PARKINSON

Question 1

What are treatment options for MANAGEMENT OF MOTOR SYMTPOMS inParkinsons?

Answer 1

Non-drug treatment-
Phsyiotherapy if balance or motor function problems are present. Speech and language therapy if they develop communication, swallowing difficulties etc

Medication-
1st line
motor symptoms-Co-careldopa or co-beneldopa

motor symtoms do not affect quality of life-
levodopa, MAOI, non ergot DRA

Question 2

What are common side effects of antiparkisonians?

Answer 2

excessive sleepiness, psychotic symptoms, sudden onset of sleep with dopamine receptor antagonist, impulse control disorders

Question 3

Why must antiparkinsonians drug concentrations NOT be allowed fall suddenly due to poor absorption?

Answer 3

To avoid the potential Acute akinesia or neuroleptic malignant syndrome.

Question 4

MANAGEMENT OF MOTOR SYMTPOMS
What should be offered to patients who have developed dyskinesia or motor complications despite optimal levodopa therapy?

Answer 4

Non ergot DRA;
Pramipexole
ropinrole
rotenone

MAOIs:
rasagline
selegiline

or COMT inhibitors such as Entacapone or tolcapaone as adjunct to levodopa.

Question 5

When would you add levodopa and an ergot derived DRA?

Answer 5

Ergot derived and levodopa should only be considered if symptoms are not adequately controlled with non ergot DRA.

Examples

bromocriptine, cabergoline, dihydroergocryptine, lisuride and pergolide

Question 6

How would you manage excessive daytime sleepiness and sudden onset of sleep (side effect)?

Answer 6

Modanifil

reviewed every 12 months

inform DVLA

Question 7

What is first line treatment for nocturnal akinesia?

Answer 7

Levodopa or oral non ergot- DRA
rotenone second line

Question 8

What is treatment for patients who develop postural hypotension?

Answer 8

Review medication

give midodrine or fludrocortisone

Question 9

What can be used to treat psychotic symptoms?

Answer 9

If hallucinations and delusions are well tolerated, do not need to be treated

quetiapine- if no cognitive impairment

then clozapine

Question 10

what is treatment for advanced Parkinson?

How is it given?

Answer 10

Apomorphine

intermittent injections or continuous subut infusions

domperidone can be given to manage nausea and vomiting.

Levodopa-carbidopa intestinal gel