Parkinson's Parkinson's Treatment and Medications 2 — Questions and Answers
Question 1: The 'wearing-off' phenomenon in Parkinson's disease refers to:
- Return of symptoms before the next levodopa dose is due (Correct answer)
- Complete loss of response to levodopa
- Dyskinesias at peak dose
- Tremor worsening at night
Correct answer: Return of symptoms before the next levodopa dose is due
Wearing-off occurs when the benefit of a levodopa dose diminishes before the next scheduled dose, causing re-emergence of Parkinson's symptoms.
Question 2: Which COMT inhibitor is used as an adjunct to levodopa/carbidopa to extend the duration of each dose?
- Entacapone (Comtan) (Correct answer)
- Amantadine
- Benztropine
- Apomorphine
Correct answer: Entacapone (Comtan)
Entacapone inhibits COMT, an enzyme that breaks down levodopa, thereby extending the duration of each levodopa dose and reducing wearing-off.
Question 3: Impulse control disorders (gambling, hypersexuality, compulsive eating) in Parkinson's patients are most commonly associated with which medication class?
- Dopamine agonists (Correct answer)
- Levodopa
- MAO-B inhibitors
- Anticholinergics
Correct answer: Dopamine agonists
Dopamine agonists are strongly associated with impulse control disorders in Parkinson's patients due to their direct stimulation of mesolimbic dopamine pathways.
Question 4: What is the primary target of deep brain stimulation (DBS) most commonly used for Parkinson's disease in the US?
- Subthalamic nucleus (STN) (Correct answer)
- Globus pallidus interna (GPi) only
- Thalamus (VIM)
- Substantia nigra
Correct answer: Subthalamic nucleus (STN)
The subthalamic nucleus (STN) is the most commonly targeted brain region for DBS in Parkinson's disease, though the globus pallidus interna (GPi) is also used.
Question 5: Which route of administration is used for apomorphine rescue therapy in Parkinson's disease?
- Subcutaneous injection (Correct answer)
- Oral tablet
- Transdermal patch
- Intravenous infusion
Correct answer: Subcutaneous injection
Apomorphine is administered as a subcutaneous injection for rapid rescue therapy during off episodes in Parkinson's disease.
Question 6: Anticholinergic medications for Parkinson's are most useful for treating which specific symptom?
- Tremor (Correct answer)
- Bradykinesia
- Postural instability
- Freezing of gait
Correct answer: Tremor
Anticholinergic drugs like benztropine and trihexyphenidyl are most effective for tremor in Parkinson's disease, particularly in younger patients.
Parkinson's Parkinson's Treatment and Medications 2
The 'wearing-off' phenomenon in Parkinson's disease refers to: