Dementia and Parkinson's disease

Question 1

First line drug class in mild to moderate Alzheimer’s disease is _______

Answer 1

AChE inhibitors - donepezil, galantamine and rivastigmine

Question 2

True or false: AChE inhibitors can cause syncope

Answer 2

TRUE - they may also cause GI discomfort, arrhythmias and urinary incontinence.

Question 3

Serious skin reactions like Stevens-Johnson’s syndrome can occur with which Alzheimer’s drug ?

Answer 3

Galantamine

Question 4

Mechanism of action of Memantine

Answer 4

Glutamate receptor antagonist

2nd line treatment

Question 5

True or false: Benzodiazepines should be avoided in dementia patients

Answer 5

FALSE - they can be used to treat aggression and agitation

Question 6

Why are dopamine decarboxylase inhibitors combined with L-dopa in Parkinson’s treatment ?

Answer 6

Peripheral decarboxylation of dopamine causes side effects e.g. postural hypotension, tachycardia and nausea

Question 7

True or false: Dopamine antagonists are better at controlling motor symptoms than levodopa

Answer 7

FALSE

Ldopa is better at controlling motor symptoms in Parkinson’s.

Question 8

Pramipexole, ropinirole and rotigotine are examples of ________ DA agonists

Answer 8

Non-ergot derivative

Ergot-derivatives e.g. bromocriptine are not recommended by NICE

Question 9

Impulse control disorders can be a side effect of ______

Answer 9

Dopamine agonists

Includes binge eating, hypersexuality, pathological gambling etc

Question 10

When is apomorphine indicated in Parkinson’s disease?

Answer 10

In advanced disease for unpredictable “off periods”

Question 11

Selegeline and rasagiline are examples of which type of antiparkinsonian drug?

Answer 11

Monoamine oxidase B inhibitor (MAOB-i)

Question 12

Entacapone is a COMT inhibitor. How does it work

Answer 12

Prevents the peripheral breakdown of L-dopa. Allows more to enter the brain

Question 13

True or false: antimuscarinic drugs are safe to use in dementia patients

Answer 13

FALSE

They should be avoided as they may increase cognitive impairment

Question 14

True or false: vascular dementia can be managed with AChE inhibitors or Memantine

Answer 14

FALSE

These drugs should only be used if the patient has co-morbid Alzheimer’s, Parkinson’s dementia or Lewy body dementia

Question 15

Which AChE inhibitors are first line (unlicensed) for Dementia with Lewy Bodies ?

Answer 15

Donepezil or Rivastigmine

Galantamine only if the above are not tolerated

Memantine only if all AChE inhibitors are contraindicated or not tolerated

Question 16

Drug used to manage daytime sleepiness in Parkinson’s disease

Answer 16

Modafinil

Question 17

Drug used to treat postural hypotension associated with Parkinson’s disease ?

Answer 17

Midodrine

Fludrocortisone as an alternative but this us unlicensed

Question 18

Which AChE inhibitor is licensed for the treatment of dementia associated with Parkinson’s disease

Answer 18

Rivastigmine

Question 19

What class of drug is apomorphine

Answer 19

A DA receptor agonist. Specialist use only

Question 20

What are the non-ergot derived DA agonists

4 points

Answer 20

Pramipexole

Rotigotine

Ropinirole

Apomorphine

Question 21

Bromocriptine and Cabergoline are examples of what class of drug

Answer 21

(ergot derived) DA agonists

Question 22

Which antipsychotic is used 1st line for psychosis in Parkinson’s disease

Answer 22

Quetiapine

2nd line clozapine

Question 23

Why are ergot derived DA agonists not used very often

Answer 23

They are associated with fibrotic reactions eg in the lungs and heart

Question 24

Levodopa preparations colour the urine what colour

Answer 24

Red/brown