Parkinson’s Disease Management
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Questions and Answers

Which patient population is most likely to benefit from the use of oxybutynin?

  • Patients with urinary tract infections
  • Patients with uninhibited neurogenic bladder, including those with detrusor overactivity associated with a neurological condition (correct)
  • Patients with bladder outlet obstruction
  • Frail older adults

    • What is the main reason why a different antibiotic should be chosen to treat any concurrent urinary tract infection when prescribing oxybutynin?

  • Oxybutynin is contraindicated in patients with bladder outlet obstruction
  • Oxybutynin is not effective in treating urinary tract infections
  • Oxybutynin is not well tolerated in long-term administration
  • Oxybutynin increases blood levels and bioavailability of nitrofurantoin (correct)

    • What is the initial recommended dose of oxybutynin for frail older adults?

  • 5 to 10 mg daily for the extended-release (XL) formulation
  • 2.5 mg given two or three times a day (correct)
  • 5 mg two or three times a day
  • 15 mg/day of immediate release

    • What is the maximum recommended daily dose of the immediate-release formulation of oxybutynin?

    <p>20 mg/day (D)</p> Signup and view all the answers

    Which of the following statements about the transdermal formulation of oxybutynin is correct?

    <p>It is available in a 3.9 mg system (A)</p> Signup and view all the answers

    What is the initial recommended dose of darifenacin, an extended-release formulation?

    <p>7.5 mg once daily (B)</p> Signup and view all the answers

    How does a high-fat meal affect the absorption of the extended-release formulation of trospium?

    <p>It reduces the absorption, with AUC and Cmax values 70% and 80% lower than those obtained while fasting (B)</p> Signup and view all the answers

    What is the recommended initial dosage of mirabegron, the newest drug approved for the treatment of overactive bladder in adults?

    <p>25 mg once daily (C)</p> Signup and view all the answers

    How long does it typically take for mirabegron to reach full effectiveness?

    <p>Up to 8 weeks (D)</p> Signup and view all the answers

    What is a potential safety concern with the use of mirabegron?

    <p>Increased risk of poorly controlled hypertension (B)</p> Signup and view all the answers

    What is the first-line management approach for Parkinson's disease?

    <p>Dopaminergics (C)</p> Signup and view all the answers

    In Parkinson's disease, cholinergic blockers are primarily used for what purpose?

    <p>To control tremor by relaxing smooth muscle (D)</p> Signup and view all the answers

    Which patient group is most likely to benefit from cholinergic blockers early in the course of Parkinson's disease?

    <p>Middle-aged patients with little rigidity or bradykinesia (B)</p> Signup and view all the answers

    What is the initial dose of Trihexyphenidyl when used as an adjunct to carbidopa/levodopa therapy?

    <p>1-2 mg/day (C)</p> Signup and view all the answers

    When is it recommended to switch a patient from regular formulations to sustained-release capsules of medication in Parkinson's disease management?

    <p>After initial stabilization on regular formulations (A)</p> Signup and view all the answers

    How should high doses of Trihexyphenidyl be administered in Parkinson's disease management?

    <p>Four times daily at mealtimes and bedtime (A)</p> Signup and view all the answers

    What is the most common adverse effect associated with the drugs discussed in the text?

    <p>Nausea (B)</p> Signup and view all the answers

    What is the recommended dose adjustment for fesoterodine and solifenacin in patients with severe renal impairment (CrCl less than 30 mL/min)?

    <p>The dose should not exceed the initial dose. (B)</p> Signup and view all the answers

    How should trospium be dosed in patients with severe renal impairment?

    <p>The dose must not exceed the initial dose of 20 mg. (A)</p> Signup and view all the answers

    Which of the drugs discussed is contraindicated in the presence of severe hepatic impairment?

    <p>All of the drugs except trospium (A)</p> Signup and view all the answers

    What is the recommended initial adult dose of atropine for the management of irritable bowel syndrome (IBS) and peptic ulcer disease?

    <p>400 mcg every 4 to 6 hours (A)</p> Signup and view all the answers

    What is the only oral dose of dicyclomine shown to be effective for the management of irritable bowel syndrome (IBS)?

    <p>160 mg/day in four equally divided doses (C)</p> Signup and view all the answers

    How is scopolamine transdermal used for the prevention of nausea and vomiting associated with motion sickness?

    <p>One disk is applied to the clean, dry, postauricular skin at least 4 hours before the antiemetic effect is desired. (A)</p> Signup and view all the answers

    What is the maximum dose of atropine recommended for children?

    <p>400 mcg (C)</p> Signup and view all the answers

    What is the antidote for atropine poisoning?

    <p>Physostigmine (C)</p> Signup and view all the answers

    Which of the following is a symptom of atropine poisoning in infants and children?

    <p>All of the above (D)</p> Signup and view all the answers

    What is the recommended daily fluid intake for patients taking cholinergic blockers?

    <p>At least 2 quarts of noncaffeinated fluid (B)</p> Signup and view all the answers

    Which activity should be avoided when taking cholinergic blockers due to the drug's side effects?

    <p>Vigorous activities in warm weather (C)</p> Signup and view all the answers

    What is a common side effect of cholinergic blockers on the respiratory system?

    <p>Decreased sweating (A)</p> Signup and view all the answers

    How can dry mouth caused by cholinergic blockers be alleviated?

    <p>Chewing sugarless gum (C)</p> Signup and view all the answers

    What should patients do if they experience a heart rate above 100 bpm while on medication?

    <p>Report it immediately (C)</p> Signup and view all the answers

    Besides medications, what other therapies can be used in treating incontinence and related disorders?

    <p>Kegel exercises and bladder retraining (C)</p> Signup and view all the answers

    What is the recommended dose of propantheline for adults?

    <p>15 mg 30 minutes before meals and 30 mg at bedtime (D)</p> Signup and view all the answers

    For which group of patients is the lower dose of propantheline recommended?

    <p>Patients with mild manifestations, older adults, and patients of small stature (D)</p> Signup and view all the answers

    What is the recommended dose of propantheline for children for antisecretory indications?

    <p>1.5 mg/kg per day (B)</p> Signup and view all the answers

    Which drug was commonly prescribed as an adjunct treatment for IBS?

    <p>Donnatal (A)</p> Signup and view all the answers

    How is benztropine recommended to be administered to minimize gastric irritation?

    <p>With food or immediately after meals (C)</p> Signup and view all the answers

    When should oxybutynin be administered?

    <p>On an empty stomach (A)</p> Signup and view all the answers

    How long should the scopolamine disk be left in place for its antiemetic effect?

    <p>Up to 3 days (C)</p> Signup and view all the answers

    'Slightly fewer adverse reactions' is associated with some drugs based on what parameter?

    <p>'Adherence' (B)</p> Signup and view all the answers

    'Monitoring beyond adverse reactions' is not required for which type of medications?

    <p>'Cholinergic blockers' (A)</p> Signup and view all the answers

    'Calibrated measuring instruments' should be used with liquid formulations to ensure what?

    <p>'Accurate dose' (D)</p> Signup and view all the answers

    Which medication is used for the treatment of symptomatic neurogenic orthostatic hypotension caused by Parkinson's disease?

    <p>Droxidopa (C)</p> Signup and view all the answers

    What is a potential adverse effect of droxidopa that requires regular monitoring?

    <p>Supine hypertension (A)</p> Signup and view all the answers

    Which medication is recommended for the management of akathisia arising from antipsychotic drugs?

    <p>Both trihexyphenidyl and benztropine (C)</p> Signup and view all the answers

    What is the initial recommended dose of trihexyphenidyl for managing extrapyramidal symptoms (EPS)?

    <p>1 mg (B)</p> Signup and view all the answers

    Which of the following statements is true regarding the use of benztropine for managing extrapyramidal symptoms?

    <p>Dosage titration is in 0.5 mg increments at 5- or 6-day intervals. (C)</p> Signup and view all the answers

    Which of the following medications is used for the treatment of overactive bladder and urinary incontinence?

    <p>Oxybutynin (B)</p> Signup and view all the answers

    Which of the following statements is true about the mechanism of action of medications used for overactive bladder and urinary incontinence?

    <p>They inhibit the muscarinic action of acetylcholine on smooth muscle. (C)</p> Signup and view all the answers

    What is the recommended approach for managing extrapyramidal symptoms (EPS) caused by antipsychotic drugs?

    <p>Temporarily reduce the dose of the antipsychotic drug while initiating trihexyphenidyl or benztropine therapy. (A)</p> Signup and view all the answers

    Which of the following statements is true regarding the use of trihexyphenidyl for managing extrapyramidal symptoms (EPS)?

    <p>Symptoms have been controlled with as little as 1 mg/day in some patients. (D)</p> Signup and view all the answers

    What is a potential approach for determining the need for continued therapy with trihexyphenidyl or benztropine for extrapyramidal symptoms (EPS)?

    <p>Withdraw the drug after several weeks to see if symptoms return. (D)</p> Signup and view all the answers

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