Antiparkinson Mcq Flashcards
Which of the following best explains why carbidopa is combined with levodopa (in Sinemet)? A. Carbidopa increases dopamine release in the brain B. Carbidopa blocks dopamine receptors in the periphery C. Carbidopa inhibits peripheral decarboxylation of levodopa, increasing CNS availability D. Carbidopa prevents dopamine reuptake in the substantia nigra E. Carbidopa crosses the blood-brain barrier to protect neurons
C. Carbidopa inhibits peripheral decarboxylation of levodopa, increasing CNS availability
Which of the following is a common adverse effect of long-term levodopa therapy? A. Stevens-Johnson syndrome B. Cardiac arrhythmia due to QT prolongation C. Dyskinesia due to excessive dopamine in the CNS D. Cholinergic crisis with respiratory depression E. Irreversible hepatotoxicity
C. Dyskinesia due to excessive dopamine in the CNS
Which Parkinson’s medication is associated with potential hepatotoxicity? A. Amantadine B. Entacapone C. Tolcapone D. Pramipexole E. Selegiline
C. Tolcapone
Which of the following drugs enhances dopamine release, inhibits reuptake, and is also an antiviral agent? A. Levodopa B. Amantadine C. Entacapone D. Ropinirole E. Benztropine
B. Amantadine
A patient with Parkinson’s develops hallucinations and compulsive gambling behavior. Which drug is most likely responsible? A. Levodopa B. Pramipexole C. Entacapone D. Benztropine E. Selegiline
B. Pramipexole
Which of the following statements about selegiline is TRUE? A. It inhibits MAO-A and increases serotonin levels B. It inhibits MAO-B and reduces dopamine breakdown in the CNS C. It increases GABA activity in the substantia nigra D. It blocks D2 receptors in the striatum E. It causes irreversible Parkinsonism with long-term use
B. It inhibits MAO-B and reduces dopamine breakdown in the CNS
Which of the following best describes the mechanism of action of entacapone? A. MAO-B inhibition B. Dopamine receptor agonism C. COMT inhibition in the periphery D. Muscarinic receptor blockade E. Inhibition of dopamine reuptake
C. COMT inhibition in the periphery
Which drug is most effective at reducing resting tremor in Parkinson’s Disease but has limited effect on bradykinesia? A. Ropinirole B. Selegiline C. Amantadine D. Benztropine E. Entacapone
D. Benztropine
What is the likely outcome if a high-protein meal is taken with L-DOPA? A. Increased risk of serotonin syndrome B. Reduced L-DOPA absorption from the gut C. Enhanced conversion to dopamine in the CNS D. Increased nausea due to CTZ stimulation E. Liver enzyme inhibition prolonging L-DOPA half-life
B. Reduced L-DOPA absorption from the gut
What is the primary neurotransmitter deficiency in Parkinson’s Disease? A. Acetylcholine B. Norepinephrine C. Serotonin D. GABA E. Dopamine
E. Dopamine
A 70-year-old man with PD is started on levodopa/carbidopa. After 2 years, he experiences end-of-dose “wearing off.” Which drug class can be added to reduce this? A. MAO-A inhibitors B. Dopamine antagonists C. COMT inhibitors D. Anticholinergic agents E. SSRIs
C. COMT inhibitors
A young patient with drug-induced Parkinsonism from haloperidol is started on benztropine. Which mechanism explains its benefit? A. Increased dopamine reuptake B. Enhanced dopamine synthesis C. Antagonism of acetylcholine at muscarinic receptors D. Inhibition of dopamine breakdown via MAO-B E. GABA receptor stimulation
C. Antagonism of acetylcholine at muscarinic receptors
A patient with PD has postural instability and bradykinesia but no tremor. Which drug is LEAST likely to improve symptoms? A. Carbidopa-levodopa B. Ropinirole C. Pramipexole D. Benztropine E. Entacapone
D. Benztropine
Which Parkinson’s medication must be avoided or used with extreme caution in patients with liver dysfunction? A. Ropinirole B. Selegiline C. Tolcapone D. Entacapone E. Levodopa
C. Tolcapone
Which of the following best explains the purpose of using dopamine agonists like pramipexole early in treatment? A. They prevent the need for MAO inhibitors B. They cause fewer hallucinations than L-DOPA C. They delay L-DOPA use and reduce risk of dyskinesia D. They enhance absorption of L-DOPA E. They are safer in patients with cognitive decline
C. They delay L-DOPA use and reduce risk of dyskinesia
A 68-year-old man with Parkinson’s disease reports “freezing” episodes between doses of Sinemet. What is the best next step in pharmacologic management? A. Add a dopamine receptor antagonist B. Increase the interval between Sinemet doses C. Add entacapone to prolong levodopa activity D. Discontinue levodopa and start benztropine E. Administer a high-protein meal with medication
C. Add entacapone to prolong levodopa activity
A 65-year-old woman with PD develops vivid dreams, hallucinations, and new-onset gambling behavior. Which medication is most likely responsible? A. Levodopa B. Entacapone C. Selegiline D. Pramipexole E. Benztropine
D. Pramipexole
A 72-year-old male with PD develops involuntary movements (dyskinesias) after several years of levodopa use. What is the most appropriate adjustment? A. Add trihexyphenidyl B. Reduce the levodopa dose C. Add an SSRI D. Add a COMT inhibitor E. Stop carbidopa
B. Reduce the levodopa dose
A 75-year-old with long-standing PD has depression and mild motor symptoms. Which adjunctive therapy would improve mood and reduce dopamine breakdown? A. Benztropine B. Amantadine C. Selegiline D. Entacapone E. Haloperidol
C. Selegiline
A 70-year-old woman with PD is started on tolcapone. What is the most important lab to monitor during therapy? A. Serum creatinine B. Liver function tests C. Blood glucose D. Complete blood count E. Prolactin level
B. Liver function tests
A patient is given benztropine for tremor-predominant PD. Which of the following is the most likely side effect? A. Bradycardia and salivation B. Diarrhea and pupillary constriction C. Dry mouth and blurry vision D. Insomnia and serotonin syndrome E. Weight loss and hyperreflexia
C. Dry mouth and blurry vision
A 59-year-old man presents with sudden onset of Parkinson-like symptoms 2 months after starting haloperidol. What is the best treatment option? A. Add levodopa B. Stop haloperidol and begin benztropine C. Begin tolcapone immediately D. Switch to bromocriptine E. Administer MAO-A inhibitor
B. Stop haloperidol and begin benztropine
A 65-year-old patient with PD has good symptom control with levodopa/carbidopa but complains of dizziness when standing. What is the likely cause? A. Anemia B. Peripheral neuropathy C. Levodopa-induced orthostatic hypotension D. Sinus bradycardia E. Vestibular dysfunction
C. Levodopa-induced orthostatic hypotension
A 60-year-old patient with mild PD wants to delay starting levodopa. Which of the following is appropriate monotherapy for early disease? A. Benztropine B. Tolcapone C. Ropinirole D. Trihexyphenidyl E. Selegiline only
C. Ropinirole
