CC Sept 2015 Nonmotor symptoms of Parkinson's disease

echoecho's version from 2015-10-30 02:24


Question Answer
In addition to Parkinson's disease (PD) motor-related s/s (tremors, bradykinesia, gait disturbances) affected pts can experience a number of non-motor s/s that can affect what in these patients?their quality of life
List one common nonmotor complaint of Parkinson's disease?daytime somnolence
What is the mechanism regarding the daytime somnolence?1) use of dopamine agonists 2) PD-associted insomnia 3) disease progression
True or false? Pts may have s/s of daytime somnolence with or without insomnia and symptoms may persist despite alterations in PD treatment?true
Pts may be unable to carry out normal daily activities despite what ?good control of their underlying motor disease
*** What medication (commonly used for narcolepsy) improves daytime sleepiness in PD patients as measured by the Epworth Sleepiness Scale?Modafinil (Provigil)
*** Has Modafinil (Provigil) been shown to objectively improve maintenance of wakefulness or improve objective measurement on the Multiple Sleep Latency Test? Therefore, Modafinil is considered the drug of choice for what, but not for what?1)no 2) reducing symptoms 3) but not reducing objective measures of daytime somnolence
Management of sleep disorders, common in PD< may help to reduce what?fatigue and insomnia
What medication reduces restless leg syndrome movements associated with PD and may improve sleep?Levodopa/carbidopa (Sinemet)
Comment on Melatonin, whether it has been shown to improve REM sleep or reduce sleepiness in PD?no it does not
Comment on brain stimulation (that reduces motor symptoms) whether it improves sleep in PD patients?no
What medication improves s/s of fatigue in PD patients, but is ineffective for daytime somnolence? Methylphenidate (Ritalin)
Why should Methylphenidate (Ritalin) be used with caution?as a dopamine agonist, it may increase the chance of habituation and addiction
Does Sertraline (Zoloft) reduce sleepiness or PD-associated depression?no
What type of anti-depressants appear to be the most effective meds for mgmt of depression in PD? What side effects can occur?1) TCAs 2) anticholinergic side effects that may increase the risk of confusion and orthostatic hypotension
Is psychosis (auditory or visual hallucinations) common in PD? Caused by what?1) yes 2) diseaes itself or medical therapy used in its management
List commonly used PD drugs that may result in delirium and psychosis?1) selegiline (Eldpryl) 2) amantadine (Symmetrel) 3) dopamine receptor agonits 4) catechol-O-methyltransferase inhibitors 5) Levodopa
What else may lead to acute delirium that may be confused with psychosis?underlying medication conditions
*** If medication reduction or medical evaluation can't resolve psychotic features, what is the drug of choice for PD-related psychotic features? Why should pts undergo routine CBC testing?1) clozapine (Clozaril) 2) due to the possibility of agranulocytois with this medication
Should olanzapine (Zyprexa) be used in the management of PD psychosis?no
Psychosis must also be differentiated from _____ decline (which is common in PD)? What is the treatment of choice for PD-associated cognitive decline?cognitive; rivastigmine ( Exelon)
List other common PD-asscoiated nonmotor s/s?ED, constipation, drooling, urinary incontinence, anxiety, orthostatic hypotension
It may be difficult to determine whethere these s/s result from PD or from what?medications used for management of PD
Anticholinergic agents used to manage urinary incontinence and drooling may increase what and must be used cautiously?drooling
Anxiety is best treatted with what med (that reduces anxiety w/o causing undue fatigue or sleepiness seen with benzodiazepines?SSRIs
Orthostatic hypotension may result from PD progression or as a complication of what therapy?dopamine agonist therapy
Is there effective medical means of managing orthostatic hypotension in PD?no
What is the best treatment for constipation in PD?osmotic agents like polyethylene glycol
*** SUMMARY - What is a common non-motor complaint and what is the treatment to reduce symptoms?daytime somnolence ; Modafinil
*** SUMMARY - What is another non-motor complaint that may result from the disease itself or medical therapy used for its management?psychosis (auditory or visual hallucinations)
*** SUMMARY - What class of medications is a good choice of treating anxiety in PD?SSRIs