Antiparkinsonian Drugs

Question 1

Bromocriptine

Answer 1

Works on D2 and D1, half life 6 hrs
Hepatic
Dopamine agonist

Question 2

Pramipexole

Answer 2

Dopamine agonist
D3>D2
Half life 12 hrs
Renal

Question 3

Ropinirole

Answer 3

Dopamine agonist
D2, D3,4,5
Half life is 4-6 hrs
Hepatic

Question 4

Dopamine agonist

Answer 4

Good: long lasting half life, protection against muscle symptoms
No diet changes, reduces risk of dyskinesia, delays motor complications
Bad: N/dizziness, hallucinations, somnolence, edema, compulsions
MOA: stimulates dopamine receptor directly

Question 5

Carbidopa

Answer 5

MOA: blocks GI and peripheral tissue metabolism of DOPA, doesn’t pass BBB

Question 6

Tolcapone/entacapone

Answer 6

Good: extends duration of levodopa
Bad: diarrhea and orange urine “dopaminergic”
MOA: blocks COMT, reduces inhibition of active transport of levodopa
Tolcapone:hepatotoxic

Question 7

Selegiline

Answer 7

Good: enhances effect of levodopa, small symptomatic benefit alone
Bad: metabolized to amphetamine and methamphetamine
MOA: inhibits mono amine oxidase, inhibits dopamine metabolism

Question 8

Zydis selegiline

Answer 8

Maob inhibitor

Dissolves on tongue, less side effect

Question 9

Rasagiline

Answer 9

Irreversible MAO-B inhibitor

Not converted to amphetamine

Question 10

Amantidine

Answer 10

Antiviral agent
Reduces dyskinesia
Augments dopamine release from stores
Blocks reuptake into presynaptic terminals
NMDA glutamate receptor blocker
SE: ankle edema, livedo reticularis, confusion/hallucinations

Question 11

Antimuscuranic

Answer 11

SE: dry mouth, intraocular pressure, interference with peristalsis
Benztropine
Trihexyphenidyl
Biperiden

Question 12

Apomorphine

Answer 12

Dopamine agonist
Affinity for D4..2,3,5
Short acting: 10 minute onset and lasts 60 minutes
Needs to be injected
Rescue OFF
SE: dyskinesia, nausea, low bp, skin irritation
May need tigan for nausea

Question 13

Stalevo

Answer 13

Carbidopa, levodopa, entacapone

Question 14

Comtan

Answer 14

Entacapone

Question 15

Sinemet

Answer 15

Levidopa, carbidopa

Question 16

Parcopa

Answer 16

Levodopa and carbidopa
Orally dissolvable/ mint taste
Booster dose, awaken from sleep

Question 17

Levodopa

Answer 17

Good: oral bioavailability, quick, best for PD
Bad: dyskinesia and dystopia, diet can affect drug, does not treat postural instability, freezing, and gait
MOA: dopa that can cross BBB