DRUGS USED FOR PARKINSONISM/DRUGS OF ABUSE

Question 1

inhibits peripheral metabolism via dopa
decarboxylase

Answer 1

CARBIDOPA

Question 2

What drugs are dopamine agonists that are ergot alkaloids (4)

Answer 2

Bromocriptine, Pergolide, Cabergoline, Piribedil

Question 3

MOA of Bromocriptine, Pergolide, Cabergoline, Piribedil?

Answer 3

Partial agonist at dopamine D2 receptors in brain,
D2 agonism leads to inhibition of prolactin release

Question 4

Piribedil also has alpha 2 antagonistic action. Additional use for???

Answer 4

intermittent claudication.

Question 5

Non ergot dopamine agonists drugs (3)

Answer 5

Pramipexole, Ropinirole, Rotigotine

Question 6

MOA of PRAMIPEXOLE and ROPIRINOLE?

Answer 6

Partial agonist at dopamine D2 (pramipexole) &
D3 receptors (ropinirole) in brain

MNEMONICS:
D2 = pramipexole
Imagine twins (2 babies) being carried in a pram by their mom Pam
Also remember that P comes before R and 2 comes before 3 (P =
pramipexole = D2; R = ropinirole = D3)

Question 7

SE of Pramipexole, Ropinirole,

Answer 7

ICD or impulse control disorder: compulsive
gambling, hypersexuality, overeating

Question 8

MOA of APOMORPHINE

Answer 8

Agonist at dopamine D2 receptors.
Antagonist at 5-HT and alpha adrenoceptors.

Question 8

Rescue treatment for off-periods of Parkinson’s
disease (temporary relief), Alcoholism, Opiate addiction,
Erectile dysfunction, Alzheimer’s disease

Answer 8

APOMORPHINE

Question 9

SE of APOMORPHINE

Answer 9

• QT prolongation
• Severely emetogenic

Question 10

Treatment of Nausea caused by apomorphine?

Answer 10

TRIMETHOBENZAMIDE! Do not use Ondansetron

Question 11

MAO- B inhibitors used for parkinsonism?

Answer 11

Selegiline, Rasagiline, Safinamide

Question 12

SE of MAO-B Inhibitors?

Answer 12

Serotonin syndrome

Question 13

COMT inhibitors used in Parkinsonism?

Answer 13

Tolcapone, Entacapone

Question 14

SE of ENTACAPONE, TOLCAPONE?

Answer 14

• Orange urine
• Hepatotoxicity (Tolcapone)
• SEs Related to increased levels of L-DOPA

Question 15

TOLCAPONE, ENTACAPONE MOA?

Answer 15

Block L-dopa metabolism by inhibiting catechol-Omethyltransferase
in periphery (both) and CNS
(tolcapone only)

MNEMONICS:
TWOlcapone – tolcapone inhibits both central and peripheral COMT
while entacapone only inhibits centrally

Question 16

MOA: Amantadine?

Answer 16

Alter dopamine release in striatum, has anticholinergic
properties, blocks NMDA and glutamate receptors

Question 17

SE of Amantadine?

Answer 17

Livedo reticularis

Question 18

What drugs causes Livedo Reticularis?

Answer 18

A man reads FHM and GQ!

Amantadine Gemcitabine
Hydroxyurea Quinidine
Minocycline

Question 19

Anticholinergic drugs used in parkinsonism?

Answer 19

Benztropine, Biperiden, Trihexyphenidyl, Procyclidine

Question 20

MOA of anticholinergic drugs used in parkinsonism?

Answer 20

Block muscarinic receptors = dec. excitation in
cholinergic neurons in striatum

Question 21

neurodegenerative disease caused by
degeneration of dopaminergic neurons in the substantia nigra

Answer 21

Paralysis Agitans aka Parkinsons Dse

Question 22

Classic triad (4) of Parkinsons?

Answer 22

PARKINSON DISEASE: It’s a TRAP! Tremor, Rigidity, Akinesia, Postural
Instability!

Question 23

Treatment Strategies for Parkinson’s Disease?

Answer 23

Restore dopaminergic activity in the basal ganglia via:
▪ (1) dopamine precursors (increase level of levodopa)
▪ (2) dopamine agonists
▪ (3) drugs that inhibit its metabolism

Question 24

State characterized by signs and symptoms, frequently the
opposite of those caused by a drug, when it is withdrawn from
chronic use or when the dose is abruptly lowered

Answer 24

DEPENDENCE

Question 25

• decreased response to a drug, necessitating larger doses to
  achieve the same effect

Answer 25

TOLERANCE

Question 26

What stimulant: * Promotes release of norepinephrine,
dopamine, and serotonin
* Key features: agitation, psychotic state
(delusions + paranoia), hyperthermia,
sympathetic overdrive
* Acidification of urine can promote
elimination

Answer 26

METHAMPHETAMINE (SHABU)

Question 27

What stimulant? * More selective serotonin releaser
* Sexual enhancer
* Key features: hypertension, delusions +
hallucinations, hyperthermia, serotonin
syndrome

Answer 27

Methylene
dioxymethamphetamine
(MDMA/Ecstasy)

Question 28

What stimulant? * Inhibits reuptake of dopamine,
norepinephrine, and serotonin
* Amphetamine-like effects but more shortlasting
* Key features: enhanced self-confidence,
sympathetic overdrive
* Can cause an MI and arrhythmias and bowel
ischemia from vasoconstriction

Answer 28

Cocaine (coke)

Question 29

Most dangerous hallucinogen?

Answer 29

Phencyclidine
(PCP)