parkinson

Question 1

Parkinsonism refers to the presence of…. (3)

Answer 1

rest tremors
rigidity
bradykinesia

Question 2

how to treat Parkinson in early symptomatic stage without complications

Answer 2

physiotherapy and exercise regime
healthy and balanced diet
knowledge on disease
social support

Question 3

classes of oral medications in antiparkinson

Answer 3

anticholinergic agents
MAO-B/COM-T inhibitors
dopamine agonists
levodopa

Question 4

what are the 2 levodopa preparations

Answer 4

levodopa + benserazide: madopar
levodopa + carbidopa: sinemet
available as a regular form or long acting form

Question 5

side effects of levodopa

Answer 5

short term: nausea, vomiting postural hypotension

long term: motor fluctuations and dyskinesia

Question 6

What is an example of anticholinergics

Answer 6

trihexyphenidul (Artane) 2-15mg.day

Question 7

advantages of anticholinergics

Answer 7

effective in controlling tremor

peripherally acting agents may be useful in treating sialorrhoea

Question 8

SE of anticholinergics

Answer 8

dry mouth, sedation, constipation, urinary retention, delirium, confusion, hallucinations

Question 9

how should anticholinergic agents be used

Answer 9

symptomatic mono therapy or as an adjunct to levodopa

Question 10

example of MAO-B inhibitors (1)

Answer 10

selegiline

Question 11

when is the MAO-B inhibitors used

Answer 11

mild antiparkinson activity

symptomatic monotherapy

Question 12

how does MAO=B wrk

Answer 12

inhibit enzyme monoamine oxidase B, interferes with breakdown of dopamine
may delay the mitral brain cell degeneration

Question 13

SE of MAO-B

Answer 13

heartburn, loss of appetite, nausea, constipation, dizziness, anxiety, headache, palpitation, insomnia, confusion, nightmares, visual hallucination

Question 14

name 2 COMT inhibitors

Answer 14

entacopone

tolcapone

Question 15

MOA of COMT

Answer 15

blocks an enzyme that converts levodopa into an inactive form
more levodopa available to enter the brain
only effective when used with levodopa
increases duration of each dose of levodopa, beneficial in treating ‘wearing off’ response

Question 16

side effects of COMT

Answer 16

increased abnormal movements (dyskinesias) 
liver dysfunction (tolcapone) 
nausea, diarrhoea 
urinary discolouration
visual hallucinations actions 
daytime drowsiness, sleep disturbances

Question 17

name 5 dopamine agonists

Answer 17

bromocriptine, pergolide, piribedil, ropinirole, pramipexole

Question 18

MOA of dopamine agonists

Answer 18

act directly on dopamine receptors in the brain to reduce the symptoms of PD

Question 19

usage of dopamine agonists

Answer 19

prevent or delay onset of motor complications

Question 20

SE of dopamine agonists

Answer 20

fibrosis, pedal edema, somnolence with ropinirole, pramipexole
arrhythmia
pergolide: restrictive valvular heart disease

Question 21

When to use dopamine agonists

Answer 21

symptomatic mono therapy
adjunct to levodopa in the treatment of Parkinson’s disease
younger Parkinson’s disease patients, therapy should commence first with dopamine agonists rather than levodopa

Question 22

what is amantadine

Answer 22

antiviral agents, accidentally discovered to have mild antiparkinsonian effect
given mono therapy or adjunct to levodopa

Question 23

amantadine MOA

Answer 23

enhance release of stored dopamine
inhibit presynaptic uptake of catecholamine
dopamine receptor agonist
NMDA receptor antagonist (anti-glutamate)
antidyskinetic

Question 24

when to use amantadine

Answer 24

reduce dyskinesia in patients with Parkinson’s disease who have motor fluctuations

Question 25

SE of amantadine

Answer 25

limits its use in advanced disease
cognitive impairment (inability to concentrate), hallucination, insomnia, night ares, lived reticular
mottled reticulated discolouration of limbs