parkinson's management

Question 1

levodopa - usually combined with

Answer 1

decarboxylase inhibitor to prevent peripheral metabolism

Question 2

levodopa - unwanted effect s

Answer 2

dyskinesia
on-off effect
dry mouth 
anorexia
palpitations 
postural hypotension 
psychosis
drowsiness

Question 3

levodopa - when not to use

Answer 3

neuroleptic induced parkinson’s

Question 4

dopamine receptor agonists

Answer 4

e.g. bromocriptine, ropinirole

potential to cause impulse control disorders and daytime somnolence

Question 5

dopamine receptor agonists - prior to starting

Answer 5

ECHO, ESR, creatinine, CXR

• risk of pulmonary, retroperitoneal and cardiac fibrosis

Question 6

Monoamine Oxidase B Inhibitors

Answer 6

e.g. selegiline

inhibit breakdown of dopamine secreted by domaminergic neurones

Question 7

Amantidine - MOA

Answer 7

not fully understood. -probs increases dopamine release and inhibits synaptic uptake

Question 8

Amatidine - side effects

Answer 8

ataxia
slurred speech
confusion 
dizzy 
livedo reticularis

Question 9

COMT Inhibitors

Answer 9

inhibit COMT which is an enzyme involved in dopamine breakdown

e.g. entacapone, tolcaone

Question 10

COMT inhibitors - how are they used

Answer 10

in conjunction with levodopa in patients with established PD

Question 11

Anti-muscarinics

Answer 11

block cholinergic receptors
Rx drug induced parkinsonism

e.g. procyclidine, benzotropine

Question 12

Mx - motor symptoms affecting QoL

Answer 12

levodopa

Question 13

Mx - motor symptoms not affecting QoL

Answer 13

dopamine agonist, levodopa or monoamine oxidase inhibitor