Parkinsons

Question 1

What is Parkinson’s defined by?

Answer 1

Parkinson’s disease is a progressive neurodegenerative condition resulting from the death of dopaminergic cells

Question 2

Patients with Parkinson’s disease classically present with motor-symptoms including

Answer 2

hypokinesia, bradykinesia, rigidity, rest tremor, and postural instability

Question 3

Non-motor symptoms include

Answer 3

dementia, depression, sleep disturbances, bladder and bowel dysfunction, speech and language changes, swallowing problems and weight loss.

Question 4

Patients with suspected Parkinson’s disease should be referred every how often? Do they tell the DVLA?

Answer 4

to a specialist and reviewed every 6 to 12 months. When Parkinson’s disease diagnosis is confirmed, patients should be advised to inform the DVLA and their car insurer

Question 5

Aim of Parkinson’s treatment?

Answer 5

Parkinson’s disease is an incurable progressive condition, and the aim of treatment is to control the symptoms and to improve the patient’s quality of life

Question 6

First-line treatment

Answer 6

In early stages of Parkinson’s disease, patients whose motor symptoms decrease their quality of life should be offered levodopa combined with carbidopa (co-careldopa) or benserazide (co-beneldopa).

Question 7

Parkinson’s disease patients whose motor symptoms do not affect their quality of life, could be prescribed a choice of

Answer 7

levodopa, non-ergot-derived dopamine-receptor agonists (pramipexole, ropinirole or rotigotine) or monoamine-oxidase-B inhibitors (rasagiline or selegiline hydrochloride).

Question 8

Daytime sleepiness

Answer 8

Modafinil

Question 9

Nocturnal Akinesia- what is it defined by??

Answer 9

Loss of movement

Question 10

Postural Hypotension- what do they have reviewed? What is given first line of drug therapy is needed, what is the second option?

Answer 10

Patients who develop postural hypotension should have their drug treatment reviewed to address pharmacological cause. If drug therapy is required - midodrine hydrochloride as the fist option and fludrocortisone as an alternative

Question 11

Psychotic symptoms:
What would be the first thing to do? What would we give to patients with non cognitive impairment - what happens if treatment is ineffective??

What can worsen motor Parkinson’s???

Answer 11

Hallucinations and delusions can be treated but don’t have to if they are well tolerated, dosage of any antiparkinson drug may have triggered hallucinations
Patients with non cognitive impairment- quetiapine considered to treat hallucinations and delusions, if standard treatment not effective- clozapine. Phenothiazines and butyrophenones can worsen motor features of Parkinson’s

Question 12

Rapid eye movement/ drooling treatment only if speech therapy not effective

Answer 12

Clonazepam or melatonin should be considered to treat rapid eye movement
Drooling- Only if speech therapy and language therapy not effective - Glycoprronium bromide 1st line, Botulunum toxin type A 2nd line.

Question 13

Dementia- is treated using what??

Answer 13

Rivastigmine,memantine

Question 14

Deep brain stimulation - should be considered with which patients???

Answer 14

should only be considered with patients with advanced Parkinson’s disease whose symptoms aren’t adequately controlled

Question 15

Intestinal gel contains what? What can it treat?

Answer 15

containing co-carledopa or continuous subcutaneous infusion of foslevodopa with foscarbidopa may be used to treat advances levadopa - responsive Parkinson’s disease with motor fluctuations and hyperkinesis or dyskinesia

Question 16

Non ergot derived dopamine receptor:
Pramipexole,ropinirole, rotigotine
Can cause what (3)
Non ergot cause what more than what???

Answer 16

• Impulse disorders
  
  • Sudden onset of sleep
  • Hypotension
    Non ergot= more impulse disorders than levadopa

Question 17

Patients who develop dyskinesia or motor fluctuations despite optimal levadopa therapy should add an adjuvant to levadopa:

Answer 17

-ergot-derived dopamine receptor agonist

Question 18

Ergot derived dopamine receptor agonist (bromocriptine,cabergoline)
What is bromocriptins used in???

Answer 18

Bromocriptine rescue drug for neuroleptic malignant syndrome

Question 19

Ergot derived dopamine receptor agonist (bromocriptine,cabergoline)

Answer 19

Bromocriptine rescue drug for neuroleptic malignant syndrome

Question 20

Pulmonary reactions:

Answer 20

report SOB

Question 21

Pericardial reactions:

Answer 21

chest pain

Question 22

If a person has off periods, due to end of dose deterioration?

Answer 22

Use MR preps

Question 23

Gambling

Answer 23

The dopamine agonists pramipexole and ropinirole, and the dopamine modulator aripiprazole, are associated with an increased risk of developing problematic gambling.

Question 24

Levodopa and oral dopamine receptor agonists should be considered as first line? What is second line? When would we opt for that?

Answer 24

Levodopa or oral dopamine receptor agonists should be considered as a first lien option and rotigotine as second line (if levadopa and oral dopamine- receptor agonists are ineffective)

Question 25

Advanced Parkinson’s which intermittent injections do we use?

Answer 25

Advanced Parkinson’s -apomorphine as intermittent injections or continuous subcutaneous infusions

Question 26

• Nausea and vomiting unlicensed under what kg? Need to start when? What issues are associated with concomitant use??

Answer 26

Domperidone (unlicensed in less than 35kg)need to start two days before apomorphine therapy and then discontinued as soon as possible to reduce risk of arrhythmias due to QT prolongation associated with concomitant use of Domperidone,apomorphine hydrochloride - assessment if cardiac risk and ECG monitoring to ensure that the befits outweigh the risks