ic16, 17 parkinsons, dementia

Question 1

What are 2 risk factors that decrease risk of parkinsons

Answer 1

smoking
caffeine

Question 2

What are the 2 types of neuroimaging? Are they done to diagnose parkinsons?

Answer 2

MRI and Dopamine Transporter imaging (DaT)

MRI can help to diagnose other parkinsonian conditions

DaT will have a positive result for PD and negative for non dopamine deficient etiologies. but it is not used to diagnose

Question 3

What are the initial features of PD

Answer 3

Asymmetric tremors
Will respond to Levodopa
Dont have postural instability yet

Question 4

As parkinsons develops, what signs are there?

Answer 4

Unable to perform basic ADL eg. using stairs, swallowing, toileting, urinary or bowel incontinence
Develop aspiration pneumonia (cos cannot swallow properly), choking
Falls

Question 5

What are the 2 tests to measure disease progression

Answer 5

Hoehn and Yahr staging
Describes extent of impairment

MDS - UPDRS (Unified Parkinsons Disease Rating Scale)
New version incorporates non-motor experiences of daily living

Question 6

What are the non motor symptoms of parkinsons

Answer 6

Dementia

Depression

Psychosis

Sleep disorder

Constipation

GI motility (use peripherally acting dopamine antagonist)
Use Domperidone
Dont use Metoclopramide (centrally acting)

Orthostatic hypotension
Use Fludrocortisone, Midodrine (vasopressor), Pyridostigmine (AChEi)

Sialorrhea
Use Atropine drops, Botulinum toxin A, B

Question 7

What is the common feature of young onset PD

Answer 7

dystonia

Question 8

When can modified release levodopa be used?

Answer 8

Stiffness on waking

Wearing off effect, peak dose dyskinesia

Question 9

What is the dose adjustment for IR to CR

Answer 9

Increase dose of CR by 25-50%

Question 10

Drug drug interactions of Levodopa (2 points)

Drug food interactions (2 points)

Answer 10

Pyridoxine (Vitamin B6)
Not relevant if administered with Carbidopa, Benserazide (DCI)
May interact with high dose vitamin B6

Iron
Affect absorption of Levodopa
Space out administration

Dopamine Antagonists
Antiemetics: Metoclopramide, Prochlorperazine → centrally acting
Use Domperidone (peripherally acting) instead
First gen antipsychotics
Risperidone (SGA)

Protein
Affect absorption of Levodopa
Space out administration

Question 11

Between dopamine agonist and Levodopa, what is the difference in side effects

Answer 11

DA have more hallucinations, sleep disturbances, leg oedema, orthostatic hypotension
Levodopa have more motor complications eg. peak dose dyskinesia
DA preferred in younger patients, as dyskinesia will set in eventually

Question 12

What is the essential counselling point for Dopamine Agonist

Answer 12

compulsive disorders

Question 13

Difference between Drug induced parkinsons VS idiopathic parkinsons (5 points)

Answer 13

DIP
Typically symmetrical
Acute onset
Poor response to Levodopa
May not have resting tremors
Normal DAT scan