Parkinson II

Question 1

Examples of anticholinergics and their side effects

Answer 1

trihexyphenidyl

constipation
urinary retention
dry eyes and mouth

Question 2

NMDA antagonist MOA

Answer 2

• bind to NMDA receptors and prevent the binding of glutamate, thus reducing cell death and prevent levodopa-induced dyskinesias from happening.

Question 3

PK of NMDA antagonists

Answer 3

renally excreted, reduce dose in renal impairment

Question 4

When should the doses be administered for NMDA antagonists?

Answer 4

first dose in the morning, second dose in the afternoon

Question 5

Drug-drug interactions

Answer 5

avoid concurrent use with memantine

Question 6

Adverse effects

Answer 6

nausea, light-headedness, livedo reticularis

Question 7

Place in management of PD

Answer 7

adjunctive

managing levodopa-induced dyskinesia

Question 8

Several proposed MOAs of amantadine

Answer 8

• NMDA antagonist
• Anticholinergic
• Upregulates D2 receptors, increases sensitivity of D2 receptors

Question 9

Characteristics of vascular PD

Answer 9

• usually bilateral
• no resting tremor
• stepwise in progression
• vascular risk factors and age
• mostly not caused by infarcts / lesions in the brain

Question 10

Characteristics of drug-induced PD

Answer 10

• symptoms tend to occur bilaterally
• more common in women than men
• treatment should be the withdrawal of the drug

Question 11

difference between drug-induced PD and idiopathic PD

Answer 11

1. IPD is completely irreversible, DIP may still be reversible.
2. IPD symptoms are typically asymmetrical, DIP symptoms are symmetrical.
3. IPD has tremor, DIP does not.

Question 12

Which drug classes are most likely to cause DIP?

Answer 12

Dopamine antagonists&raquo_space; antipsychotics&raquo_space; antiepileptics&raquo_space; immunosuppressants

Question 13

Management of drug-induced PD

Answer 13

remove offending drug

treatment with anticholinergics and amantadine.

Question 14

Causes of parkinson hyperexia syndrome

Answer 14

changes in dopaminergic treatment
trauma, surgery
may have no apparent trigger

Question 15

Clinical presentation of PHS

Answer 15

symptoms deteriorate rapidly, pt becomes progressively more immobile and rigid.
systemic complications: reduced consciousness and rhabdomyolysis

Question 16

Management of PHS

Answer 16

• if it is caused by dopaminergic meds, reinstate previous treatment and increase dose of levodopa gradually.
• if PO route cannot be used, options are:
  » rotigotine patch
  » amantadine injection
• dontrolene, bromocriptine

Question 17

Management of patients in acute care: admitted with Parkinsonian features but without known PD (new diagnosis)

Answer 17

• accurate diagnoses is important

- specialist advice is recommended

Question 18

Management of patients in acute care:

known PD, admitted for an unrelated problem

Answer 18

• review meds: avoid anti-dopaminergics and anti-cholinergics
• screen for possibly-related symptoms (drooling, aspiration, constipation, fecal loading)
• arrange for specialist input

Question 19

Management of patients in acute care:

Admitted for specific complications of PD

Answer 19

• aspiration pneumonia
• dopamine agonist withdrawal
• psychosis
• dyskinesias

Question 20

Reasons why people do not take their medications

Answer 20

• they believe that the medications are not working for them
• they do not know what the medication is for
• they forget to take their medications
• they have difficulty taking their medications out of their containers

Question 21

What is a pharmacists’ role in disease management?

Answer 21

1. Support maintenance of prescribed orders
2. Understanding the wide-ranging impacts of PD and its medicines
3. Ensure other medicines don’t worsen PD symptoms
4. Support people to take control, post-discharge
5. Find out more about PD

Question 22

Consequences of missing doses of meds

Answer 22

longer hospital stay