parkinson's

Question 1

`what drugs are used as neuroprotective therapies for parkinson’s
[2]

Answer 1

selegiline

coenzyme Q-10

Question 2

which drugs are used for early symptomatic treatment of PD [3]

Answer 2

amantadine

benzhexol

selegiline

Question 3

what drug is used for main symptomatic therapy

Answer 3

levodopa

Question 4

levodopa MOA

Answer 4

dopamine precursor –> increase dopamine synthesis

Question 5

levodopa is prepared with what class of drugs to prevent side effects d/t excess dopamine in PNS

Answer 5

peripheral decarboxylase inhibitors

Question 6

what is sinemet

Answer 6

levodopa + carbidopa

Question 7

what is madopar

Answer 7

levodopa + beserazide

Question 8

levodopa S/E

Answer 8

short term: n&v, postural hypotension
long-term: motor fluctuation, dyskinesia

Question 9

what drug is given to counter levodopa side effect of nausea & vomiting

Answer 9

domperidone

Question 10

levodopa cautions

Answer 10

• most efficacious but dose should be kept to minimum
• wearing-off effect – beneficial effects wear off after few hours
  1. take on empty stomach
  2. adjust dose, increase frequency
  3. ER formulation, additional PD meds

Question 11

what drugs are given with levodopa to treat dyskinesia

Answer 11

amantadine (antiviral)
memantine

anticholinergics

Question 12

side effects of amantadine / memantine [3]

Answer 12

ankle swelling

skin rashes

hallucinations

Question 13

which drug is a COMT inhibitor

Answer 13

selegiline (Jumex)

Question 14

COMT inhibitor MOA

Answer 14

inhibit monoamine oxidase B –> inhibit dopamine breakdown

Question 15

COMT inhibitor uses

Answer 15

mild antiparkinson activity
delay nigral brain degeneration
efficacious as symptomatic monotherapy for early parkinsons

Question 16

which drug delays nigral brain degeneration

Answer 16

selegiline

Question 17

what is coenzyme Q-10

Answer 17

antioxidant, decrease rate of progression

Question 18

what anticholinergics are given for PD

Answer 18

trihexyphenidyl (onset 60min)
benzhexol (onset 60min)

Question 19

why are anticholinergics given for PD

Answer 19

• symptomatic monotherapy
• adjunct to levodopa to treat tremors & stiffness

Question 20

anticholinergics side effects

Answer 20

dry mouth, urinary retention, constipation

sedation, confusion, hallucination, delirium, memory problems

Question 21

dopamine agonists MOA

Answer 21

act on dopamine receptors in brain to reduce symptoms

Question 22

dopamine agonists use

Answer 22

delay/prevent onset of motor complications

Question 23

which has stronger antiparkinson effects, levodopa or dopamine agonists?

Answer 23

levodopa

Question 24

which drugs are dopamine agonists? [4

Answer 24

bromocriptine (parlodel)
ropinirole (requip)
pramipexole (sifrol)
pergolide (celance, permax)
piribedil (trivastal retard)

Question 25

are dopamine agonists used as monotherapy or adjunct to levodopa

Answer 25

both

Question 26

side effects of dopamine agonists 7

Answer 26

n&v, postural hypotension, dyskinesia (same as levodopa)

hallucinations (esp elderly)

cardiac fibrosis (bromo, pergolide)

pedal edema

arrhythmia

restrictive valvular heart disease (pergolide)

ropinirole, pramipexole > somnolence

Question 27

is levodopa or dopamine agonists preferred for younger patients?

Answer 27

dopamine agonists

Question 28

what are the cardinal features of parkinson’s

Answer 28

resting tremor
rigidity
bradykinesia
gait abnormality

Question 29

does parkinson’s usually present unilaterally or bilaterally?

Answer 29

unilateral progressing to bilateral

Question 30

what is the main concern for patients with late parkinson’s

Answer 30

worsning postural instability leading to falls

Question 31

what is an indicator that a patient does not have idiopathic parkinson’s

Answer 31

failure to respond clinically to large doses of levodopa

Question 32

risk factors of parkinson’s (5)

Answer 32

old age
early onset dementia
fam hx
herbicide/pesticide, heavy metal exposure
repeated head trauma

Question 33

diagnostic tests for parkinson’s

Answer 33

MRI brain/spine
PET (positron emission tomography)
SPECT (single photon emission computerised tomography)
hx, neurological assessment

Question 34

rigidity most commonly affects flexors or extensors?

Answer 34

flexors