Mngt PD - Cases

Question 1

UT is prescribed with a drug for her PD. The doctor told UT to avoid taking the drug at night.

Which of the following options can be the drug that UT was prescribed? Select more than one option

A. Amantadine
B. Rasagiline
C. Selegiline
D. Moclobemide
E. Memantine

Answer 1

Ans: A, C

• Selegiline H met to stimulating Amphetamine
• Amantadine is stimulating
• B: Rasagiline not met to amphetamines
• D: Moclobemide is not used in PD
• E: Memantine is not used in PD

Question 2

BW is a 65yo M who has been taking Levodopa + DCI combo for 5 years. Today, he presents with Dyskinesia due to disease progression of PD. He is otherwise healthy. NKDA.

Which of the following is/are appropriate for BW’s situation? You can select more than one answer

A. Add Amantadine
B. Replace Levodopa with Pramipexole
C. Add Tolcapone
D. Replace specific doses with Sinemet SR
E. Add Rasagiline

Answer 2

Ans: A, D

• B: No point since dysK already occured
• C: Adding Tolcapone causes spike in [LevoD] = worsen dyskinesia
• E: Not a management for dysK

Question 3

TY is a 73yo M who is diagnosed with PD. His medical hx is significant for DVT, in which he is taking Warfarin. He has NKDA, and his liver and renal functions are normal.

Which of the following is most appropriate for TY?

A. Bromocriptine + Amantadine
B. Rasagiline
C. Levodopa + Tolcapone
D. Levodopa + Carbidopa + Entacapone
E. Levodopa + Benserazide

Answer 3

Ans: E

• A: For young onset
• B: For young onset, or adjunct in later stages
• C and D: COMT-I increases anticoagulation effect of warfarin, try to avoid

Question 4

AY is a 46yo man who was diagnosed with PD. He is currently taking Ropinirole. The doctor noticed AY’s tremor is still uncontrollable and recommended to add an anti-cholinergic.

Which of the following anti-cholinergic is the doctor most likely to prescribe?

A. Tolterodine
B. Ipratropium
C. Scopolamine
D. Benztropine
E. Hyoscine N-butylbromide

Answer 4

Ans: D

• A: Limited systemic absorption
• B, E: Can’t cross BBB
• C: For NNV, not used in PD

Question 5

John is a 59yo M who was diagnosed with PD, and is currently on Levodopa + Carbidopa. He presents with NNV and is seeking for medication to help ease his sx.

Which of the following is the most appropriate choice for his NNV?

A. Metoclopramide
B. Domperidone
C. Prochlorperazine
D. Risperidone
E. Lactulose

Answer 5

Ans: B (Choice of antiemetic for PD)

Question 6

Meena is a 51yo F who was diagnosed with PD and is on Levodopa + DCI IR tablets. Recently, she has requested for a less cumbersome dosage regimen.
She has NKDA, and is currently taking Calcium supplements.

Which of the following action(s) is/are appropriate? Can select more than one option.

A. When changing to CR tablets, decrease the dose of CR tabs by 25%
B. When changing to CR tablets, increase the dose of CR tabs by 25%
C. Change to CR tablet with the same dose as IR tabs
D. Add on Entacapone to the CR tablets
E. Space out Ca supplements from the CR tabs

Answer 6

Ans: B, E

(CR has lower F than IR, hence need to increase dose to make sure patient is getting the same dose)

(recall: Fe and Ca decrease levoD absorption, hence space out if possible)

(recall other levoD interactions: Protein and fat diet, antiDA like antipsychotics, and Non-selective MAOI)