Parkinson's Other

Question 1

What are two non-pharm options that may decrease symptoms/prevent PD?

Answer 1

Coffee

Exercise

Question 2

The decision to initiate therapy in symptomatic PD is determined by what?

Answer 2

Degree of functional impairment

Question 3

Drug of choice if symptoms seriously threaten a patient’s lifestyle or gait

Answer 3

Levodopa

Question 4

Tx initiation:
<65yo
>65yo

Answer 4

Under 65: dopamine agonist

Over 65: levodopa

Question 5

This occurs when patients get too much dopamine

Answer 5

Dyskinesias

Question 6

Name a few quality measures

Answer 6

Review dx
Avoid dopamine blockers
Review psych and autonomic symptoms, cog impairment
Document FALLS**
Rehab options, counseling on exercise
Discuss advance care planning**

Question 7

Impairment of attention, exec function, visuospatial function, and free recall; behavioral changes include apathy, depressed/anxious mood, delusions, daytime sedation

Answer 7

Parkinson’s Disease Dementia (Lewy Body Dementia)

Question 8

Tx of hallucinations and delusions in PDD? Interactions? ADRs?

Answer 8

Pimavanserin (Antipsychotics)
Interactions: QT prolonging drugs
ADRs: peripheral edema and confusion MC, QT prolongation

Question 9

Rapid eye movement sleep behavior disorder with PD

Answer 9

Melatonin > clonazepam

Question 10

Mood disorders with PD

Answer 10

SSRIs/SNRIs + CBT

Question 11

Orthostatic hypotension in pts with PD

Answer 11

Increase salt/fluid consumption, elevate HOB, use compression stockings (can add midodrine)

Question 12

Sialorrhea in pts with PD

Answer 12

Anticholinergic meds or botulinum A toxin

Question 13

Axial motor symptoms in PD, what is crucial?

Answer 13

Therapy (PT, speech, OT)

Question 14

Surgical ablation or deep brain stimulation for what type of PD patients

Answer 14

Advanced PD and intolerable dyskinesia or motor fluctuations on levodopa