PD

Question 1

Dopamine receptor agonists (purpose and SE)

Answer 1

Examples: Pramipexole, Ropinirole, Rotigotine

If less than 65 y/o: used as monotherapy (delays the initiation of L-Dopa)

Adjunct: to prolong the effects of L-Dopa

SE: Nausea/vomiting, hallucinations, somnolence, postural hypotension, edema

Question 2

NMDA receptor antagonist (purpose and SE)

Answer 2

Example: Amantadine

To treat L-dopa-induced dyskinesias

SE: Cognitive SE

Question 3

L-Dopa Therapy + Combination

Answer 3

Madopar: L-Dopa + Benserazide
Sinemet: L-Dopa + carbidopa

Peripheral DOPA Carboxylase Inhibitors: inhibit the premature conversion of L-dopa into dopamine in the liver, higher quantities of L-dopa can reach CNS

Question 4

SE of L-dopa

Answer 4

1) Levadopa induced dyskinesia
- Peak-dose dyskinesia:
–> Tx: reduce dose, increase frequency (immediate release), add on adjunct: COMT inhibitor, NMDA receptor antagonist
- Off period dystonia: happens in the early morning, Tx: increase dose, frequency (long acting, controlled release formulations), add on adjunct (dopamine agonist, MAO-B inhibitors or COMT inhibitors)
- Diphasic Dyskinesia

2) Motor fluctuations

3) Delay onset of response - take before meals at least 30-60 mins

4) Confusion, Psychosis, Nausea/Vomiting, Dizziness, Dry Mouth
Postural Hypotension

Question 5

What is the absolute contraindication of L-Dopa

Answer 5

Melanoma

Question 6

Symptomatic adjuncts

Answer 6

Tremors - Anticholinergics (Benzhexol)
Rigidity - Selective MAO-B inhibitors

Question 7

SE of COMT inhibitors

Answer 7

Examples: Tolcapone, Entacapone

SE: Diarrhea, Hepatotoxicity

Question 8

Mx Principles for PD

Answer 8

MDT
- Non-pharmaco
- Pharmaco
- Pharmaco for complications
- Surgical