Pharm
Which gold-standard Parkinson's medication functions by crossing the blood-brain barrier and converting directly into dopamine within the brain?
Levodopa
What drug must be combined with DDC inhibitors that don't cross the blood-brain barrier?
Levodopa
This intervention uses gait training, balance exercises and external cues, such as rhythmic music or floor markings, to help patients overcome freezing of gait and reduce falls.
Physiotherapy and structured exercise.
How do dopamine agonists (such as pramipexole and ropinirole) work differently from levodopa?
Instead of converting into dopamine (levodopa is a precursor to dopamine), dopamine agonists partially bypass metabolic conversion and work by directly stimulating dopamine receptors
Why are dopamine agonists frequently chosen as a first-line therapy for Parkinson's patients under the age of 50?
They are preferred in younger patients to help delay the onset of levodopa-induced motor fluctuations and dyskinesias
A patient with Parkinson’s struggles to button their shirt, prepare meals, speak loudly and swallow safely. These two allied health professionals address daily living activities and communication or swallowing difficulties, respectively.
Occupational therapist (OT)+ Speech pathologist
Why is levodopa routinely paired with a peripheral enzyme inhibitor, and give an example of one?
It inhibits the peripheral DOPA decarboxylase enzyme. This prevents levodopa from breaking down prematurely in the bloodstream, reducing systemic side effects and ensuring more of the drug reaches the brain safely, for example carbidopa.
Why are COMT inhibitors strictly used as an add-on therapy rather than a standalone treatment?
COMT inhibitors have no therapeutic effect on their own; they must be combined with carbidopa-levodopa specifically to prevent its breakdown, thereby extending the patient's "on" time (periods of optimal symptom control).
A patient with Parkinson’s develops constipation, reduced appetite and unintentional weight loss. Name three non-pharmacological strategies that may help manage these problems.
Individualised dietary changes, adequate hydration and physical activity, with dietitian support where appropriate.
What is the MOA for MAO-B inhibitiors, give an example?
What are impulse control disorders (ICDs) in Parkinson's management, and what pharmacological mechanism causes them?
Impulse control disorders are the inability to resist intense, potentially harmful urges—manifesting as compulsive gambling, shopping, binge eating, or hypersexuality. They are primarily caused by dopamine agonists (not antagonists) overstimulating D3 dopamine receptors within the brain's mesolimbic reward and pleasure pathways.
Besides rehabilitation and nutrition, name three other non-pharmacological approaches that can improve safety or quality of life in Parkinson’s disease, and try explain their purpose.
Home modifications + Psychological and social support + Sleep hygiene and daily routines
Entacapone inhibits the COMT (catechol-O-methyltransferase) enzyme. By blocking this enzyme, it prevents the peripheral breakdown of levodopa, allowing a higher concentration to cross into the central nervous system where we want it to be
What movement complications can develop from the long-term use of levodopa therapy?
Long-term use can lead to dyskinesias—which are involuntary, erratic, dance-like movements—as well as unpredictable "on-off" motor fluctuations throughout the day.
This surgical intervention uses implanted electrodes to stimulate specific brain regions. It can improve selected motor symptoms and motor fluctuations in carefully selected patients, but it does not cure Parkinson’s disease or stop its progression.
Deep brain stimulation (DBS).