Parkinsons

Question 1

Drug Treatment for patient whose QOL is NOT affected

Answer 1

Levodopa
Non-ergot derived dopamine receptor agonists
Monoamine-oxidase-B Inhibitors (MAOIs)

Question 2

Drug Treatment for patient whose QOL is affected

Answer 2

Levodopa (co-careldopa or co-beneldopa)

Question 3

Adjuvant Therapy (in addition to optimal levodopa)

Answer 3

Non-ergot derived dopamine receptor agonists
MAOI
COMT Inhbitor

Question 4

Name 3: Dopamine receptor agonists

Answer 4

Pramipexole, Ropinirole, Rotigotine

Question 5

Name 3: MAOIs

Answer 5

Rasagilione, Selegiline, Cabergoline

Question 6

Name 2: COMT Inhibitors

Answer 6

Entacapone, Tolcapone

Question 7

Name 2 PD Drugs That Discolour Urine (and what colour)

Answer 7

Levodopa: reddish/darker urine
Entacapone: red/brown urine

Question 8

3 Main Anti-parkinsons medication symptoms

Answer 8

psychotic symptoms, excessive sleepiness, impulse control disorders

Question 9

How do you manage impulse control disorders?

Answer 9

Reduce dose of dopamine

Question 10

What group is more likely to cause impulse control disorders?

Answer 10

Dopamine receptor agonists (Pramipexole, Ropinirole, Rotigotine)

Question 11

Why should PD drugs not be stopped abruptly

Answer 11

Risk of neuroleptic malignant syndrome

Question 12

Who should patients inform about their PD diagnosis?

Answer 12

DVLA

Question 13

2 Issues with MAOIs

Answer 13

1. Can cause hypotension.
   Specifically can cause hypotensive crisis if taken with phenylephrine (sudafed)
2. Interacts with tyramine rich foods
   - spikes blood pressure
   - avoid for 2 weeks after stopping MAOI

Question 14

Examples of tyramine rich foods

Answer 14

mature cheese, salami, marmite, yeast, tofu

Question 15

What antiemetic interacts with levodopa?

Answer 15

Metoclopramide (decreases effects of dopamine)