Parkinsons

Question 1

What symptoms have to be present for a diagnosis of Parkinsons?

Answer 1

Bradykinesia PLUS one of the following:
- 4-6Hz resting tremor
- muscle ridgidity
- postural instability

Question 2

Which other neurodegenerative disorder most mimics parkinson’s symptoms?

Answer 2

progressive supranuclear palsy

Question 3

Why is carbidopa or benserazide combined with levodopa in the treatment of parkinsons?

Answer 3

Prevents peripheral breakdown of levodopa- prolonging it’s effect.

Question 4

Name the two contra-indications to levodopa.

Answer 4

history of melanoma/ suspicious undiagnosed lesions and angle-closure glaucoma

Question 5

Name 3 main side effects of levodopa

Answer 5

postural hypotension, impulse control disorders, and dyskinesia

Question 6

Which drug used in parkinson’s disease is most associated with motor fluctuations?

Answer 6

Levodopa

Question 7

What can be done if a patient is experiecing nocturnal akinesia or end-of-dose detioration whilst taking levodopa?

Answer 7

Can be changed to MR preparation

Question 8

What is 1st line therapy in patients whose motor symptoms ARE affecting their quality of life? (Early disease)

Answer 8

Levodopa

Question 9

What is 1st line therapy in patients whose motor symptoms AREN’T affecting their quality of life? (Early disease)

Answer 9

Levodopa OR non-ergot derived dopamine agonists OR monoamine-oxidase inhibitors

Question 10

Name the 2 contra-indications of non-ergot derived dopamine agonists.

Answer 10

severe cardiovascular disease and psychotic disorders

Question 11

Name 3 main side effects of non-ergot derived agonists

Answer 11

sudden onset of sleep, hypotension, and impulse control disorders

Question 12

Which drug class used in parkinson’s disease can cause erythema to lower legs?

Answer 12

non-ergot derived dopamine agonists

Question 13

What can occur if parkinson’s meds are abruptly withdrawn?

Answer 13

neuroleptic malignant syndrome and acute akinesia

Question 14

What gastrointestinal conditions are monoamine-oxidase-B inhibitors contra-indicated in?

Answer 14

active duodenal and gastric ulceration

Question 15

What other condition are monoamine-oxidase-B inhibitors contra-indicated in other than ulceration?

Answer 15

postural hypotension

Question 16

What is an uncommin cardiovascular side effect of COMT inhibitors?

Answer 16

Myocardial infarction

Question 17

Describe ergot-derived dopamine agonists place in therapy in parkinson’s disease?

Answer 17

Only to be used as an adjunct to Levodopa if non-ergot derived dopamine agonists do not adeqautely control symptoms

Question 18

What is last-line in early parkinson’s disease if still experiencing dyskinesia?

Answer 18

Amantadine

Question 19

Which anti-emetic is administered 2 days before apopmorphine infusion?

Answer 19

Domperidone

Question 20

What is 1st line in advanced parkinson’s disease where other therapy has failed?

Answer 20

Apomorphine S/C infusion

Question 21

What treatment is recommended when symptoms of Parkinson’s disease are not adequately controlled on drug therapy?

Answer 21

Deep Brain Stimulation

Question 22

What drug treatment is indicated in advanced levodopa-responsive parkinson’s disease with dyskinesia/hyperkinesia?

Answer 22

Intestinal Levodopa gel or continuous subcutaneous infusion of foslevodopa with foscarbidopa

Question 23

What drug therapy can be used in excessive daytime sleepiness associated with Parkinson’s disease?

Answer 23

Modafinil

Question 24

First-line therapy in nocturnal akinesia?

Answer 24

levodopa or non-ergot derived dopamine agonists

Question 25

Second-line therapy in nocturnal akinesia?

Answer 25

Rotigotine

Question 26

Which drug therapy can be used for psychotic symptoms in parkinson's disease where no congitive impairment is present?

Answer 26

Quetiapine and Clozapine

Question 27

Which drug therapy is unlicensed for postural hypotension in parkinson's disease but may still be used?

Answer 27

Fludrocortisone

Question 28

Which drug therapies are recommended to treat REM sleep disorders in parkinson's disease?

Answer 28

Clonazepam and melatonin

Question 29

First-line for drooling associated with parkinson's disease?

Answer 29

Glycopyrronium