Drugs used in Parkinsonism

Question 1

what are the primary signs of Parkinson’s Disease?

Answer 1

TRAP

tremors, rigidity, akinesia, postural instability
sec to dopaminergic neuron degeneration

Question 2

what causes drug-induced parkinsonism?

Answer 2

1. typical antipsychotics
2. reserpine
3. MPTP (methylphenyltetrahydropyridine)

Question 3

dopamine precursor
PRIMARY DRUG FOR PARKINSON’S DISEASE
SE: emesis, dyskinesia (choreoathetosis), on-off phenomena, wearing-off phenomena
CI IN PATIENTS WITH HISTORY OF PSYCHOSIS
hypertensive crisis occurs when used with MAOIs

Answer 3

levodopa-carbidopa

Question 4

levodopa-carbidopa is used with what to prolong duration of effect?

Answer 4

COMT inhibitors

Question 5

difference between Parkinson’s and Huntington’s disease?

Answer 5

levels of dopamine
Parkinson’s: low dopa
Huntington’s: high dopa –> chorea

Question 6

ergot derivative
dopamine agonist (partial)
for parkinson’s disease, levodopa intolerance, hyperprolactinemia
SE: ERYTHROMELALGIA, pulmonary fibrosis

Answer 6

bromocriptine
pergolide, carbegoline

cannot be used alone

Question 7

non-ergot dopamine agonist
for Parkinson’s Disease and Restless Legs Syndrome
SE: compulsive gambling, hypersexuality, overeating, uncontrollable tendency to fall asleep
CI IN PATIENTS WITH ACTIVE PEPTIC ULCER DISEASE, PSYCHOTIC ILLNESS, OR RECENT MI

Answer 7

pramipexole

ropinirole

Question 8

dopamine agonist (partial) at D3 receptors
antagonist at 5-HT receptors
for OFF-PERIODS OF PARKINSON’S DISEASE
SE: severe nausea (premedicate with TRIMETHOBENZAMIDE for prevention)

Answer 8

apomorphine

Question 9

MAO type B inhibitor (selective only in low doses <10mg)
for Parkinson’s disease
when combined with MEPERIDINE, causes AGITATION, DELIRIUM, & DEATH (FATAL REACTION)
SEROTONIN SYNDROME occurs when used with SSRIs

Answer 9

Selegiline
Rasagiline

CANNOT eat with chees & wine (tyramine-containing) –> increase in catecholamines –> hypertensive crisis

Question 10

COMT inhibitor
prolongs response to levodopa
for parkinson’s disease (wear off phenomena)
SE: sleep disturbance, ORANGE URINE, HEPATOTOXICITY, NEUROLEPTIC MALIGNANT SYNDROME, RHABDOMYOLYSIS

Answer 10

entacapone

tolcapone (hepatotoxicity)

Question 11

antiviral
potentiates dopaminergic function
for parkinson’s disease, influenza A
SE: ACUTE TOXIC PSYCHOSIS, LIVEDO RETICULARIS, PERIPHERAL EDEMA

Answer 11

amantadine

Question 12

drugs that cause livedo reticularis

Answer 12

amantadine
hydroxyurea
minocycline
gemcitabine
quinidine

Question 13

anticholinergic
muscarinic blockade
for parkinson’s disease, EPS caused by antipsychotics
SE: atropine like effects (urinary retention, constipation, dry mouth)
exacerbates tardive dyskinesias (mostly of facE) from prolonged use of antipsychotic

Answer 13

benztropine

biperiden, trihexyphenidyl, orphenadrine, procyclidine

Question 14

FOR HUNTINGTON’S DISEASE
depletes amine transmitters by reversibly binding to VMAT2 –> decreased uptake of monoamines
reduces chorea severity

Answer 14

tetrabenazine

reserpine

Question 15

FOR TOURETTE’S SYNDROME
blocks central D2 receptors
reduces vocal and motor tic frequency and severity
SE: PARKINSONISM

Answer 15

haloperidol

pimozide