PD #2

Question 1

QuesMed

What are the main features of multiple system atrophy type C? [2]

Answer 1

characterised by cerebellar features, with profound central autonomic signs

Question 2

What is the best management of drug-induced parkinsonism? [1]

Answer 2

Stopping the offending drug - although if this is an antipsychotic that has been beneficial for the patient this should be done in communication with the psychiatrist responsible for their care.

Question 3

QuesMed

What are the main features of Parkinson’s disease [4]

Answer 3

• Resting tremor
• Rigidity
• Bradykinesia
• Postural instability

Question 4

What medications are used to treat Essential tremor? [2]

Answer 4

Propranolol, Primidone

Question 5

What drugs are most associated with drug induced parkinsonism? [3]

Answer 5

Phenothiazines (Prochlorperazine, Chlorpromazine, Fluphenazine etc) and Butyrophenones (Haloperidol, Droperidol etc)

Question 6

Suspect progresive supranuclear palsy in patients with parkinsonism and which features? [3]

Answer 6

Eye movement disorder (vertical gaze palsy)
Early postural instability and axial rigidity
Early cogntive dysfunction

Question 7

Suspect vascular parkinsonism in patients with which features? [2]

Answer 7

Parkinsonism restricted to the lower limbs (bilaterally)

Question 8

QuesMed

In addition to typical Parkinsonian features, what is the cardinal sign of Lewy body dementia? [3]

Answer 8

Early fluctuations in cognitive impairment and visual hallucinations.

Question 9

Idiopathic Parkinson’s disease: symmetric or asymmetric? [1]

Answer 9

Profoundly asymmetric, and remains so throughout disease course.

Question 10

Which brain region is affected in antipsychotic induced parkinsonism? [1]

Answer 10

Nigrostriatal tract

Question 11

What is the definition of Parkinson’s disease dementia (PDD)? [1]

Answer 11

Onset of cognitive dysfunction 1 year after symptoms onset.

Question 12

A 72-year-old man presents to the general practitioner with his wife. His wife is concerned as he is spending most of his pension on gambling, which is out of character for him. She says this has been since he started a new medication. He has a past medical history of Parkinson’s disease.

What medication is likely to have caused this change in his personality?

Entacapone
Levodopa
Procyclidine
Rasagiline
Ropinirole

Answer 12

Ropinirole

Question 13

A 67-year-old man is diagnosed with Parkinson’s disease after presenting to his GP with a resting tremor and difficulty initiating movement. He is started on a medication to treat this by his neurologist. At his review a few months later, he says that his symptoms have been much better but his wife has been complaining because he has started to spend a significant amount of money betting on football matches. His wife adds that this is very out of character for him.

Which of the following medications is he likely to have been prescribed?

Amantadine
Bromocriptine
Entacapone
Levodopa
Selegiline

Answer 13

Bromocriptine

e.g. bromocriptine, ropinirole, cabergoline, apomorphine

Question 14

Which PD drug class has greatest risk of hallucinations? [1]

Name some examples [2]

Answer 14

Dopamine agonists
- e.g. bromocriptine, ropinirole, cabergoline, apomorphine

Question 15

In general, which class of PD drugs has the greatest risk of AEs? [1]

Answer 15

COMT inhibitors

Question 16

PD medications can make patients excessively drowsy. This can be combated by adjusting medication. However, if this does not work then which anti-drowsiness medication can you use? [1]

Answer 16

Modafinil

Question 17

If orthostatic hypotension develops then a medication review looking at potential causes should be done. If symptoms persist then [] (acts on peripheral alpha-adrenergic receptors to increase arterial resistance) can be considered.

Answer 17

If orthostatic hypotension develops then a medication review looking at potential causes should be done. If symptoms persist then midodrine (acts on peripheral alpha-adrenergic receptors to increase arterial resistance) can be considered.

Question 18

Consider [] to manage drooling of saliva in people with Parkinson’s disease.

Answer 18

Consider glycopyrronium bromide to manage drooling of saliva in people with Parkinson’s disease.

Question 19

It is important not to acutely stop levodopa, for example, if a patient is admitted to hospital.

However, if a patient with Parkinson’s disease cannot take levodopa orally, they can be given a [] as rescue medication to prevent acute dystonia

Answer 19

it is important not to acutely stop levodopa, for example, if a patient is admitted to hospital
if a patient with Parkinson’s disease cannot take levodopa orally, they can be given a dopamine agonist patch as rescue medication to prevent acute dystonia

Question 20

The Committee on Safety of Medicines advice that an echocardiogram, ESR, creatinine and chest x-ray should be obtained prior to treatment and patients should be closely monitored

This relates to which medications? [2]

Answer 20

ergot-derived dopamine receptor agonists (bromocriptine, cabergoline)

Question 21

side-effects include ataxia, slurred speech, confusion, dizziness and livedo reticularis

This is about wich drug? [1]

Answer 21

Amantadine
* mechanism is not fully understood, probably increases dopamine release and inhibits its uptake at dopaminergic synapses