cirus
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| | 08/08/07 - 03:40 AM
2 of 2 forum leaders found this post helpful
| #1 |
A 39-year-old Japanese man comes to your office after he has developed a festinating gait and poverty of voluntary movement. On physical examination, he has cogwheel rigidity of the limbs and a pill-rolling type of tremor at rest. His symptoms are moderate and do not interfere with his ability to dress himself or to care for himself in general. He started noticing these symptoms seven years ago, and they have been getting progressively worse. Over the past year, his face has become mask-like. An MRI and CT scan of the head show nothing abnormal. Which of the following would be appropriate for this patient?
(A) Levodopa
(B) Pramipexole or ropinirole
(C) Sinemet (carbidopa and levodopa)
(D) Benztropine (Cogentin)
(E) Amantadine
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| kpmle2
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D)..
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| khorshid
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D  person under 60 which is still functional, we don't start with levodopa/carbidopa.
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| cirus
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Well, that was my answer too, & thats why i posted this q. We are wrong (accord to the answer)
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| khorshid
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Is it C? (what is the source of q cirus?)
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| cirus
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Answer:
(B) Pramipexole or ropinirole
Explanation:
This patient has the gait and movement abnormalities, tremor, and cogwheeling consistent with Parkinson's disease (PD). Patients who develop severe functional impairment that interferes with daily living should be treated with Sinemet (levodopa/carbidopa). Younger patients seem to be at higher risk of developing complications with long-term levodopa treatment, such as motor fluctuations, choreiform dyskinesias, and painful "on/off" dystonias. These complications are sometimes as disabling as the tremor and bradykinesia of the actual disease and may persist despite changes in the medications. The initial therapy as per current guidelines is to start with a dopamine agonist and add Sinemet later if dopamine agonists (such as pramipexole or ropinirole) at high doses don't improve function or if the patient can't tolerate the adverse effects of these medications. There is some evidence that dopamine agonists may have a protective effect upon neural tissue.
Tremor and drooling are common problems in PD that may respond particularly well to anticholinergics, such as benztropine or trihexyphenidyl. Anticholinergics are particularly useful when the patient is young and has mild parkinsonian symptoms. Amantadine is used in older patients with mild disease for tremor, rigidity, and bradykinesia. Older patients have a hard time tolerating the side effects of the anticholinergics, such as urinary retention and constipation. These adverse effects are less common with amantadine.
Fatigue may represent bradykinesia and may require levodopa or dopamine agonists, such as ropinirole, pergolide, or pramipexole. Bromocriptine is rarely used anymore because of a higher rate of adverse effects. These drugs are not as potent as levodopa, but they can be used in a younger patient to defer the need to start levodopa (therefore avoiding the adverse effects of levodopa). Dopamine agonists may be poorly tolerated in elderly patients with cognitive impairment. Selegiline, which is an MAO inhibitor, may slow down the progression of the disease. The early use of selegiline may delay the need for levodopa in patients with very mild PD. When administered as monotherapy, dopamine agonists have a very low risk of producing motor fluctuations or dyskinesias. After several years of treatment, the majority of patients may require a combination of both levodopa and a dopamine agonist. Levodopa is always used in combination with carbidopa to enhance its passage into the central nervous system.
Th source is Conrad Fischer Qs
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| khorshid
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thanx cirus, I was reading my UW notes today, and I had written that dopamine agonists for young ppl in it. good q
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| doyoudig
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yeah very good, I was also goin to say benztropine but if dopa agonist is in there that is preffered
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