Clinical Questions

Question 1

Typical Symptoms of PD

Answer 1

T - Tremor
R- Rigidity
A - Akinesia
P - Postural Instability

Others: Muffled speech, drooling, dysphagia, constipation

Question 2

Drugs that worsen PD

Answer 2

Haloperidol, Droperidol
1st/2nd antipsychotics (Risperidone, Paliperidone)
Prochlorperazine (Compazine, DA blocker)
Metoclopramide (Reglan, DA blocker)

Question 3

A PD patient starts to have dyskinesia from his treatment, what could be added on to help?

Answer 3

Amantadine

Question 4

A PD patient has really bad tremors and his current treatment is not helping, what could be added on to help?

Answer 4

Benztropine

Question 5

A PD patient is experiencing orthostatic hypotension, what could be added on to help?

Answer 5

Droxidopa

Question 6

What drugs are contraindicated when taking Sinemet?

Answer 6

Non-selective MAO inhibitors
EX: tranylcypromine, isocarboxazid, phenelzine

Question 7

A parkinson’s patient is also experiencing pychosis, what is the best antipsychotic treatment for his movement disorder?

Answer 7

Quetiapine (Seroquel)

Question 8

What is the first line treatment for PD?

Answer 8

Sinemet (Carbidopa/Levodopa)

Question 9

What drugs can be added onto Sinemet to decrease the peripheral conversion of levodopa?

Answer 9

COMT inhibitors
EX: entacapone, opicapone, topcapone

Question 10

What are the typical side effects you may experience with treatment for PD?

Answer 10

Dyskinesia
Hallucinations
Psychosis
Orthostasis
Somnolence

Question 11

Which PD treatment can cause brown/black discoloring of the urine, saliva, or sweat?

Answer 11

Sinemet (Carbidopa/Levodopa)

Question 12

What dose of Carbidopa is required to block the metabolism of Levodopa?

Answer 12

70 - 100 mg/day

Question 13

With diease progression, after the 1st line therapy, what should be added on to PD patient’s therapy?

Answer 13

COMT inhibitors (Entacapone, Opicapone, Tolcapone)
Dopamine Agonists (Pramipexole [Mirapex], Ropinirole [Requip], Rotigotine)

Question 14

What PD drug is contraindicated with opioids and SNRIs?

Answer 14

Selective MAO-B inhibitors (Selegiline, Rasagiline, Safinamide)

Question 15

Typical Symptoms of Alzeimers

Answer 15

Memory loss
Difficulty communications
inability to learn
Difficulty planning
Poor coordination/motor function
Personality changes
Inappropriate behavior
Paranoia, agitation
Hallucinations

Question 16

What drugs can worsen dementia?

Answer 16

Antiemetics (promethazine)
Antihistamines (diphenhydramine, doxylamine)
Antipsychotics (chlorpromazine, aripiprazole)
Barbiturates (phenobartbital, butalbital)
Benzodiazepines
Central anticholinergics (benztropine)
Skeletal muscle relaxants (Baclofen)
CNS depressants (opioids, sedatives)

Question 17

What is the 1st line treatment therapy for Alzheimers?

Answer 17

Acetylcholinesterase inhibitors
Ex:Donepezil (Aricept), Rivastigmine (Exelon)

Question 18

What is used at adjunct therapy for Alzheimers?

Answer 18

Memantine (Namenda)

Question 19

What drugs should cautiously be used with acetylchoninerstase inhibitors?

Answer 19

Diltiazem, BB, Verapamil, Digoxin —– decreased HR

Antipsychotics, alpha blockers, muscle relaxers, hypnotics, opioids —– dizziness

Question 20

Which formulation of Donepezil (Aricept) has less GI side effects?

Answer 20

ODT formulation

Question 21

How is Donepezil (Aricept) dosed to reduce nausea?

Answer 21

qHS

Question 22

Which formulation of Rivastigmine (Exelon has less GI side effects?

Answer 22

Patch

Question 23

Which drugs will reduce the effects of Donepezil (Aricept) and Rivastigmine (Exelon)?

Answer 23

Anticholinergic drugs