Step II Parkinson therapy Q

[lordman]

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Patient w Parkinson symptoms controlled with Levo and benztropine for the past 4 years. Recently, symptoms recurred and he asks you for advice.

A) increase levo dose
B) increase benztropine doze
c) Rasagiline

I learned from step 1 that you increase the dose of levo first....but what about Rasagiline? It's used in advanced cases...

@kirbymiester @notbobtrustme

 

[notbobtrustme]

From what I can gather, maxing out Levodopa/Carbidopa is your best bet. If the patient can't tolerate it, then add other drugs, such as rasagiline/selegine.

Also, look at what the rest of the question stem is telling you. If he's well-controlled except for tremors (eg vibrant affect, no freezing, no shuffling gait, minimal cogwheel rigidity), there's no need to up his L-dopa. Instead, add something for symptomatic relief like benztropine or amantidine.