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Old 08-10-2012
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Question Treatment of Parkinson Tremor?

A recently retired 67-year-old man makes an appointment to see his physician because his hands are beginning to tremble in an uncontrollable manner. During the examination, the physician notes that he does have an obvious resting tremor of both hands. However, he had no difficulty in picking up a quarter, and during that process the tremor ceased.
When asked to hold his hand out, palm up, his fingers underwent an involuntary movement as if he was rolling a pill across his palm. He states that although the tremor is annoying and sometimes embarrassing, it makes little difference in his lifestyle; it has not even interfered with playing golf. At this time, which of the following is the best first step in treatment?

(A) Amantadine
(B) An anticholinergic drug
(C) Levodopa
(D) Carbidopa
(E) A dopamine agonist
(F) Selegiline
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Old 08-10-2012
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Only tremor....<60 ...benztropine
Only tremor>60... Amantadine

If akinesia present too....levodopa.

If suffering from on off phenomenon side effect of levodopa ...add COMT inhibitors or MAOI, or Bromocriptine...or use sustained release form of levodopa/carbidopa...or restrict protein meal mainly at night....

Best for preventing progression of disease....MAOI

Last edited by stfidel; 08-10-2012 at 10:05 AM.
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Old 08-10-2012
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67years....(A)...Amantadine
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Old 08-10-2012
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Quote:
Originally Posted by stfidel View Post
Only tremor....<60 ...benztropine
Only tremor>60... Amantadine

If akinesia present too....levodopa.

If suffering from on off phenomenon side effect of levodopa ...add COMT inhibitors or MAOI, or Bromocriptine...or use sustained release form of levodopa/carbidopa...or restrict protein meal mainly at night....

Best for preventing progression of disease....MAOI
Very well said.
May I know the source.
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Old 08-10-2012
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Well....simplified from Kaplan notes and MTB
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