PD - treatment pathway

Question 1

If motor symptoms decrease QOL give any of the following:

Answer 1

Levodopa + carbidopa (co-careldopa)
Levodopa + benserazide (co-bendelopa)

Question 2

If motor symptoms DO NOT decrease QOL, give any of the following

Answer 2

Levodopa OR
Non-ergot derived dopamine receptor agonist (pramipexole, ropinirole, rotigotine) OR
MAO-B inhibitors (rasagiline, selegiline)

Question 3

what preparation to consider if end of dose deterioration or noctural immobility

Answer 3

MR

Question 4

Pt who develop dyskinesia or motor fluctuations despite optimal levodopa therapy should be offered a choice of one of the following as an adjunct to levodopa

Answer 4

Non ergot derived dopamine receptor agonists (e.g. pramipexole, rotigotine, ropinirole), OR
MAO-B inhibitor (rasagiline, selegiline)
COMT inhibitor (entacapone, tolcapone)

Question 5

Patient is on levodopa + non ergot derived DRA for PD. They still have dyskinesia. What next?

Answer 5

consider amantadine

Question 6

Patient is on levodopa + COMT inhibtior for PD. They still have dyskinesia. What next?

Answer 6

consider amantadine

Question 7

Patient is on levodopa + MAOB inhibitor for PD. They still have dyskinesia. What next?

Answer 7

consider amantadine

Question 8

what drug is given to treat excessive day time sleepiness and how does it work

Answer 8

modafinil
CNS stimulant so prevents sleep
take in morning

Question 9

1st and 2nd line for nocturnal akinesia (inability to move)

Answer 9

1. levodopa or oral DRA (prami, ropinirole)
2. DRA patch (rotigotine)

Question 10

1st line and 2nd line for postural hypotension

Answer 10

1. midodrine
2. fludrocortisone

Question 11

1st line and 2nd line antipsychotics that may be used in PD psychotic symptoms

Answer 11

1. quetiapine
2. clozapine

others likely to worsen motor features of PD!! e.g. c1 phenothiazines, butyrophenones

Question 12

2 drugs to treat REM sleep behaviour disorder

Answer 12

clonazepam, melatonin

Question 13

what is given for advanced PD

Answer 13

• Apomorphine HCl intermittent injections or continuous SC infusions

Question 14

this is used for treatment of advanced levodopa-responsive PD with severe motor fluctuations and hyperkinesia or dyskinesia

Answer 14

Levodopa-carbidpoa intestinal gel

Question 15

Patient comes in and says that their pee, saliva or tongue turns a reddish colour. What drug is this?

Answer 15

Normal with levodopa, not harmful

Question 16

These drugs - not levodopa - colour your urine. What drugs and what colour?

Answer 16

COMT inhibitors will colour your urine a bright reddish/brown orange colour but this isn’t harmful