Chapter 33. Parkinson Disease
Patients with Parkinson disease (PD) have both motor and nonmotor symptoms. Which of the following statements regarding nonmotor symptoms associated with PD is true?
A. Depression is common in PD and can become worse when starting a COMT inhibitor
B. Diarrhea is usually problematic throughout the course of PD in most patients
C. Sleep problems are related to drug therapy for PD and can easily be treated by changing medications
D. Improving the on time may improve select nonmotor symptoms
E. The risk of falls in patients with PD is similar to that of patients without PD
BB, a 75-year-old man with PD, comes to the pharmacy to pick up his prescriptions. He is currently taking Sinemet, ropinirole, and rasagiline. His wife tells you that for the last month after starting the ropinirole her husband has been talking to people who are not present. BB does not seem bothered by the hallucinations. Which of the following is appropriate to minimize BB’s hallucinations?
A. Decrease the dose of Sinemet or ropinirole
B. Switch rasagiline to a COMT inhibitor
C. The hallucination should improve without intervention as he becomes used to the medications changes
D. Add low dose quetiapine
CC has had PD for 10 years. He takes one carbidopa/levodopa 25/100 mg tablet at 8 am, 2 pm, and 8 pm, and he reports that the 8 am dose and 2 pm dose wear off 1 to 2 hours early. Which of the following options would be best to minimize early wearing off symptoms for this patient?
A. Administer levodopa with food and add a dopamine agonist
B. Change to carbidopa/levodopa liquid formulation
C. Increase each carbidopa/levodopa dose by one tablet
D. Decrease the dosage of carbidopa to 10 mg
E. Change dose times of carbidopa/levodopa to 8 am, Noon, 4 pm and possibly 8 pm if needed
DD is a newly diagnosed patient with PD. Which of the following statements regarding treatment with MAO-B inhibitors is true?
A. Greatest efficacy has been seen in late-stage PD