17 Questions
Which of the following is not a nonpharmacologic therapy for Parkinson's Disease?
Levodopa
What is the primary aim of pharmacologic therapy for motor symptoms in Parkinson's Disease?
Enhancing dopaminergic activity in the substantia nigra
According to treatment recommendations, what drugs do AAN and MDS suggest for Parkinson's Disease once motor symptoms appear?
Levodopa/carbidopa or a dopamine agonist
What is the recommended approach for PD medication discontinuation?
Gradual discontinuation with monitoring for worsening motor symptoms
Which medication provides the greatest motor improvement in Parkinson's Disease?
Levodopa
Which medication may delay the onset of dyskinesias but has less motor benefit and a greater risk of hallucinations or somnolence?
Dopamine agonists
Which of the following is a common side effect of rotigotine patch?
Nausea and vomiting
What is the primary adverse effect of MAO-B inhibitors in Parkinson's Disease treatment?
Confusion and hallucinations
What is one of the goals of treatment for Parkinson's Disease?
Maintaining activities of daily living (ADL) and quality of life (QOL)
According to the 2002 American Academy of Neurology (AAN) guidelines, when should pharmacologic treatment be initiated for Parkinson's Disease?
After significant functional disability appears
What does the 2017 National Institute for Health and Care Excellence (NICE) guidelines recommend regarding the timing of treatment initiation for Parkinson's Disease?
Offer early treatment even before quality of life is affected
What are the three categories into which the general approach to Parkinson's Disease treatment is categorized?
Lifestyle changes, medication, and non-pharmacologic interventions
According to the learning objectives, what should the reader be able to recommend for a patient initiating therapy for Parkinson's Disease?
Recommend appropriate drug therapy and construct patient-specific treatment goals
What is the main focus of formulating a plan to minimize patient 'off-time' and maximize 'on-time' in Parkinson's Disease management?
Timing, dosage, and frequency of medications
What is the emphasis of the 2017 NICE guidelines regarding the timing of pharmacologic treatment for Parkinson's Disease?
"Early Trt" with dopamine agonists, levodopa, or MAO-B inhibitors even before QOL is affected
What should be considered when deciding on the initial treatment for Parkinson's Disease according to the 2002 AAN guidelines?
Age, risk of adverse effects, degree of physical impairment, and readiness to initiate therapy
What are the desired outcomes of the treatment for Parkinson's Disease?
"Maintaining patient independence, activities of daily living (ADL) and quality of life (QOL)"
Study Notes
- Nonpharmacologic therapy for Parkinson's Disease (PD) includes good nutrition, physical activity, and social interactions, which improve activities of daily living (ADLs), gait, balance, and mental health.
- Pharmacologic therapy for motor symptoms aims to enhance dopaminergic activity in the substantia nigra.
- Choice of pharmacologic agent depends on patient-specific parameters and dosage regimens.
- treatment recommendations: AAN and MDS suggest levodopa/carbidopa or a dopamine agonist, while NICE recommends levodopa/carbidopa - once motor symptoms appear.
- Treatment includes initiation with gradual dosage titration, maintaining therapy at lowest effective dosage, and discontinuing therapy with gradual tapering if necessary.
- Drugs for PD:
- Drugs that affect brain dopaminergic system: dopaminergic agonists (bromocriptine, pergolide), dopamine precursor (levodopa), peripheral decarboxylase inhibitors (carbidopa, benserazide), MAO-B inhibitor (selegiline, rasagiline), and COMT inhibitors (entacapone, tolcapone).
- Drugs that affect brain cholinergic system: central anticholinergics (procyclidine) and antihistaminics (orphenadrine, promethazine).
- Drug choice is based on clinical experience and patient preference.
- PD medication discontinuation is gradual and monitored for worsening motor symptoms.
- Starting with a dopamine agonist may delay the onset of dyskinesias but has less motor benefit and a greater risk of hallucinations or somnolence.
- Levodopa provides the greatest motor improvement but has adverse effects: GIT (anorexia, nausea, and vomiting), CVS (orthostatic hypotension and cardiac arrhythmias), and centrally mediated adverse effects (dyskinesias and serious mental disturbances).
- Anticholinergics minimize resting tremor and drooling but are not as effective as other agents for rigidity, bradykinesia, and gait problems.
- Amantadine is effective as monotherapy and adjunct therapy for off time and dyskinesia.
- MAO-B inhibitors (safinamide, selegiline, and rasagiline) provide a mild symptomatic benefit and help delay dopaminergic medications.
- MAO-B inhibitors have adverse effects: nausea, confusion, hallucinations, jitteriness, insomnia, and orthostatic hypotension.
- Dopamine agonists delay levodopa therapy and have smaller risks of motor fluctuations during the first 4 to 5 years of treatment.
- Rotigotine patch minimizes pulsatile stimulation of dopamine and has common side effects: nausea, vomiting, sedation, orthostatic hypotension, and uncommon ergot side effects.
- Istradefylline, the first adenosine A2A receptor antagonist, is US-FDA approved for treating off episodes in PD.
- Specialist care for PD patients includes: dentist, dietician, speech therapist, physical therapist, occupational therapist, and social worker.
Test your knowledge of Parkinson's disease management with this quiz. Learn how to recommend appropriate drug therapy, recognize and treat motor complications and non-motor symptoms, and formulate plans to minimize patient 'off-time' and maximize 'on-time'.
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