00 Parkinson's Disease

Question 1

What are believed to be the causes of Parkinson’s Disease?

Answer 1

Degeneration of DOPAMINERGIC neurons (specifically in the substantia nigra). Decrease of dopamine leads to predominance of (pseudo-overactivity) of Acetylcholine

Question 2

What are the different classes of medication that can be used for Parkinson’s Disease?

Answer 2

Dopamine agonists, Anticholinergic agents, COMT-Inhibitors, MAO-I’s

Question 3

All patients with PD should avoid what type of medications?

Answer 3

Dopamine antagonists (i.e. conventional antipsychotics, some atypical antipsychotics (risperidone, ziprasidone, olanzapine), metoclopramide, and phenothiazines (including promethazine and prochlorperazine)

Question 4

If a patient with PD needs an antipsychotic agent, what are the best agents to choose?

Answer 4

Quetiapine or Clozapine (neither had D2 antagonism)

Question 5

What is the generic name of Symmetrel?

Answer 5

Amantadine (DA agonist)

Question 6

What is the generic name of Parlodel?

Answer 6

Bromocriptine (DA agonist)

Question 7

What is the generic name of Mirapex?

Answer 7

Pramipexole (DA agonist)

Question 8

What is the generic name of Requip?

Answer 8

Ropinirole (DA agonist)

Question 9

What is the generic name of Neupro?

Answer 9

Rotigotine (DA agonist)

Question 10

What is the generic name of Apokyn?

Answer 10

Apomorphine (DA agonist)

Question 11

When does Amantadine need to be dose adjusted?

Answer 11

Significant renal adjustment required. Once CrCl < 15, dosed once a week

Question 12

What are the most common ADRs with Amantadine?

Answer 12

Insomnia, orthostasis

Question 13

What are the most common ADRs with Bromocriptine?

Answer 13

Orthostasis

Question 14

Which DA agonists are also approved for Restless Leg Syndrome (RLS)?

Answer 14

Pramipexole, Ropinirole, Rotigotine

Question 15

How is Apomorphine administered?

Answer 15

SQ only! Dosed in mL, not mg!!!

Question 16

What is the most common ADR with Apomorphine?

Answer 16

N/V (must be given with antiemetic (trimethobenzamide 300mg po TID)

Question 17

When is Apomorphine contraindicated?

Answer 17

DO NOT GIVE w/ 5-HT3 antagonists (d/t hypotension and loss of consciousness)

Question 18

What is the generic name of Eldepryl, Zelapar?

Answer 18

Selegiline (MAO-I)

Question 19

What is the generic name of Azilect?

Answer 19

Rasagiline (MAO-I)

Question 20

When should Azilect (Rasagiline) be avoided?

Answer 20

With moderate to severe hepatic impairment. AVOID HIGH TYRAMINE FOOD

Question 21

What is the generic name of Tasmar?

Answer 21

Tolcapone (COMT)

Question 22

Why is Tasmar (Tolcapone) not used much anymore?

Answer 22

BBW: Acute fulminant liver failure

Question 23

What is the generic name of Comtan, Stalevo?

Answer 23

Entacapone (COMT)

Question 24

What is the generic name of Sinemet, Parcopa?

Answer 24

Levodopa w/ Carbidopa

Question 25

When is Sinemet contraindicated?

Answer 25

Hx of melanoma, Current nonselective MAO-Is, Narrow angle glaucoma

Question 26

What must COMT medications be given with?

Answer 26

Have to be given with Levodopa, useless when used by themselves since they are used to increase Levodopa’s AUC

Question 27

Which Dopamine Agonists are Ergot Derivatives?

Answer 27

Parlodel (Bromocriptine)

Question 28

What ADRs do the ergot derivative Dopamine Agonists cause?

Answer 28

Orthostasis

Question 29

Non-ergot DA agonists are more likely to cause what side effects?

Answer 29

Sleep attacks

Question 30

Which medications have been associated with compulsive gambling?

Answer 30

Dopamine Agonists

Question 31

What is the max dose/day of Selegiline? Why?

Answer 31

10mg, lose selectivity

Question 32

What needs to be monitored in patients receiving Tolcapone?

Answer 32

LFTs

Question 33

How often is Rotigotine replaced?

Answer 33

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