#11: AD/PD/DLB

Question 1

What drugs should be avoided in PD due to worsening of SXS? (3)

Answer 1

-Drugs that deplete central dopamine

In particular: antipsychotics, metoclopramide (reglan), prochlorperazine

Question 2

the most effective treatment with the fewest side effects for PD:

Answer 2

Levodopa

Question 3

Why don’t we give Levodopa alone in the tx for PD?

Answer 3

administered alone, levodopa causes a high incidence of N/V due to the formation of dopamine in the peripheral circulation

Question 4

Most effective drug of the Levodopa/carbidopa forms in tx for PD?

Answer 4

Sinemet (immediate release tablets)

Question 5

Levodopa/carbidopa forms and dose routes: (5)

Answer 5

1-Sinemet (immediate release tabs) 		
2-Sinemet CR (sustained release tabs) 
3-Parcopa (oral disentegrating tablet)		
4-Rytary (sustained release capsules)  
5-Duopa (admin via jejeunal pump)

Question 6

Why do some neurologists feel it’s best to delay treatment with Sinemet?

Answer 6

Bc drug effects wear off in 5 yrs and pts develop motor fluctuations (“wearing off”) and dyskinesias

Question 7

Normal Pressure Hydrocephalus is characterized by the gradual onset of these classic symptoms: (3)

Answer 7

• *Abnormal gait:
• –bradykinetic, broad-based, magnetic, and shuffling gait
• *Urinary incontinence:
• –urinary frequency
• –urgency
• –frank incontinence
• *Dementia:
• –Prominent memory loss and slow thought
• –forgetfulness
• –decreased attention
• –inertia

Question 8

earliest feature and most responsive to tx in NPH

Answer 8

abnormal gait

Question 9

etiology of NPH:

Answer 9

caused by the build-up of too much CSF in the cranium when pts do not reabsorb CSF adequately or overproduce CSF

Question 10

This should be suspected when there is poor response to therapy with L-dopa in a pt who displays hand tremors, dyskinesia, micrographia, etc.

Answer 10

A Parkinson-plus syndrome

Question 11

CT or MRI imaging w/ NPH should show:

Answer 11

ventricular enlargement out of proportion to sulcus atrophy

Question 12

A significant supportive feature of DLB includes their severe sensitivity to these drugs? Rx?

Answer 12

• neuroleptics (1st gen. antipsychotics– haldol)

- pt may sleep +20 hrs

Question 13

Dx for DLB rqs. 2/4 of these criteria:

Answer 13

1- Fluctuations in cognition and alertness (“good and bad days”)
2- Visual hallucinations
3- Parkinsonism (more B/L)
4- REM sleep behavior disorder (dream enactment)