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DONE CLINICAL > Parkinsons > Flashcards

Parkinsons Flashcards

1
Q

Explain ‘long term levodopa syndrome’

A
  • Premature wearing off of anti-Parkinsonian effects of Levodopa, and response fluctuations.
  • Wearing off effect is time before next dose when become increasingly bradykinetic
  • Response fluctuations: Dramatic swings between dyskinesias and frozen, immobile state
  • ‘ON-OFF’
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2
Q

Levodopa induced dyskinesias and fluctuations develop earlier in ____ patients.

A

YOUNGER

  • Management shifted towards later admin of levodopa OR
  • Use of combination therapies, in effort to reduce cumulative levodopa dose
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3
Q

What is in…
Co-Careldopa AND Co-Beneldopa

LIST THE BRAND NAMES TOO!

A

Co-Careldopa:
Sinemet = Carbidopa and Levodopa

Co-Beneldopa:
Madopar = Benserazide and Levodopa

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4
Q

What type of enzymes are Carbidopa and Benserazide?

A

Peripheral dopa-decarboxylase inhibitors.

Block peripheral conversion of levodopa to dopamine and allows lower dose of levodopa to be administered

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5
Q

What dose is Levodopa immediate release normally started at?

10mg/day 50mg/day or 100mg/day

A

50mg/day

The dose then increases every 3-4 days until dose of 50mg TDS reached

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6
Q

What is the maximum dose of Levodopa /day that can be considered before the diagnosis of PD should be reviewed?

400mg/day 500mg/day or 600mg/day

A

600mg/day

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7
Q

List 3 common side effects seen on initiation of Levodopa therapy…

A

Nausea, vomiting and orthostatic hypotension (postural hypotension)

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8
Q

State one anti-emetic suitable for treatment of nausea and vomiting in a patient with PD

DOSE?

A

Domperidone 10-20mg tds

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9
Q

List two things that can affect absorption of Levodopa

A

Iron compounds and Protein in diet

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10
Q

What is the interaction between Levodopa and antihypertensives?

A

Levodopa can enhance the hypotensive effects of antihypertensive agents

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11
Q

What is the rough BA of Levodopa controlled release?
50-60%
60-70%
70-80%

A

Levodopa controlled release has a BA of 60-70% compared to Levodopa immediate release which has a BA of 90-100%

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12
Q

What is the response duration of immediate release Levodopa compounds?

A

1-3hours

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13
Q

What is the response duration of controlled release Levodopa compounds?

A

2-4hours

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14
Q

What is an advantage of co-prescribing controlled release Levodopa with immediate release Levodopa?

A

This can relieve end-of-dose deterioration/motor complications in later disease

Prevent motor complications in later PD patients but NOT drug of choice! NICE

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15
Q

What is the name of the intestinal gel preparation of Levodopa and Carbidopa?

A

Duodopa

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16
Q

What is an advantage of using Levodopa and Carbidopa intestinal gel? (pumped into small bowel via percutaneous route)

A

It is a continuous delivery which can significantly reduce motor fluctuations

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17
Q

Which non-ergot derived dopamine agonist is available as a patch? How long is the patch applied to the skin for?

A

Rotigotine - 24hr patch

18
Q

List one ergot derived dopamine agonist and two non ergot derived dopamine agonists

A

Ergot derived = Cabergoline, Bromocriptine, Pergolide

Non ergot derived = Ropinirole, Pramipexole, Rotigotine

19
Q

What annual and regular monitoring should take place when a patient is on an ergot derived dopamine agonist?

A

Annual chest X-Rays and ESR (Pleuropulmonary fibrosis)

AND regular echocardiographic monitoring (Cardiac valvulopathy) AND RENAL FUNC TESTS

20
Q

Which of the COMT inhibitors is associated with hepatoxicity fears?

What monitoring is needed because of this?

A

Tolcapone - LFT’s every 2 weeks in first year

21
Q

When may Tolcapone be initiated?

A

To reduce motor fluctuations if Entacapone fails due to lack of efficacy or side effects

22
Q

At what dose is Entacapone given with each dose of Levodopa?

What is the maximum frequency of admin per day?

A

200mg with every Levodopa dose up to 10 doses/day

23
Q

Tolcapone and Entacapone can increase dyskinesias so what can be done to combat this?

A

Reduce the Levodopa dose - by around 10-30%

24
Q

Diarrhoea, abdominal pain, dryness of the mouth and urine discolouration is often associated with which class of drug?

A

COMT inhibitors

25
Q

What is Selegiline and it’s single daily dose?

A

MAOBI - 5-10mg daily

26
Q

What is the daily dose of Rasagiline?

A

1mg daily

27
Q

Which of the following is associated with hallucinations and confusion and why?

Selegiline or Rasagiline

A

Selegiline as it is metabolised to amphetamine like products so neuropsychiatric side effects may be seen

28
Q

Amantadine is useful as a WHAT?

A

Anti-dyskinetic agent in advanced disease

29
Q

What usual dose of amantadine is given daily?

A

100-300mg daily

30
Q

What is livedo reticularis? and what drug is it associated with?

A

A persistent patchy reddish blue mottling of legs - associated with Amantadine use

31
Q

What class of drug is Apomorphine?

A

A potent dopamine agonist

32
Q

Patients taking Apomorphine and Levodopa need screening for Coomb’s positive haemolytic anaemia at what intervals?

A

Every 6 months

33
Q

List 4 of the classic symptoms of Parkinsons

A
  • Tremor
  • Stiffness
  • Slowness
  • Balance problems and/or gait disorders.
34
Q

Which of the following drugs is being described?
Levodopa, Dopamine agonist, MAOBI, COMT

First line therapy in early PD

Good degree of symptom control

Evidence of increased motor complications

Evidence of increased other adverse events

A

Levodopa

Dopamine agonist:
Mod symp control and reduced motor complications

MAOBI:
Limited symp control and reduced motor complications

COMT = NOT FIRST OPTION FOR EARLY (adjuvant)

35
Q

Anticholinergics should not be drugs of first choice due to limited efficacy and the propensity to cause ________ side effects.

A

Neuropsychiatric

36
Q

Which of the following are 1st line options as adjuvants to treat PD in later disease?

Levodopa, COMT inhib, MAOBI, Amantadine, Dopamine agonists, anticholinergics, apomorphine

A
  • COMTI
  • MAOBI
  • Dopamine Agonists

(Others NOT first line)
Levodopa not adjuvant in later

37
Q

Which combinations of drugs are available in a triple therapy preparation to improve concordance?

A
  • Levodopa, carbidopa and entacapone
  • Used in later PD to reduce motor fluctuations
  • Entacapone is a COMT inhib
38
Q

Intermittent Apomorphine injections can be used to reduce __ ____ in those with severe motor complications

A

off-time

39
Q

Antiparkinsonian medication should not be withdrawn abruptly or allowed to fail suddenly due to poor absorption (for example, gastroenteritis, abdominal surgery) to avoid the potential for acute _____ or ______ ______ ______.

A

1) akinesia

2) neuroleptic malignant syndrome (muscle rigidity, fever, delirium)

40
Q

____ antipsychotics such as _____ may be used in the treatment of psychotic symptoms in PD, but registration with a mandatory monitoring scheme is required.

A

1) Atypical

2) Clozapine

41
Q

_____ may affect sleep alertness

A

Selegiline (MAOBI)

DONE CLINICAL (10 decks)

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