Anti PARKINSON

Question 1

Pt is on L dopa, however developed motor flucturation, what can be added?

Answer 1

COMT inhibitors ( e.g. tolcapone, entacapone)

Question 2

After added tolcopone, what s/e to monitor?

Answer 2

1. May worsen dyskinesia
   2 liver dysfunction
2. Nausea
3. Diarrhoea
4. Urine discoloration
5. Visual hallucination
6. Daytime drawsiness

Question 3

Amantadine, is used for PD, what effect dose it bring?

Answer 3

1. Enhance release of stored dopamine
2. Inhibit presynaptic uptake of catecholamine
3. Dopamine receptor agnonist
4. NMDA receptor antagonism ( anti glutamate)

With effect on “anti dyskinetic” and have mild antiparkinsonism (tremor. Rigidity, bradykinesia, and dyskinesa)

Question 4

What s/e to moniotr when pt is on amantadine?

Answer 4

1. Cognitive impairment
2. Hallucination
3. Insomnia
4. Nightmares
5. Livedo reticularis
6. Ankle edema
7. Withdrawal effects

Question 5

When pt is on pergolide (which is a dopamine agonist), what s/e may happen?

Answer 5

1. Fibosis
2. Restrictive valvular heart disease
3. Nausea
4. Vomiting

Question 6

Pt with PD, developed hallucination or psychosis, how to manage?

Answer 6

1. To simply regime: off MAO B inhibitor, anticholinergic, amandatine, dopamine agonist)
2. To maintain L dopa at lowest possible dose
3. Atypical antipscyhotic (e.g. clozapine, quetiapine maybe helpful)
4. Do not use typical antipsychotic in PD in view of S/E of EPSE
5. Avoid olanzapine