PD/AD Quiz Flashcards
After approximately 5-8 years of carbidopa/levodopa treatment, most patients develop:
A) Nausea and vomiting
B) Severe constipation
C) Motor fluctuations and dyskinesia
D) Cognitive impairment
C – tardive dyskinesia is a common ADR of carbidopa/levodopa b/c it increases [dopamine]
COMT inhibitors:
A) Can cause serious renal toxicity
B) Prolong the half-life of levodopa without increasing the peak serum concentration
C) Are used as monotherapy in PD
D) Decrease the risk of dyskinesia in patients managed with levodopa
B
The FDA approved a reversible MAO-type B inhibitor, safinamide, in 2017.
Safinamide:
A) Is approved for use as monotherapy
B) Retains selectivity at high doses
C) Modestly improves “on time” without dyskinesia
D) Is safer than irreversible MAO-B inhibitors
C
A 70 y/o M with advanced PD asks your opinion about deep brain stimulation. He has been taking carbidopa/levodopa plus selegiline for more than a decade. His dyskinesia is intolerable. Your advice about DBS treatment:
A) DBS treated patients continuing medication have less dyskinesia
B) DBS treated patients can have marked improvement in off-medication motor function
C) Speech, freezing of gait, and cognition may worsen following DBS
D) All are correct
D
An 83 year old M with AD has shown no signs of improvement from donepezil for at least the past year. His GI effects are becoming intolerable and his children want to know if he can stop this medication. Your adivce:
A) Stopping donepezil could exacerbate his GI symptoms
B) Stopping donepezil might result in lower mental status scores
C) Donepezil efficacy increases over time
D) All of the above
B
Use of second generation antipsychotic medications (risperidone, for example) in patients with AD dementia has been shown to:
A) Increase QOL
B) Improve functioning
C) Increase risk of death
D) All of the above
C – this question is on the picky side, but I chose it because the risk of severe AE is high when antipsychotic medications are used in AD. A single RCT supports the use of antipsychotic agents in dementia. This trial found modest improvement for anger, aggression and paranoid ideation. There was no change in functioning, care needs or QOL. Mortality is nearly doubled in patients with AD dementia taking antipsychotic medications to manage agitation.
A 75 y/o M has moderate Parkinson disease. His tremors and bradykinesia are no longer responding to anticholinergic treatment. Which combination of antiparkinsonian drugs is an appropriate treatment?
A) Amantidine, carbidopa, and entacapone
B) Levodopa, carbidopa, and entacapone
D) Pramipexole, carbidopa, and entacapone
D) Ropinirole, carbidopa, and selegiline
B – to reduce the dose of levodopa and its peripheral side effects, the peripheral decarboxylase inhibitor carbidopa, is administered. As a result of this combination, more levodopa is available for metabolism by catechol-O-methytransferase (COMT) to 3-)-methyldopa, which competes with levodopa for the active transport processes into the CNS. By administering entacapone (COMT inhibitor), the competing product is not formed, and more levodopa enters the brain.
The other choices are unlikely to offer benefit because neither peripheral decarboxylase nor COMT nor monoamine oxidase metabolizes amantadine or the direct-acting dopamine agonists ropinirole and pramipexole; thus, carbdopa and entacapone should only be given with levodopa, otherwise they are not contributing to the clinical response of the patient.
