Parkinson's/RLS

Question 1

Gold standard for Parkinson’s is ___ (aka Sinemet).

Answer 1

carbidopa/levodopa

Question 2

Long-term use of carbidopa/levodopa can l/t ___.

Answer 2

dyskinesia

Question 3

Meds used to tx PD:

Answer 3

levodopa/carbidopa, dopamine agonists, COMT inhibitors, MAO selective inhibitors, amantadine, anticholinergics

Question 4

Dopamine agonists have potential for ___ behaviors.

Answer 4

compulsive

Question 5

MAO inhibitor includes: ___. Metabolites are amphetamine, so can cause ___ if taken later in day. Wait ___ wks before starting on another med.

Answer 5

Selegiline, insomnia, 2

Question 6

COMT inhibitors include:

Answer 6

tolcapone, entacapone

Question 7

Tolcapone has risk of ___, so monitor ___. Take ___ before or after meals at same time each day.

Answer 7

hepatotoxicity, LFT, 2

Question 8

Entacapone has a ___ onset and ___ duration.

Answer 8

quick, short

Question 9

___ is used as adjunctive therapy w/COMT, MAO inhibitors, carbidopa/levodopa if pt’s continue to have ___.

Answer 9

Amantadine, tremors

Question 10

___ can also be used as adjunctive therapy for PD tx and is useful for ___. Avoid in ___ d/t urinary retention and confusion. May be difficult to ___ once started.

Answer 10

Anticholinergics, tremors, elderly, withdraw

Question 11

From lowest to strongest potency:

Answer 11

MAO inhibitors, dopamine agonists, carbidopa/levodopa

Question 12

Peripheral dopaminergic s/e include:

Answer 12

n/v/d, orthostatic hypotension

Question 13

Central dopaminergic s/e include:

Answer 13

insomnia, somnolence, sleep attacks, hallucinations, psychosis, nightmares

Question 14

Levodopa/carbidopa may interact w/___.

Answer 14

iron/ferrous sulfate

Question 15

Avoid ___ w/dystonia.

Answer 15

CR

Question 16

D-I-D represents ___ of disease.

Answer 16

progression

Question 17

Nonmotor symptoms may include:

Answer 17

erectile dysfunction, orthostatic hypotension, urinary incont, constipation, excessive daytime sleepiness, insomnia, periodic limb movements of sleep, fatigue, REM sleep behavior disorder, anxiety

Question 18

For cognitive-related PD, tx dementia w/___.

Answer 18

rivastigmine

Question 19

Atypical antipsych’s to use in PD include:

Answer 19

quietiapine, clozapine, ariprazole

Question 20

___ and ___ are shown to be effective in tx’ing essential tremors.

Answer 20

Propranolol, primidine

Question 21

Tx for RLS is similar to that of ___.

Answer 21

PD

Question 22

Nonpharmacologic tx for RLS includes: ___ activities, stopping ___/___/___, supplementing w/___ if deficient.

Answer 22

alerting, caffeine, nicotine, alcohol, iron

Question 23

Most common cause of RLS is ___ deficiency.

Answer 23

iron

Question 24

70% of pts who use carbidopa/levodopa experience ___ of RLS symptoms, which is known as ___. Tx is to ___ the dose and change meds.

Answer 24

worsening, augmentation, decrease

Question 25

Both ___ and ___ stimulation alleviate the symptoms of RLS.

Answer 25

physical, mental

Question 26

Any pt w/a plasma ferritin concentration < 50mcg and have RLS symptoms should be started on an ___ ___.

Answer 26

iron replacement

Question 27

___/___ is a good choice for pt’s w/intermittent symptoms b/c it can be taken on a ___ basis.

Answer 27

carbidopa/levodopa, PRN

Question 28

___ is effective in tx’ing tremors.

Answer 28

propranolol