Parkinsons

Question 1

C

Answer 1

C

Question 2

C

Answer 2

C

Question 3

C

Answer 3

V

Question 4

C

Answer 4

C

Question 5

C

Answer 5

C

Question 6

Clinical manifestations of Parkinson disease?

Answer 6

The symptoms of Parkinson’s disease are characteristically asymmetrical.

Triad
1) rigidity - cogwheel: due to superimposed tremor
flexed posture,drooling of saliva, postural hypotension,

2) bradykinesia

3) tremor - most marked at rest , typically ‘pill-rolling’,

gait - shuffling walk

psychiatric features: depression is the most common feature (affects about 40%)

mask face

Question 7

Drug-induced parkinsonism has slightly different features to Parkinson’s disease such as ?

Answer 7

motor symptoms are generally rapid onset and bilateral
rigidity and rest tremor are uncommon

Question 8

x

Answer 8

x

Question 9

treatment of parkinson disease first line if motor symptoms are not affecting patients quality of life ?

Answer 9

dopamine agonist (NON-ergot derived),
levodopa
or monoamine oxidase B (MAO‑B) inhibitor

Question 10

treatment of parkinson disease first line if motor symptoms are affecting patients quality of life ?

Answer 10

levodopa

Question 11

dopamine agonist (non-ergot derived),monoamine oxidase B (MAO‑B) inhibitor effects on motor skills compared to levodopa ?

Answer 11

Less improvement in motor symptoms

Less improvement in activities of daily living

Question 12

If a patient continues to have symptoms despite optimal levodopa treatment or has developed dyskinesia then NICE recommend the addition of ?

Answer 12

dopamine agonist,
MAO‑B inhibitor
or catechol‑O‑methyl transferase (COMT) inhibitor

Question 13

if alternative strategies fail from dopamine agonist , MOA inhibitors and (COMT) inhibitor , what can be considered ?

Answer 13

Modafinil - called wakefulness promoting agents

Question 14

to manage drooling of saliva in people ?

Answer 14

glycopyrronium bromide (used for bowel colic in pliative too !)

Question 15

Levodopa
nearly always combined with a decarboxylase inhibitor why ?

Answer 15

carbidopa or benserazide

prevents the peripheral metabolism of levodopa to dopamine outside of the brain

Question 16

levodopa adverse effects ?

Answer 16

common adverse effects:
dry mouth
anorexia
palpitations
postural hypotension
psychosis

Question 17

NICE recommends not to have a ‘drug holiday’ from Parkinson medication because ?

Answer 17

risk of acute dyskinesia /akinesia or neuroleptic malignant syndrome if medication is not taken/absorbed (for example due to gastroenteritis)

= fever,
muscle rigidity,
encephalopathy,
myoglobinuria,
unstable vital signs and
raised creatine kinase

autonomic lability: typical features include hypertension, tachycardia and tachypnoea
agitated delirium with confusion

======

dopamine agonist - impulse control diroders

Question 18

clinicians may limit levodopa doses due to ?

Answer 18

dyskinesias at peak dose: dystonia, chorea and athetosis (involuntary writhing movements)

Question 19

what should be given for a patient with Parkinson’s disease cannot take levodopa orally, they can be given

Answer 19

dopamine agonist patch as rescue medication to prevent acute dystonia

Question 20

what are the dopamine receptor agonist ?

Answer 20

bromocriptine, ropinirole, cabergoline, apomorphine

Question 21

ergot-derived dopamine receptor agonists ?

Answer 21

bromocriptine, cabergoline

Question 22

side effects of ergot-derived dopamine receptor agonists ?

Answer 22

pulmonary, retroperitoneal and cardiac fibrosis.

The Committee on Safety of Medicines advice that an echocardiogram, ESR, creatinine and chest x-ray should be obtained prior to treatment and patients should be closely monitored

Question 23

MAO-B (Monoamine Oxidase-B) inhibitors

Answer 23

selegiline

Question 24

function of mao b inhibitors ?

Answer 24

inhibits the breakdown of dopamine secreted by the dopaminergic neurons

Question 25

COMT inhibitor example ?

Answer 25

entacapone, tolcapone

Question 26

how to treat drug induced parkinisoms ?

Answer 26

Antimuscarinics

help tremor and rigidity

. procyclidine, benzotropine, trihexyphenidyl (benzhexol)

Question 27

dopamine agonist for tremor ?

Answer 27

Pramipexole is a dopamine agonist (used in also restless leg syndrome)

Question 28

What is seen on blood results for neuroleptic malignant syndrome is given what ?

Answer 28

raised creatine kinase is present in most cases.
Acute kidney injury (secondary to rhabdomyolysis)
A leukocytosis may also be seen

Question 29

Max of neuroleptic malignant syndrome ?

Answer 29

stop any antipsychotic

IV fluids to prevent renal failure

dantrolene may be useful in selected cases
thought to work by decreasing excitation-contraction coupling in skeletal muscle by binding to the ryanodine receptor, and decreasing the release of calcium from the sarcoplasmic reticulum

bromocriptine, dopamine agonist, may also be used

Question 30

MOI inhibited side effects ?

Answer 30

Serotonin syndrome

Question 31

Clinical creatures of serotonin syndrome

Answer 31

Abrupt onset
Hypereflexia
Dilated pupils
CLONUS

Question 32

MX of severe serotonin reuptake syndrome ?

Answer 32

Cyproheptadine
Chlorpromazine

Question 33

X

Question 34

X

Question 35

Drug induced Parkinson differing in

Answer 35

motor symptoms are generally rapid onset and bilateral

rigidity and rest tremor-UNCOMMON