PD #2 Flashcards
QuesMed
What are the main features of multiple system atrophy type C? [2]
characterised by cerebellar features, with profound central autonomic signs
What is the best management of drug-induced parkinsonism? [1]
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.
QuesMed
What are the main features of Parkinson’s disease [4]
- Resting tremor
- Rigidity
- Bradykinesia
- Postural instability
What medications are used to treat Essential tremor? [2]
Propranolol, Primidone
What drugs are most associated with drug induced parkinsonism? [3]
Phenothiazines (Prochlorperazine, Chlorpromazine, Fluphenazine etc) and Butyrophenones (Haloperidol, Droperidol etc)
Suspect progresive supranuclear palsy in patients with parkinsonism and which features? [3]
Eye movement disorder (vertical gaze palsy)
Early postural instability and axial rigidity
Early cogntive dysfunction
Suspect vascular parkinsonism in patients with which features? [2]
Parkinsonism restricted to the lower limbs (bilaterally)
QuesMed
In addition to typical Parkinsonian features, what is the cardinal sign of Lewy body dementia? [3]
Early fluctuations in cognitive impairment and visual hallucinations.
Idiopathic Parkinson’s disease: symmetric or asymmetric? [1]
Profoundly asymmetric, and remains so throughout disease course.
Which brain region is affected in antipsychotic induced parkinsonism? [1]
Nigrostriatal tract
What is the definition of Parkinson’s disease dementia (PDD)? [1]
Onset of cognitive dysfunction 1 year after symptoms onset.
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
Ropinirole
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
Bromocriptine
e.g. bromocriptine, ropinirole, cabergoline, apomorphine
Which PD drug class has greatest risk of hallucinations? [1]
Name some examples [2]
Dopamine agonists
- e.g. bromocriptine, ropinirole, cabergoline, apomorphine
In general, which class of PD drugs has the greatest risk of AEs? [1]
COMT inhibitors
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]
Modafinil
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.
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.
Consider [] to manage drooling of saliva in people with Parkinson’s disease.
Consider glycopyrronium bromide to manage drooling of saliva in people with Parkinson’s disease.
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
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
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]
ergot-derived dopamine receptor agonists (bromocriptine, cabergoline)
side-effects include ataxia, slurred speech, confusion, dizziness and livedo reticularis
This is about wich drug? [1]
Amantadine
* mechanism is not fully understood, probably increases dopamine release and inhibits its uptake at dopaminergic synapses
