias upon initiation, potentiation of dopaminergic effects, diarrhoea, urine discolouration (orange)

Question 27

comti benefits

Answer 27

decreases 'off' time

Question 28

levodopa food interactions

Answer 28

high fat or protein meals. space 2h

Question 29

issues with levodopa

Answer 29

'on off phenomenon': unpredictable and unrelated to dosing' 'wearing off': shortened on time peak dose dyskinesias

Question 30

amantadine moa

Answer 30

nmda antagonist and antichol, increases sensitivity of d2 receptors

Question 31

amantadine place in therapy

Answer 31

adjunctive and monotherapy (ad)

Question 32

se of nmda

Answer 32

Stimulating Nausea Light-headed Insomnia Confusion Hallucinations Livedo reticularis

Question 33

dopamine agonist what to counsel pts/caregivers on

Answer 33

compulsive behaviours

Question 34

livedo reticularis is caused by?

Answer 34

amantadine

Question 35

which drug class interacts with warfarin

Answer 35

com ti

Question 36

example of com ti

Answer 36

entacapone