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Chapter 52. Parkinson Disease

NI has been taking carbidopa/levodopa for her Parkinson disease for 6 years. She recently had her dose increased to 50/200 mg po qid, and is now experiencing writhing movements in her trunk and arms. What medication is Food and Drug Administration (FDA)-approved to treat this side effect of carbidopa/levodopa therapy?

a. Gocovri

b. Osmolex

c. Stalevo

d. Symmetrel

Answer a is correct. Gocovri is an extended-release formulation of amantadine that is FDA-approved for the treatment of carbidopa/levodopa-induced dyskinesia.

Answer b is incorrect. While Osmolex is an extended-release formulation of amantadine, it is not FDA-approved for the treatment of dyskinesias.

Answer c in incorrect. Stalevo is a combination of carbidopa/levodopa and entacapone. Adding this drug to NI's current regimen is likely to cause dyskinesias to get worse by increasing the amount of exogenous levodopa administered, as well as inhibiting its breakdown with the use of a catechol-o-methyltransferase (COMT) inhibitor.

Answer d is incorrect. Immediate-release amantadine is not FDA-approved for use as a treatment for dyskinesias.

AB is a 57-year-old woman who has just been diagnosed by a movement disorder specialist in your clinic as having Parkinson disease. Her diagnosis was delayed as she lives in a rural area, and there are no neurologists near her home. She presents with moderate bradykinesia, and only mild tremor and rigidity on her right side. She is not currently taking any other medications. Which of the following are appropriate to be considered as monotherapy for AB? Select all that apply.

a. Carbidopa/levodopa

b. Benztropine

c. Pramipexole

d. Rasagiline

Answer a is correct. Carbidopa/levodopa replaces dopamine, therefore appropriate to treat all of the symptoms of Parkinson disease exhibited by AB.

Answer b is incorrect. Benztropine is an anticholinergic medication that is appropriate primarily for patients who have a predominant tremor. It might treat AB's rigidity but is unlikely to be particularly efficacious for bradykinesia. In addition, use is possibly linked to an increased risk of dementia in the future.

Answer c is correct. While not as potent as carbidopa/levodopa, the dopamine agonist pramipexole will treat all of AB's Parkinson disease symptoms.

Answer d is correct. Rasagiline can be used as monotherapy early in Parkinson disease treatment as long as the patient has enough endogenous dopamine for the drug, a monoamine oxidase (MAO) inhibitor, to act upon (as patients in the early stages of ...

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