Parkinson's - finals

Question 1

parkinson’s - quadridad

Answer 1

tremor
rigidity
bradykinesia
loss of postural reflexes - falls

Question 2

parkinson’s - history points

Answer 2

ADL
micrographia
function - shoelaces, buttons
movement - turning in bed, getting in/out of car

Question 3

levodopa - unwanted effects

Answer 3

dyskinesias - choreo(jerky)-athetoid(writhing) movements
motor fluctuations - predictable end-of-dose effect
motor fluctuations - unpredictable on-off effect

Question 4

parkinson’s - management

Answer 4

early, moderate - L-dopa + decarboxylase inhibitor
early, mild - ropinirole or pramipexole (dopamine agonists - fewer motor complications)

later can add dopamine agonist, COMT inhibitor (entacapone), MAO-B inhibitor (selegiline), DBS

Question 5

dopamine agonists - examples, SEs, when used?

Answer 5

ropinirole, pramipexole
young pts - less motor comps
addition to Ldopa in advanced disease

sleepiness
hallucinations (visual) + delusions
impulse control disorders

Question 6

L-dopa plus dopa decarboxylase inhibitor - pros and cons

Answer 6

good for bradykinesia + rigidity

can cause dyskinesias
5y lastage - delay use
don’t help tremor