Parkinsons Disease

Question 1

What motor (movement) symptoms can parkinson cause?

Answer 1

• bradykinesia - with at least one of the following:
• unilateral resting tremor
• muscle rigidity
• postural instability

Also motor symptoms relating to medication are:
immobility
slowness
communication difficulties
motor fluctuation
dyskinisea
freezing of gait

Question 2

Non-motor symptoms can include

Answer 2

• constipation
• urinary problems
• postural hypotension
• reduced sense of smell
• pain
• dementia
• depression
• REM sleep behaviour disorder (dream enacting behaviour)

Question 3

Suspect parkinson disease if a person has progressive:

Answer 3

bradykinesia - slowness in initiation of voluntary movement with progressive reduction in speed and amplitude of repetitive actions such as finger or foot tapping

or

Hypokinesia - poverty of movement for example reduced facial expression, arm swing or blinking. difficulty with fine movements such as opening jars, buttoning clothes, cramped handwriting. or slow, shuffling, festinating fait or difficulty turning in bed.

In addition a persoon typically presents with at least one of the following

• stiffness or rigidity predominantly affecting side of onset
• rest tremore
• balance or gait problems

These conditions are usually unilateral in early disease but become bilateral as disease progresses

Question 4

Differential diagnosis and what can cause this

Answer 4

drug induced parkinosium
-antipyscotics
-antiemetics
other drugs e.g. lithium, amiodorone, CCB’s etc

• cerebrovascualr disease
• non-parkinsons dementia
• wilsons disease
• head injury

Question 5

What do we offer people at the early stages of parkinson who motor symptoms do effect their quality of life?

Answer 5

levodopa

Question 6

What do we offer people at the early stages of parkinson who motor symptoms do not effect their quality of life?

Answer 6

a choice of dopamine agonist, levodopa, monoamine oxidase inhibitor

Question 7

What side effects can patients get with dopaminergic therapy - especially dopamine agonists?

Answer 7

impulse disorders. Also excessive sleepiness and sudden onset of sleep.

Question 8

What do we add to levodopa for people with parkinson disease who have developed dyskinesia or motor fluctuations despite optimal levodopa therapy

Answer 8

dopamine agonist
monoamineoxidase inhibitor
catechol-o-methyl transferase inhibitor

Question 9

What can contribute to the risk of a patient developing impulse behaviour?

Answer 9

• dopamine agonist therapy
• a history of previous impulse behaviours
• smoking and alcohol XS

Question 10

whats can we use for daytime sleeping?

Answer 10

modafinil

Question 11

what can we used for orthostatic hypertension?

Answer 11

midodrine (if not tolerated can use fludricortisone)

Question 12

what can we use for dementia?

Answer 12

cholinesterase inhibitor

Question 13

which one of the following is not recommended as mono therapy early in PD?

• co-careldopa
• pramipexole
• entacapone
• rasagiline
• rotigotine

Answer 13

entacapone

Question 14

What are side effects of dopamine agonists?

Answer 14

nausea
impulse control disorders
peripheral oedema
hallucinations

NOT HYPERTENSION because it is HYPOTENSION

Question 15

what is the initial dose of entacapone and the max dose of entacapone?

Answer 15

200 mg daily

Max dose 2gram per day

Question 16

Examples of medicines that may worsen the symptoms of parkinson disease

Answer 16

lithium
methyldopa
metoclopramide
prochlorperazine

Question 17

What is entacapone used for?

Answer 17

End of dose motor fluctuations so can be taken frequently throughout the day

Question 18

Facts about PD meds

Answer 18

• amantadine should be avoided in the evening as it may cause insomnia
• apomorphine injections/infusions can cause skin modules
• rotigotine patches should be left on overnight aswell as during the day
• entacpone May turn urine a red/brownish colour

Question 19

Levodopa + DDA (Decarboxylase inhibitor)

Co-beneldopa
Co-careldopa

Answer 19

Precursor of dopamine
It acts by replenishing depleted dopamine

It is given with the inhibitor to reduce the peripheral conversion of levodopa to dopamine

Question 20

dopamine agonists

Answer 20

Rapinerole, rotigotine, pramipexole

Act on post synaptic dopamine receptors

Question 21

Antimuscarinics

Answer 21

orphenadrine Hcl
Procyclidine
trihexyphenidylhydrochloride

Reduced the effects of the relative central cholinergic excess that occurs as a result of dopamine deficiency

Question 22

catechol-O-amine transferase inhibitor

Answer 22

entacapone
tokapine

Increase the amount of levodopa that can cross the BBB

Question 23

monoamine oxidase inhibitors

Answer 23

rasagaline
selegiiline

They increase the amount of dopamine at receptors int he stratum by preventing its metabolism

Question 24

amantadine

Answer 24

symmetry
lysovir
prevents the reuptake of dopamine at the synapses.