parkinsons disease

Question 1

what are the motor symptoms of parkinsons disease

Answer 1

motor = movement

bradykinesia [slow movements]
tremor
rigidity
hypokinesia [small movements]
postural instability

Question 2

list the non motor symptoms of parkinsons disease?

Answer 2

dementia
depression
sleep disturbance
bladder and bowel dysfunction
speech and language changes
swallowing problems
weight loss

Question 3

what are the 1st line treatment for motor symptoms which DO AFFECT QUALITY OF LIFE?

Answer 3

levodopa and carbidopa [co-careldopa]

levodopa and benserazide [co-beneldopa]

Question 4

what are the 1st line for motor symptoms which do NOT AFFECT QUALITY OF LIFE?

Answer 4

monoamine oxidase B inhibitors [eg selegiline and rasagiline]

levodopa

non ergot derived dopamine receptor agonists [pramipexole, ropinirole]

Question 5

what are the pt and carer advice regarding antiparkinsonian drugs?

Answer 5

impulse control disorders
psychotic symptoms
sudden sleep onset
[occur with dopamine agonists eg pramipexole and ropinirole] etc

Question 6

what is dyskinesias and which anti parkinson drug does it occur in?

Answer 6

uncontrolled involuntary movements

occurs with long term levodopa

Question 7

which drugs should be ADDED to levodopa in patients who have developed dyskinesia with levodopa?

Answer 7

• offer non ergotic dopamine agonists [eg pramipexole, ropinerole]
• offer monoamine oxidase B inhibitors [eg rasaligine or selegiline]
• offer COMT inhibitors [entacapone]

Question 8

when should ergot derived dopmaine agonists [eg bromoctiptine, cabergoline or pergolide] be considered as adjunct to levodopa in patients who develop dyskinesia?

Answer 8

when pt symptoms are not being controlled with non-ergot dopamine agonist [pramipexole]

Question 9

which drug should be given if dyskinesia not managed by adjunct therapy?

Answer 9

amantadine

Question 10

which drug should be given for excessive daytime symptoms and sudden onset of sleep?

how often should you review pt?

Answer 10

modafinil

review every 12 months

Question 11

what is nocturnal akinesia in parkinsons?

Answer 11

inability pass urine at night or to turn in bed

Question 12

what is 1st and 2nd line for nocturnal akinesia?

Answer 12

1st line: levodopa or dopamine agonists [eg amantadine, pramipexole, ropinirole]

2nd line: rotigotine [dopamine agonist]

Question 13

what is 1st line and 2nd line for postural hypotension in parkinsons?

Answer 13

1st line: midodrine [sympathomimetic]

2nd line: fludrocortisone

Question 14

what drug should be used to treat psychotic symptoms in parkinsons for patients with NO cognitive impairment?

what is the alternative?

Answer 14

quetiapine

an alternative is clozapine

Question 15

which drugs should be used to treat rapid eye movement sleep behaviour disorder in parkinsons [2]?

Answer 15

melatonin

clonazepam

Question 16

which 2 drugs should be used to treat drooling salvia in parkinsons? which one of them is 1st line

Answer 16

glycopyrronium bromide - 1st line

botulinum toxin type A

Question 17

what is 1st line to treat mild to moderate parkinsons disease dementia and what is the alternative?

Answer 17

cholinesterase inhibitor [eg donepezil]

memantine alternative

Question 18

which drug should be used to treat advanced parkinsons disease and by which formulation?

which antiemetic can be given for the N&V side effects of this drug?

Answer 18

apomorphine injections/infusions

domperidone for nausea and vomiting

Question 19

give examples of impulse control disorders in parkinsons?

Answer 19

hyper-sexuality, gambling, excessive shopping

Question 20

how is impulse control disorders managed in parkinsons?

Answer 20

reduce the dose of dopamine agonists and gradually withdraw drug

offer CBT if this fails

Question 21

what are the 2 important safety advice with anti parkinson drugs?

Answer 21

1. impulse control disorder develops on dopaminergic therapy esp if pt has history of impulsive behaviour
2. fibrotic reactions: monitor pt for dyspnoea [breathing], persistent cough, chest pain, cardiac failure and abdominal pain

Question 22

which anti emetic should be used for n&v in parkinsons and why?

which one should not?

Answer 22

use domperidone bc does not cross blood brain barrier

do not use metoclopramide

Question 23

why should you not stop antiparkinson drugs suddenly?

Answer 23

increases Neuroleptic malignant syndrome - fever, confusion, rigid muscles, sweating, fast heart rate

Question 24

why must metoclopramide be avoided in nausea and vomiting for parkisons?

Answer 24

bc can increase EPSE and worsens parkinsons disease

Question 25

when should domperidone be started and stopped when given with apomorphine?

Answer 25

start domperidone 2 days before apomorphine and stop asap

Question 26

what is the risk of domperidone together with apomorphine?

Answer 26

increases risk of qt interval prolongation and arrhthmia

Question 27

which parkinson drugs are meant to be used IN ADDITION to levodopa?

Answer 27

COMT inhibitors eg entacapone

Question 28

what is the pt and carer advice for tolcapone [COMT inhibitor]?

Answer 28

liver toxicity: warn if signs of liver toxicity eg dark urine etc

Question 29

what is the pt and carer advice for entacapone [COMT inhibitor]

Answer 29

may colour urine red brown

Question 30

what are the pt and carer advice regarding most anti parkinsons drugs? [3]

Answer 30

1. sudden onset of sleep with dopamine agonists. caution with driving
2. hypotensive reactions during first few days of treatment
3. may colour ur urine