MCQ Quiz: Management of Parkinson’s Disease

The management of Parkinson’s Disease is a complex, long-term endeavor aimed at controlling motor and non-motor symptoms to improve a patient’s quality of life. As the disease progresses, pharmacists play an increasingly vital role in helping to manage complex medication regimens, navigate motor complications like “wearing-off” and dyskinesias, and counsel patients and caregivers. This quiz will test your knowledge of the pharmacotherapeutic strategies used to manage this challenging neurodegenerative disorder.

1. The primary goal of pharmacotherapy in Parkinson’s Disease is to:

• a. Cure the disease by regenerating dopaminergic neurons.
• b. Increase the levels of acetylcholine in the brain.
• c. Increase dopaminergic activity in the brain to manage symptoms.
• d. Prevent the formation of Lewy bodies.

Answer: c. Increase dopaminergic activity in the brain to manage symptoms.

2. What is the most effective drug for the symptomatic treatment of Parkinson’s Disease?

• a. Amantadine
• b. Levodopa/Carbidopa
• c. Benztropine
• d. Ropinirole

Answer: b. Levodopa/Carbidopa

3. The purpose of adding carbidopa to levodopa is to:

• a. Directly stimulate dopamine receptors.
• b. Inhibit the enzyme DOPA decarboxylase in the periphery, allowing more levodopa to reach the brain.
• c. Help levodopa cross the blood-brain barrier.
• d. Treat the non-motor symptoms of the disease.

Answer: b. Inhibit the enzyme DOPA decarboxylase in the periphery, allowing more levodopa to reach the brain.

4. A patient on levodopa therapy for several years begins to experience involuntary, dance-like movements. This motor complication is known as:

• a. Bradykinesia
• b. Dyskinesia
• c. A “wearing-off” episode
• d. A “freezing” episode

Answer: b. Dyskinesia

5. A patient reports that their Parkinson’s symptoms return and they feel slow and stiff before their next dose of levodopa is due. This is known as:

• a. Dyskinesia
• b. The “on-off” phenomenon
• c. The “wearing-off” phenomenon
• d. Akathisia

Answer: c. The “wearing-off” phenomenon

6. Dopamine agonists, like pramipexole and ropinirole, work by:

• a. Increasing the release of dopamine.
• b. Directly stimulating dopamine receptors in the brain.
• c. Preventing the breakdown of levodopa.
• d. Blocking acetylcholine receptors.

Answer: b. Directly stimulating dopamine receptors in the brain.

7. In a younger patient with early-stage Parkinson’s Disease, why might a physician choose to start therapy with a dopamine agonist instead of levodopa?

• a. Dopamine agonists are more effective than levodopa.
• b. To delay the need for levodopa and potentially postpone the onset of motor complications.
• c. Dopamine agonists have fewer side effects.
• d. Dopamine agonists cure the disease.

Answer: b. To delay the need for levodopa and potentially postpone the onset of motor complications.

8. A key counseling point for a patient starting a dopamine agonist is the risk of:

• a. A severe dry cough.
• b. Impulse control disorders, such as compulsive gambling or shopping.
• c. Severe hypertension.
• d. Weight loss.

Answer: b. Impulse control disorders, such as compulsive gambling or shopping.

9. Selegiline and rasagiline are inhibitors of which enzyme?

• a. Catechol-O-methyltransferase (COMT)
• b. Monoamine Oxidase B (MAO-B)
• c. DOPA decarboxylase
• d. Acetylcholinesterase

Answer: b. Monoamine Oxidase B (MAO-B)

10. Entacapone is a COMT inhibitor used as an adjunct to levodopa/carbidopa. It must be taken:

• a. Once daily at bedtime.
• b. On an empty stomach.
• c. With every single dose of levodopa/carbidopa.
• d. Only when the patient feels “off.”

Answer: c. With every single dose of levodopa/carbidopa.

11. Which medication is most effective for treating a resting tremor in an early-stage, younger patient?

• a. An anticholinergic agent like benztropine.
• b. A COMT inhibitor.
• c. A high dose of levodopa.
• d. Amantadine.

Answer: a. An anticholinergic agent like benztropine.

12. The use of anticholinergics for Parkinson’s is limited in elderly patients due to the risk of:

• a. Confusion, dry mouth, and constipation.
• b. Hypotension.
• c. Dyskinesias.
• d. Nausea.

Answer: a. Confusion, dry mouth, and constipation.

13. A patient taking levodopa/carbidopa should be counseled to avoid taking their dose with what type of meal?

• a. A low-protein meal
• b. A high-carbohydrate meal
• c. A high-protein meal
• d. A high-fiber meal

Answer: c. A high-protein meal

14. Amantadine can be useful for treating which specific motor complication of levodopa therapy?

• a. “Wearing-off”
• b. Dyskinesias
• c. “Freezing” of gait
• d. Bradykinesia

Answer: b. Dyskinesias

15. A patient taking entacapone should be counseled that their urine may:

• a. Become very light yellow.
• b. Turn a harmless brownish-orange color.
• c. Become very dark brown, indicating liver damage.
• d. Become foamy.

Answer: b. Turn a harmless brownish-orange color.

16. A patient is being started on apomorphine for acute “off” episodes. This medication is administered via:

• a. Oral tablet
• b. Transdermal patch
• c. Subcutaneous injection
• d. Intravenous infusion

Answer: c. Subcutaneous injection

17. Due to the risk of severe nausea and vomiting, patients starting apomorphine must be pre-treated with:

• a. An antiemetic like trimethobenzamide.
• b. A 5-HT3 antagonist like ondansetron.
• c. A proton pump inhibitor.
• d. Diphenhydramine.

Answer: a. An antiemetic like trimethobenzamide.

18. Which of the following is a non-motor symptom of Parkinson’s Disease?

• a. Depression
• b. Constipation
• c. Dementia
• d. All of the above

Answer: d. All of the above.

19. A patient with Parkinson’s Disease develops psychosis. Which antipsychotic is generally preferred due to its low risk of worsening motor symptoms?

• a. Haloperidol
• b. Risperidone
• c. Quetiapine
• d. Olanzapine

Answer: c. Quetiapine

20. A pharmacist’s role in the management of Parkinson’s Disease includes:

• a. Helping to manage complex dosing schedules.
• b. Counseling on side effects and drug interactions.
• c. Recommending strategies to manage motor fluctuations.
• d. All of the above.

Answer: d. All of the above.

21. A patient on rasagiline (an MAO-B inhibitor) should be advised to avoid concomitant use of which medication?

• a. Acetaminophen
• b. The herbal supplement St. John’s Wort
• c. Atorvastatin
• d. Amlodipine

Answer: b. The herbal supplement St. John’s Wort

22. Which of the following is the most significant side effect of carbidopa/levodopa therapy?

• a. Orthostatic hypotension
• b. Nausea and vomiting
• c. Dyskinesias and motor fluctuations with long-term use.
• d. Hallucinations

Answer: c. Dyskinesias and motor fluctuations with long-term use.

23. The rotigotine patch is a formulation of a:

• a. Levodopa precursor
• b. COMT inhibitor
• c. Dopamine agonist
• d. MAO-B inhibitor

Answer: c. Dopamine agonist

24. The overall management of advanced Parkinson’s Disease often requires:

• a. Monotherapy with levodopa.
• b. Discontinuation of all medications.
• c. Combination therapy with multiple drug classes to manage symptoms and motor complications.
• d. A focus on non-pharmacologic therapy only.

Answer: c. Combination therapy with multiple drug classes to manage symptoms and motor complications.

25. Deep Brain Stimulation (DBS) is a surgical option for Parkinson’s disease that is most effective for:

• a. Curing the disease.
• b. Managing medication-refractory motor fluctuations, tremor, and dyskinesias.
• c. Treating the non-motor symptoms.
• d. Patients with early, mild disease.

Answer: b. Managing medication-refractory motor fluctuations, tremor, and dyskinesias.

26. Which of the following is NOT a primary goal of Parkinson’s disease management?

• a. To improve motor function.
• b. To improve quality of life.
• c. To stop the progression of the neurodegenerative process.
• d. To manage non-motor symptoms.

Answer: c. To stop the progression of the neurodegenerative process.

27. A patient experiences “freezing,” where they are transiently unable to initiate movement. This is a type of:

• a. Dyskinesia
• b. Motor fluctuation
• c. Dystonia
• d. Bradykinesia

Answer: b. Motor fluctuation

28. Istradefylline is a non-dopaminergic add-on therapy that works as a(n):

• a. Acetylcholine antagonist
• b. Adenosine A2A antagonist
• c. NMDA antagonist
• d. Serotonin agonist

Answer: b. Adenosine A2A antagonist

29. The management of non-motor symptoms like constipation and orthostatic hypotension is a critical part of comprehensive care.

• a. True
• b. False

Answer: a. True

30. Which of the following is NOT a common side effect of dopamine agonists?

• a. Nausea
• b. Somnolence (sleepiness)
• c. Orthostatic hypotension
• d. Significant weight loss

Answer: d. Significant weight loss

31. A pharmacist should counsel a patient starting levodopa that:

• a. The full benefit may take several weeks to months to become apparent.
• b. The medication will work at its full effect on the first day.
• c. It should be taken on an empty stomach if possible, but with a low-protein snack if nausea occurs.
• d. Both a and c.

Answer: d. Both a and c.

32. The timing of levodopa doses relative to meals and other activities is a key aspect of management in advanced disease.

• a. True
• b. False

Answer: a. True

33. What is the role of a pharmacist in managing a patient with dyskinesias?

• a. To recommend a dose reduction of levodopa.
• b. To suggest adding a medication like amantadine.
• c. To assess if the dyskinesias are bothersome to the patient.
• d. All of the above.

Answer: d. All of the above.

34. The pharmacotherapy of Parkinson’s Disease is highly individualized.

• a. True
• b. False

Answer: a. True

35. A “drug holiday” from levodopa is:

• a. A first-line strategy to manage motor complications.
• b. No longer routinely recommended due to risks like aspiration pneumonia and depression.
• c. A one-week break taken every month.
• d. A safe and effective strategy for all patients.

Answer: b. No longer routinely recommended due to risks like aspiration pneumonia and depression.

36. Pimavanserin is an antipsychotic specifically approved for the treatment of:

• a. Parkinson’s disease itself.
• b. Hallucinations and delusions associated with Parkinson’s disease psychosis.
• c. The motor symptoms of Parkinson’s.
• d. Dyskinesias.

Answer: b. Hallucinations and delusions associated with Parkinson’s disease psychosis.

37. Which of the following is a symptom of orthostatic hypotension?

• a. High blood pressure upon standing.
• b. Dizziness or lightheadedness upon standing.
• c. A slow heart rate.
• d. A resting tremor.

Answer: b. Dizziness or lightheadedness upon standing.

38. The use of a COMT inhibitor like entacapone will lead to an increase in levodopa’s:

• a. Rate of metabolism.
• b. Half-life and area under the curve (AUC).
• c. Side effect of dyskinesia.
• d. Both b and c.

Answer: d. Both b and c.

39. A patient asks why they can’t just take dopamine pills. The pharmacist explains that:

• a. Dopamine is a controlled substance.
• b. Dopamine does not cross the blood-brain barrier.
• c. Dopamine pills are not manufactured.
• d. Dopamine is not effective for Parkinson’s disease.

Answer: b. Dopamine does not cross the blood-brain barrier.

40. A key counseling point for the rotigotine patch is to:

• a. Apply it to the same site every day.
• b. Rotate the application site daily.
• c. Cut the patch to adjust the dose.
• d. Apply it to the soles of the feet.

Answer: b. Rotate the application site daily.

41. The management of Parkinson’s Disease requires regular follow-up and adjustment of therapy as the disease progresses.

• a. True
• b. False

Answer: a. True

42. Which of the following is NOT a cardinal motor symptom of Parkinson’s disease?

• a. Resting tremor
• b. Bradykinesia
• c. Postural instability
• d. Memory loss

Answer: d. Memory loss

43. A pharmacist counseling on a new prescription for ropinirole should warn the patient about the potential for:

• a. Sudden sleep attacks.
• b. An impulse control disorder.
• c. Nausea and dizziness.
• d. All of the above.

Answer: d. All of the above.

44. The medication management of Parkinson’s Disease is a dynamic balance between improving motor function and minimizing adverse effects.

• a. True
• b. False

Answer: a. True

45. What is the role of amantadine in managing Parkinson’s disease?

• a. It is a first-line agent for all patients.
• b. It can provide mild symptomatic benefit in early disease and is also used to treat levodopa-induced dyskinesias.
• c. It is a potent dopamine agonist.
• d. It is an anticholinergic agent.

Answer: b. It can provide mild symptomatic benefit in early disease and is also used to treat levodopa-induced dyskinesias.

46. A patient is taking selegiline. They should be counseled to take the second dose of the day no later than early afternoon to avoid:

• a. Drowsiness
• b. Insomnia
• c. Nausea
• d. Hypotension

Answer: b. Insomnia

47. A “freezing” episode can sometimes be overcome by:

• a. Standing still and waiting for it to pass.
• b. Using a visual or auditory cue, like stepping over a line or marching to a beat.
• c. Taking an extra dose of levodopa.
• d. Closing one’s eyes.

Answer: b. Using a visual or auditory cue, like stepping over a line or marching to a beat.

48. A multidisciplinary approach involving physical therapy, occupational therapy, and speech therapy is essential in managing Parkinson’s disease.

• a. True
• b. False

Answer: a. True

49. The overall strategy for managing Parkinson’s disease pharmacotherapy is to:

• a. Use the lowest dose of levodopa that provides adequate symptom control for as long as possible.
• b. Start every patient on a dopamine agonist.
• c. Achieve a state free of all motor symptoms, regardless of side effects.
• d. Use a combination of at least three medications from the start.

Answer: a. Use the lowest dose of levodopa that provides adequate symptom control for as long as possible.

50. The ultimate goal of a pharmacist’s involvement in the management of Parkinson’s Disease is to:

• a. Help the patient and healthcare team navigate complex medication regimens to maximize quality of life.
• b. Cure the disease.
• c. Prevent all side effects.
• d. Only dispense medications accurately.

Answer: a. Help the patient and healthcare team navigate complex medication regimens to maximize quality of life.