4.4 Movement disorder - Parkinson's

Question 2

A 70-year-old man with advanced Parkinson’s disease is being started on apomorphine therapy.

Which of the following treatment options is the most appropriate for the management of nausea and vomiting as a result of the apomorphine?

Select one:
A. Domperidone Correct
B. Haloperidol
C. Metoclopramide
D. Ondansetron
E. Prochlorperazine

Answer 2

Metroclopramide, haloperidol and prochlorperazine should not be used in Parkinson’s disease as they cross the blood brain barrier and cause dopamine blockade, resulting in worsening of symptoms. Ondansetron is contraindicated with apomorphine due to additive QTc prolongation and risk of serious arrhythmia. The manufacturers of apomorphine recommend the use of domperidone to control nausea and vomiting, however there is still a risk of QT prolongation with this combination , hence an assessment of cardiac risk factors and ECG monitoring is recommended to ensure that the benefits outweight the risks.

Ref: https://bnf.nice.org.uk/treatment-summary/parkinsons-disease.html

The correct answer is: Domperidone

Question 3

This medication is used at a continuing dose of 1 mg daily in the management of Parkinson’s disease.

Trihexyphenidyl
Procyclidine hydrochloride
Orphenadrine hydrochloride
Tolcapone
Amantadine hydrochloride
Selegiline hydrochloride
Entacapone
Rasagiline

Answer 3

Rasagiline

Rasagiline is used at a dose of 1 mg daily in the management of Parkinson’s disease. It is either used alone or as an add on therapy with either co-beneldopa or co-careldopa.

Question 4

Early treatment with this drug can delay the need for levodopa therapy in Parkinson’s disease.

Trihexyphenidyl
Procyclidine hydrochloride
Orphenadrine hydrochloride
Tolcapone
Amantadine hydrochloride
Selegiline hydrochloride
Entacapone
Rasagiline

Answer 4

elegiline hydrochloride

Early treatment with selegiline can delay the need for levodopa therapy.
References: BNF, Nervous system, Parkinson’s disease and related disorders
https://www.medicines.org.uk/emc/medicine/22193 (Note rasagiline is not indicated for delaying the need for levodopa therapy although it is a monoamine oxidase B inhibitor as well)

Question 5

This drug may cause hair loss as a side effect.

Trihexyphenidyl
Procyclidine hydrochloride
Orphenadrine hydrochloride
Tolcapone
Amantadine hydrochloride
Selegiline hydrochloride
Entacapone
Rasagiline

Answer 5

Selegiline hydrochloride

Hair loss is a side effect of treatment with selegiline hydrochloride.

Question 6

A 67-year-old male who has been prescribed co-careldopa for Parkinson’s disease.

• Take this medication after food
• You may experience sudden onset of sleep. Please exercise caution when performing skilled tasks
• Report any signs of visual impairment immediately to your prescriber
• Your medication may colour your urine blue. This is harmless
• Do not take this medication at the same time as antacids
• Immediately report any signs or symptoms of anaemia, bruising or infection to your doctor
• Take this medication at night

Answer 6

You may experience sudden onset of sleep. Please exercise caution when preforming skilled tasks

Dopamine receptor agonists are associated with sudden onset of sleep.

Question 7

You are supporting a hospital outpatient service for patients with Parkinson’s disease. Which of the following is the most appropriate treatment option for daytime sleepiness in Parkinson’s patients?

Amantadine
Domperidone
Levodopa
Midodrine
Modafinil

Answer 7

The correct answer was Modafinil

If reversible pharmacological and physical causes have been excluded, modafinil should be considered to treat excessive daytime sleepiness, and treatment should be reviewed at least every 12 months.

Question 8

You are supporting a hospital outpatient service for patients with Parkinson’s disease. Impulse control disorders are most likely a side effect of which of the following medicines?

Domperidone
Levodopa
Midodrine
Modafinil
Ropinirole

Answer 8

Ropinirole

Impulse control disorders (compulsive gambling, hypersexuality, binge eating, or obsessive shopping) can develop in a person with Parkinson’s disease who is on any dopaminergic therapy at any stage in the disease. Levodopa is also associated with impulse control disorders, however the answer reference given states: ‘Conversely, excessive sleepiness, hallucinations, and impulse control disorders are more likely to occur with dopamine-receptor agonists than with levodopa.’ Thus ropinirole is the best answer.

Question 9

What side effect may not be observed during treatment with Levodopa?

Dyskinesia
Neuroleptic malignant syndrome
Hallucinations
Impotence

Answer 9

impotence