Central Nervous System - Parkinsons

Question 1

what is parkinsons?

Answer 1

alleviated high levels of dopamine

Question 2

if patient has parkinsons and their motor symptoms reduce QoL what is the tx?

Answer 2

levodopa + carbidopa/berserazide

Question 3

if patient has parkinsons and their symptoms do not reduce their QoL what is the tx?

Answer 3

• levodopa
• non-ergot derived dopamine receptor
• monoamine-oxidase B inhibitors

Question 4

what is added to levodopa in order to prevent breakdown of levodopa before it crosses into the brain

Answer 4

carbidopa or benserazide

Question 5

what is the s/e of levodopa?

Answer 5

• impulsive disorders; pathological gambling, binge eating and hypersexuality
• sudden onset of sleep
• red urine

Question 6

what is the tx of sudden onset of sleep?

Answer 6

modafinil

Question 7

give examples of non-ergot derived dopamine receptors

Answer 7

• pramipexole
• ropinirole
• rotigotine

Question 8

what are the side effects of non-ergot derived dopamine receptors?

Answer 8

• impulse disorders (higher than levodopa)
• sudden onset of sleep
• hypotension

Question 9

give examples of monoamine-oxidase B inhibitors

Answer 9

rasagiline or selegiline

Question 10

which drug interacts with rasagiline or selegiline and what does it cause?

Answer 10

• phenylephrine
• causes hypertensive crisis

Question 11

mature cheese, salami, marmite, yeast, tofu

Which MAO interacts with tyramine rich foods?

Answer 11

MOA-A inhibitors

Question 12

If pt develops dyskinesia or motor fluctuations despite optimal levodopa therapy what is added?

Answer 12

added to levodopa:
- non-ergot dopamine receptor agonists
- monoamine oxidase B inhibitors
- COMT inhibitors

Question 13

give two examples of COMT inhibitors

Answer 13

• entacapone
• tolcapone

Question 14

what is the s/e of entacapone

Answer 14

red-brown urine

Question 15

what is s/e of tolcapone

Answer 15

hepatotxicity

Question 16

in CVD events does parasympathetic s/e increase or decrease with entacapone and tolcapone?

Answer 16

increase

Question 17

when is ergot dervied dopamine receptor agonist added to levodopa

Answer 17

if symptoms x adequately controlled with non-ergot derived dopamine receptors

Question 18

give two examples of ergot dervied receptor agonists

Answer 18

• bromocriptine
• cabergoline

Question 19

what are the s/e of
bromocriptine, cabergoline

Answer 19

• pulmonary reactions; SoB, chest pain and cough
• pericardial reactions; chest pain

Question 20

should you withdraw medications abruptly in parkinsons?

Answer 20

NO

Question 21

If patient is experiencing “off-periods” due to end of deterioration what do you give?

Answer 21

MR preparation

Question 22

what is 1st line tx of noctural akinesia?

Answer 22

levodopa or oral dopamine receptor agonists

Question 23

What is 2nd line tx of noctural akinesia?

Answer 23

rotigotine

Question 24

What is the tx of hypotension in parkinsons?

Answer 24

midodrine