Parkinsons

Question 1

what helps alleviate Parkinson’s?

Answer 1

-increase in dopamine

Question 2

what are the two types of patients that you will come across regarding Parkinson’s?

Answer 2

-their motor symptoms affect their quality of life and those whose motor symptoms dont affect their quality life

Question 2

what is the treatment for patients whose motor symptoms decrease their quality of life?

Answer 2

-levodopa +carbidopa/benserazide

Question 3

what’s the treatment for those whose motor symptoms dont affect their quality of life?

Answer 3

-levodopa
-non-ergot-derived dopamine-receptor
-monoamine-oxidase-B inhibitor

Question 4

what are the 2 other drugs used with levodopa? and why?

Answer 4

carbidopa or benserazide
-to prevent breakdown of levodopa before it crosses into the brain

Question 5

what are the side effects (impulse disorder) from levodopa?

Answer 5

-pathological gambling
-binge eating
-hypersexuality
-sudden onset of sleep (treat with modafinil)
-red urine

Question 6

what are example of non-ergot-derived dopamine-receptor agonists? + SE

Answer 6

-pramipexole, ropinirole and rotigotine

-Impulse disorders
-sudden onset of sleep
-hypotension

Question 7

what type of drug causes the most impulse disorder?

Answer 7

non-ergot-derived dopamine-receptor agonists

Question 8

what are examples of monoamine-oxidase-B inhibitors?

Answer 8

rasagiline and selegiline, safinamide

Question 9

what drug can cause hypertensive crisis if given with a monoamine-oxidase-B inhibitors?

Answer 9

-phenylphrine

Question 10

what do monoamine-oxidase-B inhibitors interact with tyramine rich food which are?

Answer 10

-mature cheese
-salami
-marmite
-yeats
-tofu

Question 11

what should happen if patients develop dyskinesia or motor fluctuations despite optimal levodopa therapy?

Answer 11

-add an adjunct to the levodopa like:
~non-ergot-derived dopamine-receptor agonists
~monoamine-oxidase-B inhibitors

and
~COMT inhibitors

Question 12

what are some examples of COMT inhibitors?

Answer 12

-entacapone or tolcapone

Question 13

what are some side effects of COMT inhibitors?

Answer 13

entacapone: red-brown urine
tolcapone: hepatotoxic

increases sympathetic side effects therefore increased CVD events

Question 14

when should you use an ergot-derived dopamine-receptor agonists ?

Answer 14

when symptoms aren’t being controlled by using just levodopa and a non-ergot-derived dopamine-receptor agonists

Question 15

what are examples of an ergot-derived dopamine-receptor agonist?

Answer 15

bromocriptine cabergoline

Question 16

what are some side effects of ergot-derived dopamine-receptor agonist?

Answer 16

-pulmonary reactions : report SOB chest pain and cough
-pericardial reactions : chest pain

Question 17

when can patients stop taking a parkinsons meds?

Answer 17

shoudknt be stopped abruptly

Question 18

what should be abscess of skinne is a patients deteriorates during off period?

Answer 18

use MR preparations

Question 19

what should be used for nocturnal akinesia?

Answer 19

with levodopa or oral dopamine-receptor agonist as first line options and rotigine as second line

Question 20

what should be used to treat hypotension?

Answer 20

midodrine