Parkinson Disease

Question 1

What are the 3 main features of PD?

Answer 1

Ridigity, bradykinesia, tremor

Question 2

What are common causes of drug induced parkinsonism? (2 of them)

Answer 2

Antipsychotics, metoclopramide

Question 3

What is the role of carbidopa in levocarb?

Answer 3

to enhance the amount of levodopa that crosses the BBB by reducing peripheral breakdown of levodopa into dopamine

Question 4

What issues do people begin to experience with long term levodopa therapy?

Answer 4

motor fluctuations and dyskinesias

Question 5

what are motor fluctuations?

Answer 5

end of dose “wearing off” or “on-off” phenomena, where the response fluctuates

Question 6

What are the dyskinesias associated with levodopa?

Answer 6

Peak dose dyskinesia (occurring at peak levels of the drug), diphasic dyskinesias (occurring at the beginning and end of dosing intervals), and off-period dystonias (painful spasm of the feet, occurring when the dose is wearing off or early morning)

Question 7

How can “wearing off” of levodopa be helped?

Answer 7

Use levodopa CR, or more frequent dosing, add entacapone

Question 8

How to counsel dopamine agonists?

Answer 8

Start low, go slow. Will cause nausea for a bit. take before bed. adjust dose every 4-7 days. Do not d/c too quickly. Can be taken with or without food.
side effects: Nausea, orthostatic hypotension, impulsive behaviours, hallucinations

Question 9

How to counsel levodopa?

Answer 9

start with low dose and increase slowly. If stopping medication, do not stop suddenly, taper slowly.
take with food to help with nausea.
may cause nausea, orthostatic hypotension, sudden sleeping.
dose adjustment will be required over time as the disease progresses.
space from multivitamins by 2 hours

Question 10

What is Neuroleptic malignant-like syndrome and what are the symptoms?

Answer 10

Caused by discontinuing dopaminergic drugs too quickly. Symptoms include high fever, confusion, rigid muscles, variable blood pressure, sweating, and fast heart rate