Anti-Parkinsons

Question 1

Drugs and Chemicals that may cause Parkinsons

Answer 1

Antipsychotics (Haloperidol)
MPTP
Alpha Synuclein Protein

Question 2

Dopamine Precursor

Answer 2

L Dopa

Question 3

Dopamine Receptor Antagonists

Answer 3

Pramipexole
Ropinirole
Bromocriptine
Apomorphine

Question 4

MAOI

Answer 4

Selegiline

Rasagiline

Question 5

COMT Inhibitors

Answer 5

Entacapone

Tolcapone

Question 6

Dopamine Facilitators

Answer 6

Amantadine

Question 7

CNS Anticholinergic Agents

Answer 7

Benztropine

Trihexyphenidyl

Question 8

Carbidopa

Answer 8

• Inhibits DOPA Decarboxylase BUT cannot cross BBB

Question 9

DOPA Decarboxylase Co-Factor

Answer 9

Pyridoxine

Question 10

L Dopa

Answer 10

• Prodrug of Dopamine
• Stimulates D2 receptors
  PHARMACOKINETICS: Mostly metabolized cereberally, given in combo w/ Carbidopa to prevent peripheral metabolism

Question 11

L Dopa: Clinical & Pharmacologic Effects

Answer 11

CLINICAL
- Best Results in first few years of Tx
- Works faster on rigidity and bradykinesia than on tremor
PHARMACOLOGIC
- Tolerance to effects builds up after 5 years
- Effective in relieving Bradykinesia

Question 12

L Dopa: GI Effects

Answer 12

• Anorexia, Nausea/Vomiting at first (tolerance builds up)
• Avoid Antiemetics
• GI effects less frequent w/ L Dopa/Carbidopa combo

Question 13

L Dopa: SE

Answer 13

CVS
- Arrhythmias, Tachycardia, postural hypotension
BEHAVIORAL
- Depression, Anxiety, Agitation, Insomnia, Confusion, Hallucinations, Nightmare, Euphoria
DYSKINESIA
- Choreoathetosis
RESPONSE FLUCTUATIONS
- Wearing-off Rxns (End Dose Akinesia)
- On-Off Phenomena
MISC
- Mydriasis, Glaucoma (maybe)
- Brown saliva, urine, vaginal secretions

Question 14

L DOPA: Drug Interactions and CI

Answer 14

DRUG INTERACTIONS

• L DOPA + MAOI = HTN Crisis, Hyperpyrexia
• L DOPA + Pyridoxine = Peripheral conversion of L DOPA to Dopamine
• Antiemetics = Block Dopamine Receptors

CI

• Psychotic Pts
• Angle Closure Glaucoma
• Peptic Ulcer
• Melanoma& Skin Lesions

Question 15

Carbidopa

Answer 15

• DOPA Decarboxylase Inhibitors
• Can’t Breach BBB
• Usually Combo w/ L DOPA

Question 16

MPTP

Answer 16

• Cause irreversible damage to nigrostriatal neurons

Question 17

Dopamine Receptor Agonists

Answer 17

• Bromocriptine: D2 agonist (Valve Fibrosis)
• Pramipexole: D3 agonist, Used in Advanced Parkinsons, scavenge hydrogen peroxide
• Ropinirole: Pure D2 Receptor Agonist
• Apomorphine: Potent Dopamine Agonist, quick relief of off-periods of akinesia
  SE: May enhance SE of L DOPA

Question 18

COMT Inhibitor

Answer 18

Tolcapone
Entacapone
- Inhibit L DOPA Peripheral Metabolism
- Good for pts w/ Response fluctuation
SE: Orange Urine, INC Liver enzymes (Hepatic Failure)

Question 19

Amantadine

Answer 19

• Antiviral
• May potentiate INC in Dopamine synth, release or reuptake
  SE: Liveto Reticularis

Question 20

M Receptor Antagonist

Answer 20

Benztropine
Trihexyphenidyl
Diphenhydramine
- Tx of Drug Induced Dyskinesia
- Helps Tremor and Dyskinesia but not Bradykinesia
SE: Agitation, Confusion, Constipation, Delirium, Dry mouth, Memory Loss, Urinary retention, Tachycardia

Question 21

Parkinsons Vaccine

Answer 21

• Immune response against Aggregated Alpha-Synuclein

Question 22

Restless Leg Syndrome Rx

Answer 22

Pramipexole
Ropinirole
Diazepam
Gabapentin
Opiates

Question 23

Wilson’s Disease Rx

Answer 23

Penicillamine
Trientine
Tetrathiomolybdate
Zinc

Question 24

ALS Rx

Answer 24

Baclofen
Tizanidine
Gabapentin
Riluzole

Question 25

MS Rx

Answer 25

Interferons
Natalizumab
Mitoxantrone
Glatiramer
Fingolimod
Dalfampridine

Question 26

Alzheimer’s Rx

Answer 26

- Acetylcholine Esterase Inhibitors
Rivastigmine
Donepezil
Gallantamine
Tacrine
- Glutamate Receptor Antagonists
Memantine

Question 27

Huntington’s Rx

Answer 27

• Tetrabenazine & Reserpine (Inhibit VMAT = limit dopamine vesicle packaging and release
• Haloperidol