Parkinson's

Question 1

What is the MOA of Levodopa?

Answer 1

Levodopa is a precursor to Dopamine that can cross the BBB and caust dopaminergic effects in brain

Question 2

What is the first-line medical management for patients with mild Parkinson’s disease?

Answer 2

Supportive therapy (PT/ OT) and as soon as motor symptoms have an impact on life:

Dopamine agonists as long as little interference with patients life

Levodopa when interference with patient’s life

Question 3

What is the main side-effects of Levodopa?

Answer 3

1. Diskinesia (excess and involuntary movements)
2. Wearing-off efects (worsening sx towards end of dose)
3. Nausea + Vomiting (but less than dopamin agonists)
4. Impulse-control disorders
5. Sedation + hallucinations

(Also might cause hallucinations + confusion but less than dopamine agonists)

Question 4

What medication is usually co-prescribed to Levodopa? Why?

Answer 4

Carbidopa

Dopa-decarboxilase inhibitor helps with reducing side-effects of nausea and vomiting

Question 5

Name an example of a Dopamine agnoist

Answer 5

pramipexole, ropinirole, rotigotine

Usually preferred in initial stages of PD due to reduced risk of diskinesia

Question 6

How is treatment in PD usually stepped up from a dopamine agonist if more severe symptoms are experienced?

Answer 6

Increase in dose followed by

combination of
1. Levodopa and dopamine agonists
2. or Levodopa and MAO-B inhibitor

Question 7

Which anti-emetics are contrainidicated in PD?

Answer 7

D2 antagonists e.g. Metaclopromide and prochlorperazine