Parkinsons disease

Question 1

How is parkinsons disease alleviated?

Answer 1

By increasing the amounts of dopamine

Question 2

How do you treat patients with PD whose motor symptoms decrease their quality of life?

Answer 2

Levodopa and Cardidopa/Benserazide
e.g. Co-careldopa or Co-beneldopa

Question 3

How do you treat patients with PD whose motor symptoms don’t affect their quality of life?

Answer 3

Non-ergot derived dopamine receptor
Monoamine oxidase B inhibitors

Levodopa and Cardidopa/benserazide usually withheld for pt’s with severe symptoms

Question 4

What are side effects of levodopa?

Answer 4

Impulsive disorder e.g. pathological gambling, binge eating, hyper sexuality
Sudden onset of sleep (treat with modafinil)
Red urine - not to worry

Question 5

What are the side effects of non-ergot dervied dopamine receptors?

Answer 5

e.g. Pramipexole, Ropinirole, Rotigotine
Impulsive diorders (more so than levodopa)
Sudden onset of sleep
Hypoetnsion - treat with midodrine

Question 6

What are the side effects of MAOB-I?

Answer 6

e.g. Rasagiline or selegiline
Causes hypertensive crisis if given with Phenylephrine
Interacts with tyramine rich foods:
-mouldy and rich stuff

Question 7

Whats the side effects of COMT inhibitors?

Answer 7

Entacapone: Red-brown urine
Tolcapone: Hepatotoxic

increases sympathetic side effects - increase in CVD events e.g. tachycardia, fast breathing etc.

Question 8

What are the side effects of ergot derived dopamine receptor agonists?

Answer 8

Pulomary reactions: SOB, cough
Pericardial reactions: Chest pain

Question 9

if patients are having ‘off’ periods at the end of the dose deterioration what should you do?

Answer 9

Use MR prep

Question 10

How would you treat hypotension?

Answer 10

Midodrine

Question 11

What does motor symptoms mean?

Answer 11

Movement and muscles

Question 12

What does non motor symptoms mean?

Answer 12

Not movement related

Question 13

What does impulse control disorders mean

Answer 13

Urges and behaviours that are excessive and or harmful to you and other that can cause specific impairment in social and occupational functioning

Question 14

Why is Levodopa prescribed alongside a decarboxylase inhibitor?

Answer 14

Stops levodopa being broken down peripherally and allows more to get into the brain.

Question 15

Why is levodopa preferred for the treatment of motor symptoms in Parkinson’s?

Answer 15

Overall better improvement
Less likely to cause sleepiness, hallucinations and improve control disorders

Question 16

What dopaminergic drugs have potential to cause impulse control disorders?

Answer 16

All of them

Question 17

Treatment for nausea and vomiting in patients with PD

Answer 17

NOT metocopramide.
Best one is domperidone because it does not cross the BBB

Question 18

What’s the greatest for sleepiness in PD?

Answer 18

Review therapy
If not resolved the modafinil

Question 19

How do you treat depression in PD?

Answer 19

1. Non pharmacological
2. SSRI’s

Question 20

How do you treat dementia in PD patients

Answer 20

Same as normal so acetylcholinesterase inhibitors e.g. donepezil, rivastigme, galantamine

Glutamate receptor antagonist e.g. galantamine

Question 21

How do you manage psychosis in PD patients

Answer 21

1. Review meds
2. 2nd gen antipsychotics e.g. Quetta pine or clozapine

Question 22

What PD medication is most likely to cause dyskinesias?

Answer 22

Levodopa

Question 23

What kind of medications are Parkinson’s disease meds

Answer 23

Critical time medications

Question 24

Why is PD mediation a CTM?

Answer 24

To avoid response fluctuations between on and off periods

Reduce risk of akinesia and neuroleptic malignant syndrome. Abrupt withdrawal

Question 25

If you have PD who must you inform

Answer 25

The DVLA and car insurer

Question 26

What can you use in severe off periods in Parkinsons disease?

Answer 26

Apomorphine
Levodopa transdermal gel if responsive to levodopa