parkinsons

Question 1

what is parkinsons

Answer 1

parkinsons is a neurodegenerative disease that affects the dopamine production in the brain

Question 2

what part of the brain is affected by parkinsons disease

Answer 2

substania nigra

Question 3

what build up leads to a decreased production of dopamine

Answer 3

lewy bodies

Question 4

what is the acronym given to the motor symptoms of parkinson

Answer 4

TRAP

Question 5

what does trap relate to and stand for

Answer 5

trap relates to the motor symptoms in parkinsons

t = tremor
r = rigidity
a = akinesia
p = postural instability

Question 6

what are the four different types of non motor symptoms a patient with parkinsons may experience

Answer 6

psychiatric
sleep disturbance
pain
autonomic disturbance

Question 7

what are some psychiatric symptoms a patient with parkins may present with

Answer 7

depressed
anxious
angry

Question 8

what are the different autonomic disturbances that a patient with parkinsons may experience

Answer 8

constipation
urinary dysfunction
sexual dysfunction

weightloss
polyphagia

sweating
salivation

Question 9

what are the different treatment options for a patient with parkinson

Answer 9

physiotherapy / exercise

occupational therapy

speech and language therapy

nutritional advice

Question 10

What is the main aim of pharmacological treatment

Answer 10

increase the levels of dopamine inside the substantia nigra

Question 11

what are the different medications that are used in the management of parkinsons

Answer 11

dopadecarboxylase inhibitors
comt inhibitors
Maob inhibitors

Question 12

what is the first line treatment in parkinsons

Answer 12

levodopa

Question 13

if a patient has motor symptoms affecting quality of life what do we give instead of levodopa

Answer 13

levodopa and carbidopa /benseramide

Question 14

what is dyskinesia

Answer 14

Dyskinesias are involuntary, erratic, writhing movements of the face, arms, legs or trunk. They are often fluid and dance-like.

Question 15

when it comes to learning this subject what is the main bulk of the content

Answer 15

drugs

Question 16

what is levodopa a precursor to

Answer 16

dopamine

Question 17

what is levodopa converted to dopamine by

Answer 17

decarboxylation

Question 18

why is levodopa given with dopa-decarboxylaze inhibitors

Answer 18

levodopa when given on its own is broken down before it can cross the blood brain barrier

Question 19

what are two examples of dopa-decarboxylaze inhibitors

Answer 19

carbidopa
benserazide

Question 20

what is sinemet made up of

Answer 20

levodopa and carbidopa

Question 21

what is madopar made up of

Answer 21

levodopa and benserazide

Question 22

when treating parkinsons with levodopa what period of treatment is most effective and why

Answer 22

first few years but as time goes on the effect of levodopa drops

Question 23

why is levodopa taken before food

Answer 23

levodopa is taken one to two hours before food as it can inhibit its absorption

Question 24

what are the main side effects experienced with levodopa

Answer 24

GI
Discolouration of urine
Drowsy
Postural hypotension

Question 25

What is the "on off effect"

Answer 25

Patients experience significant improvement in their motor control but when off there is significant akinesia

Question 26

what are the main interactions with levodopa

Answer 26

MOAB inhibitors = ^ chance of hypertensive crisis Antihypertensives = ^ chance of postural hypotension pyroxidine = ^ peripheral breakdown of levodopa

Question 27

If a patient is taking levodopa and carbidopa and is switching to another how long do they need to wait

Answer 27

12 hours

Question 28

if a patient is currently taking immediate release co-careldopa and is swapping to prolonged release how much do we need to increase the dosing interval

Answer 28

50%

Question 29

what is duodopa

Answer 29

intestinal gel

Question 30

when is duodopa used

Answer 30

extreme parkinsons but that is still responsive to levodopa

Question 31

if a patient is taking madopar modified release and is swapping to the dispersible how long do we redduce the dose by

Answer 31

30%

Question 32

when should we avoid madopar

Answer 32

liver impairment

Question 33

Give two examples of non ergotic dopamine agonists

Answer 33

ropinrole pramipexole

Question 34

what is noteable about pramipexole in over 65

Answer 34

longer half life 8 -> 12

Question 35

whaat does ropinrole and pramipexole have an affinity for

Answer 35

d2 + d3 receptors

Question 36

what are three ergotic dopamine agonists

Answer 36

bromocriptine cabergoline pergolide

Question 37

what is bromocriptines selectivity

Answer 37

partil d1 agonist partial d2 agonist

Question 38

what do we need to moniotor for bromocriptine

Answer 38

pituitary enlargement visiot

Question 39

what dopamine agonist needs to be avoided in pregnatn and postpartem women with hypertensive disorders

Answer 39

bromocriptine

Question 40

what are the common side effects associated with dopamine agonists

Answer 40

gi drowsy diskensia neuropsychiatric symptoms hypotension

Question 41

When is apomorphine used

Answer 41

as a last line and is given sc

Question 42

what is the most common side effect of apomorphine

Answer 42

nausea and vommiting

Question 43

name 3 anti-emetics

Answer 43

domperidone metocloprimide cyclizine

Question 44

what is the most common anti-emetic that is given with apomorphine

Answer 44

domperidone

Question 45

does apomorphine have a long or short duration of acction

Answer 45

short

Question 46

what are some other side effects of apomorphine

Answer 46

hallucination dyskinesia abnormal behaviour

Question 47

what is the mechanism of action of MAO-B inhibitors

Answer 47

MAO-b breaks down dopaamine and the inhibitors prevent this

Question 48

what are the two mao-b inhibitors to be aware of

Answer 48

rasagiline selegine

Question 49

what is the dosing requirements for maob inhibitors

Answer 49

once daily in the morning

Question 50

when are mao-b inhibitors most effective

Answer 50

early pd as there is less build up of lewy bodies

Question 51

what are the cautions for mao-b inhibitors

Answer 51

psychosis hypertension arrythmias

Question 52

what should we avoid mao-b inhibitors

Answer 52

gastric ulcers postural hypertension anti-depressants linezolid

Question 53

what sort of foods do we need to avoid in rasagaline

Answer 53

aged foods e.g. wine and cheese there is an increased risk of hypotensive crisis

Question 54

why do we avoid linezolid and mao-b inhibitors

Answer 54

serotonin syndrome

Question 55

why do we avoid opioids with mao-b inhibitors

Answer 55

serotonin syndrome

Question 56

what are comt inhibitors used in conjunction with

Answer 56

levodopa

Question 57

name two comt inhibitors

Answer 57

tolcapone entacapone

Question 58

how do comt inhibitors work

Answer 58

prevent the peripheral breakdown of levodopa before it crosses the blood brain barrier

Question 59

if initiated how long do we need to wait to see if we should continue with a comt inhibitor

Answer 59

if improvement after 3 weeks

Question 60

what special requirements to do with dosing marks comt inhibitors as different compared to other medications used to treat parkinsons

Answer 60

can be taken WITH or WITHOUT FOOD

Question 61

what do comt inhibitors bind to

Answer 61

plasma proteins

Question 62

what are comt inhibitors metabolised byq

Answer 62

liver

Question 63

what is a common side effect of comt inhibitors

Answer 63

brown / disccoloured urine

Question 64

what are the common side effects of the comt inhibitors

Answer 64

gi sleep disorders drowsy hallucinations

Question 65

with tolcapone what monitoring is required

Answer 65

LFTs every 2 weeks for first year > 4 weeks for 6 months > 8 weeks thereafter

Question 66

what important risk do we need to identify with tolcapone

Answer 66

HIGH CHANCE OF HEPATOTOXICITY