Parkinson Disease

Question 1

What would you prescribe a patient who’s motor symptoms affects their QUALITY OF LIFE

Answer 1

Levodopa + carbidopa / Benserazide
Don’t give levodopa on its own because only a small percentage goes to the BBB

Question 2

What would you prescribe a patient who motor symptoms DOESNT AFFECT their QUALITY OF LIFE

Answer 2

Levodopa
Non-ergot derived dopamine receptor
Monoamine-oxidase-B inhibitors

Question 3

What is levodopa

Answer 3

Carbidopa/ benserazide is added in order to prevent the breakdown of levodopa before it crosses the brain

Question 4

What are the side effects of levodopa

Answer 4

-Impulse disorders such as shopping
-Pathological gambling
-Binge eating
-Hypersexuality
Sudden onset of sleep (treated with modafinil)
Red urine counselling point just tell pt side effect no worries

Question 5

What drugs are non-ergot derived dopamine receptors

Answer 5

Pramipexole
Ropinirole
Rotigotine

Question 6

What are the side effects of non-ergot derived dopamine receptors

Answer 6

Impulse disorder (more than levodopa)
Sudden onset of sleep
Hypotension (treated with midodrine)

Question 7

What are monoamine-oxidase-B inhibitors

Answer 7

Rasagiline and selegiline

Question 8

What drug can cause a hypertensive crisis when given with a monoamine-oxidase-B inhibitor

Answer 8

Phenylephrine or pseudoephedrine (sudafed) - MAJOR INTERACTION

Question 9

What interacts with mono amine-oxidase-B inhibitors

Answer 9

Interacts with thyramine rich foods such as
Mature cheese
Salami
Marmite
Yeast
Tofu

Question 10

What do you do if a patient develops dyskinesia or motor fluctuation despite optimal levodopa therapy

Answer 10

Add another therapy either
non-ergot dopamine receptor antragonists
Monamine-oxidase-B inhibitors
COMT inhibitors

Question 11

What drugs fall under COMPT inhibitors

Answer 11

Entacapone or talcapone

Question 12

What side effects does entacapone give

Answer 12

Red-brown urine
Increases sympathetic side effects- increase in CVD events

Question 13

What side effects does tolcapone give

Answer 13

Hepatotoxic side effects
Increases sympathetic side effects- increase in CVD events

Question 14

What do you do if symptoms are not controlled with non-ergot derived dopamine receptor agonist as an adjunct to levodopa

Answer 14

Give ergot-derived dopamine receptor agonist

Question 15

What drugs are ergot-derived dopamine receptor agonist

Answer 15

Bromocriptine
Cabergoline

Question 16

What are the side effects associated with ergot-derived dopamine agonist

Answer 16

Pulmonary reactions: Report SOB, chest pain or cough
Pericardial reactions: chest pains

Question 17

What are some counselling points to patients who are on treatment for Parkinson’s

Answer 17

Do NOT WITHDRAW medication abruptly

If person has ‘off periods ‘ due to end of dose deterioration- Use MR preparations
- off periods is when the medication is wearing off

Treat nocturnal akinesia with levodopa or oral dopamine- receptor agonist as first line option then rotigotine as second line

Treat hypo tension with midodrine