L15-16 Parkinson's Disease

Question 1

3 cardinal signs of PD

Answer 1

tremor
- resting tremor (disappears with movement), increases with stress

rigidity
- ratchet-like stiffness (cogwheel rigidity), also leadpipe rigidity

akinesia (no movement)/bradykinesia (slow movement)
- subj sense of weakness, loss of dexterity, difficulty using kitchen tools, loss of facial expression, reduced blinking, difficulty getting out of bed/chair, difficulty turning while walking

Question 2

iPD, features at initial presentation

Answer 2

• asymmetric
• pos response to levodopa or apomorphine: relief of tremor, rigidity, slowed movement
• postural instability and falls are not present yet
• less rapid progression
• autonomic dysfunction at present yet
• neuroimaging - ??
• impaired olfaction (?)

Question 3

Which of the PD treatment has been proven to prevent degeneration of neurons?

Answer 3

x replace dopamine, cure

- no treatment for PD has ever been shown to be ‘neuroprotective’

Question 4

pharmacological treatment modalities

Answer 4

incr central dopamine, dopaminergic transmission

• levodopa + DCI
• dopamine agonists
• MAOBi
• COMTi

correct imbalance in other pathways

• anticholinergics
• NMDA antagonists

Question 5

nonpharmacological treatment modalities

Answer 5

• PT: stretching, transfers, posture, walking
• OT: mobility aids, home, workplace safety
• speech and swallowing: voice projection
• surgery

Question 6

Is pharmacologic or non-pharmacologic treatments more important for treatment of PD?

Answer 6

Both are equally important!

Question 7

Is levodopa SR form usually give OM/ON?

Answer 7

ON before bedtime: decr stiffness on waking

Question 8

Are the ergot or non-ergot derivatives dopamine agonists more commonly used?

Answer 8

Non-ergot derivatives:

ropinirole, pramipexole, rotigotine (transdermal), apomorphine (subcut)

Question 9

What is dopamine agonist available in transdermal formulation?

Answer 9

rotigotine

Question 10

Fibrosis adverse effect due to

Answer 10

Higher risk w ergot dopamine agonist agents

Question 11

Is fibrosis reversible?

Answer 11

may be partially reversible upon withdrawal

Question 12

Valvular heart disease adverse effect due to

Answer 12

incidence appears to be greater with ergot-derived dopamine agonist

Question 13

dopamine agonists have

Answer 13

more specified adverse events

- excessive sleepiness, hallucinations, impulse control disorders

Question 14

is benztropine or trihexyphenidyl longer acting?

Answer 14

benztropine (t1/2 = 7h vs 1.3h_