Exam 3- Lec 29 Parkinson

Question 1

Classification of Parkinson’s

Answer 1

1. idiopathic
2. iatrogenic: drug induced, particularly by antipsychotics
3. post-traumatic, post encephalitic, atherosclerotic

Question 2

What was observed in the brain with people with Parkinson’s disease?

Answer 2

Parkinson’s patients brain is missing Substantia Nigra- that produces dopamine as neurotransmitter

Question 3

drugs that enhance dopaminergic activity

Answer 3

1. L-DOPA
2. selgiline/deprenyl
3. entacopone

Question 4

drugs that reduce cholinergic activity

Answer 4

Benztropine
Trihexiphenidyl
diphenhydramine

Question 5

l-DOPA

Answer 5

• enhances dopaminergic activity
• dopamine precursor: converted to dopamine
• most effective drug for control of symptoms
• Do not give it to pts with cardiovascular disease

Question 6

l-dopa pharmacokinetics

Answer 6

• well absorbed from GI tract
• enters brain by active transport AA pump
• metabolized to form dopamine by DOPA decarboxylase: brain and periphery

Question 7

Selegiline/deprenyl

Answer 7

inhibits the metabolism of dopamine by MAO-B

MAO-B inhibitor

Question 8

Entacapone

Answer 8

inhibits COMT and slows the metabolism of dopamine

Question 9

Bromocryptine

Answer 9

Stimulate post-synaptic dopamine receptor
Pergolide and pramipexole - dopamine agonist

Question 10

Bentropine and trihexyphenidyl

Answer 10

• reduce cholinergic activity
• block muscarinic receptor

Question 11

Diphenhydramine

Answer 11

number one drug/ only drug used in emergency treatment of drug induced Parkinson’s
- block muscarinic receptors

Question 12

Clozapine

Answer 12

treatment of schizophrenia
manages psychiatric side effects of I-DOPA

Question 13

Extrapyramidal motor symptoms

Answer 13

choreiform movements: after long term therapy or when used with carbidopa
*Dopamine activity outweighs ACH activity

Question 14

Endocrine effects of I-DOPA

Answer 14

acts to inhibit prolactin secretion

Question 15

behavioral effects l-DOPA

Answer 15

depression
psychotic reactions
nightmares
euphoria
mood and personality changes

Question 16

Drug interaction of I-DOPA and Pyridoxine

Answer 16

Pyridoxine increases the metabolism of I-DOPA in periphery and prevent therapeutic effects

Question 17

Drug interaction of I-DOPA and Antipsychotics

Answer 17

antipsychotic blocks the effect of I-DOPA

Question 18

Drug interaction of I-DOPA and tricyclic antidepressants

Answer 18

tricyclic antidepressants cause hypertensive crises when used with I-DOPA

Question 19

Carbidopa

Answer 19

ALWAYS used with I-DOPA = Sinemet
inhibits DOPA decarboxylase in the periphery but does not enter the brain

Question 20

Bromocryptine

Answer 20

Directly stimulates dopamine receptor

Question 21

Ropinirole, Pramipexole, Rotigotine

Answer 21

Dopamine agonist

ex: in Advance Parkinson’s dopamine in neurons are gone, this medication is given to act on target cell when dopamine is not there

Question 22

Entacapone

Answer 22

Inhibits COMT