Parkinsons

Question 1

Parkinson’s Motor Features
1. B
2. T
3. R
4. P

Other motor features

5. Masked __
6. Decr ___
7. ___ gait (Festinations)
8. Decr ___
9. Stooped _____
10. Turns ____
11. Small ___

Answer 1

1. Bradykinesia
2. tremor
3. rigidity
4. Postural instability
5. Facies
6. Decr blinking
7. shuffling gait
8. decr arm swing
9. stooped posture
10. difficult “en bloc”
11. handwriting (micrographia)

Question 2

For Idiopathic PD diagnosis, u need 2 of 3 sx’s… explain the 3 total sx’s

4. +/- ___
5. No ___

Answer 2

1. Bradykinesia
2. Rigidity (cog wheeling)
3. Tremor (at rest, 4-6hz pill rolling, starts assymetric, arms > legs)
4. Postural instability
5. Atypical features

Question 3

What are some motor complications?
F, D, W, O

What are some Non motor features?

Sleep?
RLS?
REM Behavior disordrr?

Answer 3

Freezing, Dyskinesia (abnormal movements), Wearing off, On-Off

Neuropsych such as Depression, anxiety, dementia, loss of interest (Anhedonia), hallucinations/delusions

Too much or too little sleep
Restless legs syndrome
Acting out dreams

Question 4

GI/Genitourinary :
C, D, N/V, C, Loss of ____
Urinary __/___
Sexual ___

Other non motor features :
1. Orthostasis defined
2. Sensory ___/___
3. Diplopia (define)
4. __ changes
5. __ swelling
6.S

Answer 4

Choking, drooling, nausea/vom, constipation, loss of smell

retention/incontinence

dysfunction

1. Dizziness on standing
2. Changes/pain
3. double vision
4. weight
5. leg
6. Sweating

Question 5

Pharm TX of Motor Diseases

Which classes of meds? (6)

Answer 5

Anticholinergic
amantadine
levodopa
dopamine agonists
MAO-B inhibitors
COMT Inhibitors

Question 6

Anticholinergics :

1. Name 2
2. How are they dosed?
3. What sx do they target to fix?
4. how does it do this?
5. AE’s?
6. When would u use it ?

Answer 6

1. Trihexyphenidyl (Artane) or Benztropine (Cogentin)
2. TID . Artane 6mg per day, Cogentin 6mg per day
3. Tremors
4. Reduces cholinergic input to striatum
5. Sedation, pt’s > 65 can cause confusion
   -Dry mouth and glaucoma
   -urinary retention and constipation
6. Young patient w/tremor predominant disease

Question 7

Amantadine (Symmetrel)

1. What sx’s is it used for ?
2. What does it do? MOA
3. How to dose?
4. Why WOULDNT u use it? AE’s?
5. WHEN WOULD U USE IT?

Answer 7

1. Early tremor, late dyskinesia
2. NMDA antag w some anticholinergic and dopa-ergic properties
3. 100mg BID (not after noon!)
4. Anticholinergic properties, may incr dementia and confusion
   -Mild symptomatic benefit
   - Can cause insomnia
5. Modest symptomatic benefit
   -Dose earlier than noon to avoid insomnia , for use with fatigue

Question 8

For the following Dopamine Therapies, state what their MOA is

1) MAO-B inhibitors
2) Dopamine agonists
3) Levodopa

Answer 8

1. Prevent breakdown of dopamine
2. stimulate body’s own dopamine pathways
3. Direct replacement!

Question 9

MAO-B Inhibs :Selegiline 5 mg , Rasagiline 1mg , Safinimide 50 mg

1. How dosed?
2. Has benefits to ?
3. BBW ?
4. SO when would u use it ?

Answer 9

1. every day, to BID with selegiline
2. All sx’s
3. MAO-A interactions (Tyramine, wine and cheese)
   -Can cause Hypertensive crisis
   -SEROTONIN SYNDROME
4. Discuss AE’s with pt
   -Patients requiring only modest sx benefit and ONCE daily dosing

Question 10

Dopamine Agonists :
1. Ropinirole : How dosed
2. Pramipexole : How dosed?
3. Rotigotine : Admin method? Dose?
4. Apomorphine : Admin method? Dose?
5. What do these drugs treat ?
6. MOA?
7. WHy WOULDNT u use it ?
8. These drugs can cause ?
9. SO use it when ?

Answer 10

1. 3-24mg divided TID or XL
2. 1.5-4.5 mg divided TID or XL
3. SQ patch, 1-8mg /24h once per day
4. SL film, 10-30mg up to 5x/day
   –> Lots of nausea
   –> requires premed w/anti emetics (Tigan)
5. All motor features : Tremor > Rigidity > bradykinesia
6. Potentiates action of existing dopamine neurons
7. Sedation, sudden sleep onset, worsen hallucinations/dyskinesia in fluctuators
8. Impulse control disorder, gambling , shopping, punding
9. Sleep difficulties, warn about ae’s. less likely on monotherapy than in combination with LD (AE’s)

Question 11

Carbidopa
1. MOA?
2. avoids peripheral ae’s of?
3. Can be given alone in 25mg or 50mg dose

Carbidopa/Levodopa (Sinemet, Parcopa , Rytary)
4. What sx’s will it treat ?
5. How does it work ?
6. How is it dosed?
7. Ae’s? Early vs late
8. WHen would u use it?
9. PEARL?

Answer 11

1. Prevents breakdown of levodopa in gut and arteries
2. Nausea and orthostasis
3. All motor features, Tremor> rigidity > bradykinesia, NOT postural instability
4. Direct replacement of dopamine
5. TID up to 6-8x daily –> Rytary has weird dosing
6. Nausea/Dizziness
   Late : Fluctuations, dyskinesias, hallucinations, ortho hypo, incomplete/unreliable absorption
7. Patients > 80 , cant tolerate other meds
8. Tell pt’s to take it away from food to improve absorption and limit dosing

Question 12

Later PD TX:
1. Dopamine agonists shown to reduce what?
2. Apomorphine indicated for?
3. Inhaled Levodopa to treat ?

COMT Inhibitors : Entacapone, Tolcapone –> Usually used as adjunctive therapy w/Levodopa
1. What does it do ?
2. Why wouldnt u use it ? AE’s
3. Entacapone As Stalevo allows for ?
4. Tolcapone has BBW for ?

AAN Reccs for Pt’s with PD and Motor Fluctuations

1. What should pt’s be offered to reduce off time in PD pt’s?

Answer 12

1. “Off time” in advanced pt’s (Ropinirole, pramipexole)
2. Tx of acute “off” episodes
3. ## Acute “off” episodes
4. Potentiates levodopa tx –> prevents breakdown of dopamine, requires use of levodopa!
5. Side effects of dopamine such as microscopic colitis –> diarrhea
6. Reduced pill burden
7. ## Liver failure
8. Entacapone and rasagiline