Parkinsons Disease

Question 1

What happens in the brain

Answer 1

Dopamine levels decrease in the basal ganglia

Question 2

Parkinson’s leads to the disorders of what?

Answer 2

Movement

Question 3

Slow or gradual onset

Answer 3

Gradual

Question 4

Are the symptoms symmetrical or asymmetrical and what are the triad of features?

Answer 4

Asymmetrical, then developed to be bilateral

Traid of features:
• resting tremor
• rigidity
• Bradykinesia (slowness of movement)

Question 5

Function of the basal ganglia?

Answer 5

• co-ordination
• movement
• motor control

Question 6

Non-motor features?

Answer 6

• depression
• sleep disturbances/insomnia
• loss of sense of smell
• cognitive impairment
• postural instability
• swallowing issues
• weight loss
- orstatic hypotension
- contipation

Question 7

What are Lewy bodies

Answer 7

Abnormal fold of alpha synuclien

Question 8

Where are they located in the brain

Answer 8

substantia nigra - basal gnalia

Question 9

What does the substantia nigra control

Answer 9

Movement

Question 10

Which gender is it more common in

Answer 10

Males

Question 11

PD can start in the body or brain first. If it starts in the brain first, what does it affect first

Answer 11

The olfactory system (sense of smell) then spreads to brain

Question 12

PD can start in the body or brain first. If it starts in the body first, what does it affect first

Answer 12

Gut, then spreading to Nervous system

Question 13

Causes of PD

Answer 13

Pesticide
Head trauma
BB

Question 14

What imaging is used in diagnosis

Answer 14

PET & SPECT

Question 15

Where is levadopa found

Answer 15

Naturally in the brain

It is a naturally occurring L-isomer

Question 16

To prevent peripheral metabolic what is levodopa given with

Answer 16

A dopa decarboxylase inhibitor

Question 17

Does levodopa have a long or short t1/2

Answer 17

Short

Question 18

What are the first lines?

Answer 18

Levodopa

MOA-B inhibitors

Dopamine antagonist (non-ergot-derived OR ergot derived)

Question 19

Which class does pramipexole, ropinirole and Rotigotine belong to

Answer 19

Non ergot derived dopamine agonist

—————— (I forgot to add)
Ergot derived
• bromocriptine, cabergoline

Question 20

Which of these is given transdermally

Answer 20

Rotigotine

Question 21

Which class does Selegiline and rasagiline belong to

Answer 21

MAO-B inhibitors

Question 22

Which drug is given when PD effects QoL

Answer 22

Levodopa

Question 23

MOA of MOA-B inhibitor

Answer 23

Prevents breakdown of dopamine

Question 24

Which drugs stimulate dopamine receptor -

Answer 24

Dopamine agonist

Question 25

All dopamergic drugs ADR

Answer 25

Nausea, hypotension, sleepiness, confusion, impulsive behavior, hallucinations

Question 26

Which class are these ADRs most common in <<

Answer 26

Dopamine agonist

Question 27

Which drug class has better control over motor symptoms

Answer 27

Levodopa

Question 28

Which class of drugs is more common to cause motor complications such as dyskinesia (involuntary movement)

Answer 28

Levodopa

Question 29

Which class has the highest risk of cardiac /lung fiberosis

Answer 29

Dopamine agonist (argot derived) Baseline chest x ray Blood pressure a few days after

Question 30

Which drugs are used as adjuvant

Answer 30

• COMPT inhibitors Dopamine agonist (NOT non-argot OR argot derived) • amantadine • apomorphine Deep brain stimulation therapy

Question 31

Which class of drugs does Entacapone and Opicapone belong to

Answer 31

COMPT inhibitors

Question 32

Which drug is for advanced PD and helps with freezing episodes (off episodes)

Answer 32

Apomorphine

Question 33

What form does Apomorphine come in

Answer 33

SC

Question 34

Which drug also blocked NMDA (also in dementia)

Answer 34

Amantadine

Question 35

Which drug is add on to help dyskinesia

Answer 35

Amantadine

Question 36

Who would be a great candidate for deep brain stimulation

Answer 36

• advanced PD • on levodopa • no co morbidities or mental health issues

Question 37

Apomorphine can causes nausea which drug should be given 2 days before to starting this drug

Answer 37

Domperidone (can increase qt prolongation)

Question 38

Management of day times sleepiness

Answer 38

Modafinil Stop antihistamines, antipsychotics

Question 39

Management of hypotension

Answer 39

1st - miodrine 2nd - fludcortisone (unlicensed)

Question 40

Management of nocturnal akinesia - difficulty with movement during night

Answer 40

1st - MD levodopa or dopamine agonist 2nd - rotigotine

Question 41

Management of psychosis - hallucination/delusion

Answer 41

Quetiapine OR clozipine

Question 42

REM sleep behavior

Answer 42

Clonzepam or melatonin

Question 43

Management of dementia

Answer 43

ACHe OR mementine

Question 44

Management of Drooling of saliva

Answer 44

1 - speech and language therapy 2 • glycopyrronium bromide • botulinum toxin type A • hysocine

Question 45

Apomorphine + domperidone can QT prolongation What should be done before starting

Answer 45

ECG

Question 46

Which dopamine agonist is cautioned in heart failure

Answer 46

Amantadine Can exacerbate odema

Question 47

Which condition is amantadine ci in

Answer 47

Epilepsy (Remember in dementia mamentinr is ci in epilepsy