C4

Question 1

what is parkinsons’ disease

Answer 1

chronic degenerative disorder that primarily affects the neurons of basal ganglia

Question 2

PD: hallmark motor symptoms

Answer 2

tremor (occurs when resting)
rigidity (increased muscle tone)
akinesia (bradykinesia - slowness of movement)
postural instability (impaired postural reflexes)

Question 3

PD: RF

Answer 3

exposure to pesticide
fam hx
type 2 diabetes
male, age > 60yo
head injury

Question 4

PD: pharm tx

Answer 4

increase supply of dopamine
- combination formulation

Question 5

PD: combinations

Answer 5

levodopa + benserazide
levodopa + carbidopa

Question 6

PD: pharm class of levodopa & carbidopa/benserazide

Answer 6

dopamine precursor
peripheral decarboxylase inhibitors

Question 7

PD: contraindication of combi

Answer 7

< 25 yo
pregnant women / women of childbearing potential in the absence of adequate contraception

Question 8

PD: SE of combi

Answer 8

dz
n/v
orthostatic hypotension

Question 9

PD: CP of levodopa

Answer 9

• empty stomach
• taken w low-protein food (if stomach becomes irritated to reduce food-drug interaction on absorption)
• for HBS (sustained release for less symptoms) formulation, swallow whole
• important to follow regular dosing times & intervals -> maintain effects
• cannot take with metoclopramide (med used for v or digestion)

Question 10

summary: drugs

Answer 10

levodopa + carbidopa / benserazide
ropinirole
bromocriptine
entacapone
selegiline
benzhexol (trihexyohenidyl)

Question 11

PD: pharm class of ropinirole

Answer 11

non-ergot dopaminergic agonists

Question 12

PD: indi of ropinirole

Answer 12

monotherapy or adjunct to combi

Question 13

PD: SE of ropinirole

Answer 13

confusion
dz, dw / sudden onset of sleep
nervousness

Question 14

PD: CP of ropinirole

Answer 14

• taken w meals (reduce occurrence of n)
• sudden onset of sleep / excessive daytime dw
• risk of impulse-control disorders (including pathological gambling, binge eating, overspending -> see dr immediately)

Question 15

PD: pharm class of bromocriptine

Answer 15

ergot dopaminergic agonists

Question 16

PD: indi of bromocriptine

Answer 16

monotherapy or adjunct to combi (less preferred due to more SE)

Question 17

PD: SE of bromocriptine

Answer 17

hd, dw, sudden sleep onset, orthostatic hypotension

Question 18

PD: pharm class of entacapone

Answer 18

COMT inhibitor

Question 19

PD: indi of entacapone

Answer 19

adjunct only to combi

Question 20

PD: SE of entacapone

Answer 20

confusion, dm, n/v

Question 21

PD: pharm class of selegiline

Answer 21

MAO-B inhibitors

Question 22

PD: indi of selegiline

Answer 22

monotherapy or adjunct to combi

Question 23

PD: SE of selegiline

Answer 23

arthralgia, confusion, HTN, orthostatic hypotension, dyskinesia

Question 24

PD: drug interaction of selegiline

Answer 24

depression MAOi

Question 25

PD: pharm class of trihexyphenidyl (benzhexol)

Answer 25

central anticholinergics

Question 26

PD: indi of trihexyphenidyl (benzhexol)

Answer 26

PD (target tremors & muscle stiffness)
-> not recommended in elderly

Question 27

PD: SE of trihexyphenidyl (benzhexol)

Answer 27

bv, conf, c, dz, dm, urinary retention

Question 28

PD: rationale of d choice

Answer 28

dopamine precursors (levodopa) is recommended as monotherapy, especially for those whose motor symptoms in early stage of PD which decrease their QoL
- keep dose min to achieve good motor fx

Question 29

PD: considerations for choosing alternative first-line monotherapy

Answer 29

non-ergot dopamine agonists (ropinirole) are generally preferred in younger patients (<50 yo) w high risk for dyskinesia

MAO-B inhibitor (selegiline) -> reasonable for patients who prefers lesser dosing frequency & only require modest benefit in motor improvement

Question 30

dementia: RF

Answer 30

diabetes, HBP, HCL
age, fam hx, stroke, PD