Podcast
Questions and Answers
Which of the following is not a nonpharmacologic therapy for Parkinson's Disease?
Which of the following is not a nonpharmacologic therapy for Parkinson's Disease?
What is the primary aim of pharmacologic therapy for motor symptoms in Parkinson's Disease?
What is the primary aim of pharmacologic therapy for motor symptoms in Parkinson's Disease?
According to treatment recommendations, what drugs do AAN and MDS suggest for Parkinson's Disease once motor symptoms appear?
According to treatment recommendations, what drugs do AAN and MDS suggest for Parkinson's Disease once motor symptoms appear?
What is the recommended approach for PD medication discontinuation?
What is the recommended approach for PD medication discontinuation?
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Which medication provides the greatest motor improvement in Parkinson's Disease?
Which medication provides the greatest motor improvement in Parkinson's Disease?
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Which medication may delay the onset of dyskinesias but has less motor benefit and a greater risk of hallucinations or somnolence?
Which medication may delay the onset of dyskinesias but has less motor benefit and a greater risk of hallucinations or somnolence?
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Which of the following is a common side effect of rotigotine patch?
Which of the following is a common side effect of rotigotine patch?
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What is the primary adverse effect of MAO-B inhibitors in Parkinson's Disease treatment?
What is the primary adverse effect of MAO-B inhibitors in Parkinson's Disease treatment?
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What is one of the goals of treatment for Parkinson's Disease?
What is one of the goals of treatment for Parkinson's Disease?
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According to the 2002 American Academy of Neurology (AAN) guidelines, when should pharmacologic treatment be initiated for Parkinson's Disease?
According to the 2002 American Academy of Neurology (AAN) guidelines, when should pharmacologic treatment be initiated for Parkinson's Disease?
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What does the 2017 National Institute for Health and Care Excellence (NICE) guidelines recommend regarding the timing of treatment initiation for Parkinson's Disease?
What does the 2017 National Institute for Health and Care Excellence (NICE) guidelines recommend regarding the timing of treatment initiation for Parkinson's Disease?
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What are the three categories into which the general approach to Parkinson's Disease treatment is categorized?
What are the three categories into which the general approach to Parkinson's Disease treatment is categorized?
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According to the learning objectives, what should the reader be able to recommend for a patient initiating therapy for Parkinson's Disease?
According to the learning objectives, what should the reader be able to recommend for a patient initiating therapy for Parkinson's Disease?
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What is the main focus of formulating a plan to minimize patient 'off-time' and maximize 'on-time' in Parkinson's Disease management?
What is the main focus of formulating a plan to minimize patient 'off-time' and maximize 'on-time' in Parkinson's Disease management?
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What is the emphasis of the 2017 NICE guidelines regarding the timing of pharmacologic treatment for Parkinson's Disease?
What is the emphasis of the 2017 NICE guidelines regarding the timing of pharmacologic treatment for Parkinson's Disease?
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What should be considered when deciding on the initial treatment for Parkinson's Disease according to the 2002 AAN guidelines?
What should be considered when deciding on the initial treatment for Parkinson's Disease according to the 2002 AAN guidelines?
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What are the desired outcomes of the treatment for Parkinson's Disease?
What are the desired outcomes of the treatment for Parkinson's Disease?
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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.
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Description
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'.