Parkinson's Disease

Question 1

Which neurotransmitter is deficient in Parksinson’s Disease?

Answer 1

Dopamine

Question 2

What are the symptoms of Parkinson’s Disease

Answer 2

Motor Sx - hypokinesia, bradykinesia, rigidity, rest tremor and postural instability

Non-motor Sx - dementia, depression, sleep disturbances, bladder and bowel dysfunction, speech and language change, swallowing problems and weight loss

Question 3

Name the drug classes that can be used to treat Parkinson’s Disease

Answer 3

Levodopa - + carbidopa (Sinemet) or + benserazide (Madopar)

Dopamine Receptor Agonists

- Non ergot dervied -> Pramipexole, ropinorole, rotigotine, amantadine (weak) and apomorphine

• Ergot dervied - bromocriptine, carbergoline and pergolide

MAO-B Inhibitors - selegiline and rasaligine

COMT Inhibitors - Entacapone and tolcapone

Question 4

Which Parkinson’s med can colour urine reddish/brown

Which Parkinson’s med can stain urine orange

Answer 4

Entacopone - reddish/brown

Levodopa - Orange

Question 5

Which drug is used to treat advanced PD - how is it given?

Answer 5

Apomorphine (SC intermettient or infusion)

• administer domperidone 2 days before and then discountinue ASAP as both can cause QT prolongation - arrhthymias (MHRA advice assessment and ECG monitoring, weigh up pros/cons)
• Levodopa intenstinal gel - severe Parkinson’s Sx
• Deep brain stimulation

Question 6

What class of PD has a MHRA alert and what is it

Answer 6

Ergot-dervied dopamine agonists - fibrrotic reactions (retroperitoneal, pulmonary and pericardial)

Question 7

Counselling for entacpone

Answer 7

• Can colour urine red/brown
• Avoid iron preps 2 hours before/after

Question 8

Side effects of Levodopa

Answer 8

1. Impulse control disorders
2. Excessive sleeping, sudden onset of sleep
3. Motor complications - dyskinseia and response fluctuations
4. End of dose deterioation w shorter length of benefit (switch to MR)

Question 9

DRA are associated with more X symptoms compared to levodopa

Answer 9

Motor

Question 10

Side effects of DRA

Answer 10

1. Impulse control disorders
2. Excessive sleepiness and sudden onset of sleep
3. Psychotic Sx
4. Hypotensive reaction in first few days

Question 11

Important intereactions of MAO-B Inhibitors

Answer 11

Hypertensive crisis

Pseudoephredine, phenylrphrine, xylometazoline, oxymetalozine (OTC preps: nose decongestants)

Adrenaline, NA, methylphenidate, amphetamines, b2 agonists - sympathomimetics (increase BP)

Question 12

Interactions of COMT inhibitors

Answer 12

sympathomimetics - adrenaline, NA, MAOIs (tranlcypromapine)

Question 13

What is used to treat day-time sleepiness - how often reviewed

(which group of people to avoid this drug in)

Answer 13

Modanifil - yearly

Pregnancy

Question 14

Drug to treat rapid eye movement sleep behaviour disorder (RBD)

Answer 14

Clonazepam or melatonin

Question 15

Drug to treat postural hypotension

Answer 15

Midodrine, fludrocortisone

Question 16

Drug to treat dementia in PD

Answer 16

Rotigotine

Question 17

Drooling of saliva PD

Answer 17

Glycopyrronium

specialis - botulinum toxin A

Question 18

Dopamine agonists cause more what compared with levodopa?

Answer 18

Psychiatric side effects

Question 19

Which antimuscarinic drug can be used to treat parkinson side effects of antipsychotics?

Answer 19

Procyclidine

Question 20

If a patient who drives develops Parkinsons who do they need to inform?

Answer 20

DVLA

Question 21

First line treatment for Parkinsons patients who’s motor symptoms affect their quality of life

Answer 21

Levodopa

Question 22

First line treatment for Parkinsons patients who’s motor symptoms do NOT affect their quality of life

Answer 22

levodopa, non-ergot dervived dopamine agonists (e.g. Ropinorole, Pramipexole, Rotigotine) or MAOBi (rasagiline or Selegilline)

Question 23

Why should abrupt withdrawal of Levodopa be avoided?

Answer 23

Neuroleptic malginant syndrome