CPTP 3.20 Dementia & Parkinson's drugs

Question 1

Basic neurotransmitter & protein pathology of DEMENTIA

Answer 1

• Ach defect

- Amyloid plaques, tau tangles in cortex

Question 2

Basic neurotransmitter & protein pathology of PARKINSON’S

Answer 2

• Nigrostriatal dopamine defect

- Lewy bodies in substantia nigra

Question 3

Donezepil

Pharmacodynamics + clinical use + side effects

Answer 3

Ach-esterase inhibitor

Clinical use: mild-moderate dementia

Side effects:
bradycardia

Question 4

Donezepil

Pharmacodynamics + clinical use + side effects

Answer 4

Ach-esterase inhibitor

Clinical use: mild-moderate dementia

Side effects:
bradycardia, NVD, sleep disturbance, headaches

Question 5

Rivastigmine

Pharmacodynamics + clinical use + side effects

Answer 5

Ach-esterase inhibitor

Clinical use: mild-moderate dementia

Side effects:
bradycardia, NVD, sleep disturbance, headaches

Question 6

Galantamine

Pharmacodynamics + clinical use + side effects

Answer 6

Ach-esterase inhibitor

Clinical use: mild-moderate dementia

Side effects:
bradycardia, NVD, sleep disturbance, headaches

Question 7

Memantine

Pharmacodynamics + clinical use + side effects

Answer 7

• Blocks NMDA receptor
• Blocks glutamate excitotoxicity

Clinical use: moderate-severe dementia

Side effects:
drowsiness, insomnia, agitation, hallucinations

Question 8

L-DOPA

Pharmacodynamics + clinical use + side effects

Answer 8

DA precursor

Clinical use: Parkinson’s

Side effects: N&V, postural hypotension, hallucinations, mania, anxiety
Dyskinesia during peak dose

Note: wears off after 4-6 years (needs more frequent dosing, leads to more frequent dyskinesia)

Question 9

Apomorphine

Pharmacodynamics + clinical use + side effects

Answer 9

Non-ergot derived dopamine agonist

Clinical use: Parkinson’s

Side effects of non-ergot dopamine agonists:

• Impulse disorders (gambling, binge eating, hypersexuality)
• Somnolence, hallucinations, nausea,
• peripheral oedema

Question 10

Pramiprexole

Pharmacodynamics + clinical use + side effects

Answer 10

Non-ergot derived dopamine agonist

Clinical use: Parkinson’s

Side effects of non-ergot dopamine agonists:

• Impulse disorders (gambling, binge eating, hypersexuality)
• Somnolence, hallucinations, nausea,
• peripheral oedema

Question 11

Ropinirole

Pharmacodynamics + clinical use + side effects

Answer 11

Non-ergot derived dopamine agonist

Clinical use: Parkinson’s

Side effects of non-ergot dopamine agonists:

• Impulse disorders (gambling, binge eating, hypersexuality)
• Somnolence, hallucinations, nausea,
• peripheral oedema

Question 12

Rotigotine

Pharmacodynamics + clinical use + side effects

Answer 12

Non-ergot derived dopamine agonist

Clinical use: Parkinson’s

Side effects of non-ergot dopamine agonists:

• Impulse disorders (gambling, binge eating, hypersexuality)
• Somnolence, hallucinations, nausea,
• peripheral oedema

Question 13

Bromocriptine, Pergolide, Cabergoline

Pharmacodynamics + clinical use + side effects

Answer 13

Ergot-derived dopamine agonist

Clinical use: Parkinson’s (rarely used as requires frequent monitoring)

Side effets of ergot dopamine agonists:

• cardiac valvulopathy
• pleural, pericardial, retroperitoneal fibrosis

Question 14

Selegiline

Pharmacodynamics + clinical use + side effects

Answer 14

MAO-B inhibitor

Clinical use: Parkison’s

Side effects:
Well tolerated, Less dyskinesia compared to L-DOPA

Note: only slight efficacy compared to L-DOPA

Question 15

Benztropine, Benzhexol

Pharmacodynamics + clinical use + side effects

Answer 15

Anticholinergic

Clinical use: Parkinson’s

Side effects:
confusion, anticholingeric effects (urinary retension, etc)