American Board of Internal Medicine (ABIM) Certification Practice Exam

In cases where motor benefits from Parkinson's medication wear off quickly, which strategy may be employed?

1. Reducing medication dosage

2. Adding anticholinergics

3. More frequent immediate-release dosing

4. Discontinuing all medications

The correct answer is: More frequent immediate-release dosing

When patients with Parkinson's disease experience rapid wearing off of motor benefits from their medication, one effective strategy is to increase the frequency of immediate-release dosing. This approach aims to maintain more stable levels of the medication in the bloodstream, thereby reducing the fluctuations in motor control that patients may experience. Immediate-release formulations allow for quicker absorption and action, which can help alleviate symptoms as they arise, leading to improved overall functioning throughout the day. In contrast, reducing medication dosage could exacerbate symptoms and is not a viable option for managing wearing off effects. Similarly, while anticholinergics may have a role in addressing specific symptoms such as tremors, they are not typically used to counteract the motor fluctuations associated with dopamine therapy. Discontinuing all medications would result in significant deterioration in motor function and quality of life, making this an impractical strategy in the context of managing rapid wearing off of motor benefits. Thus, more frequent immediate-release dosing stands out as the most effective management strategy in this scenario.