Lippincott Chapter 8: Drugs for Neurodegenerative Diseases Flashcards
8.1 Which one of the following combinations of antiparkin-
sonian drugs is an appropriate treatment plan?
A. Amantadine, carbidopa, and entacapone.
B. Levodopa, carbidopa, and entacapone.
C. Pramipexole, carbidopa, and entacapone.
D. Ropinirole, selegiline, and entacapone.
E. Ropinirole, carbidopa, and selegiline.
Correct answer = B. To reduce the dose of levodopa and its
peripheral side effects, the peripheral decarboxylase inhibitor,
carbidopa, is coadministered. As a result of this combination,
more levodopa is available for metabolism by catechol-O-
methyltransferase (COMT) to 3-O-methyldopa, which com-
petes with levodopa for the active transport processes into
the CNS. By administering entacapone (an inhibitor of
COMT), the competing product is not formed, and more
levodopa enters the brain. The other choices are not appro-
priate, because neither peripheral decarboxylase nor COMT
nor monoamine oxidase metabolizes amantadine or the
direct-acting dopamine agonists, ropinirole and pramipexole.
8.2 Peripheral adverse effects of levodopa, including
nausea, hypotension, and cardiac arrhythmias, can be
diminished by including which of the following drugs in
the therapy?
A. Amantadine.
B. Ropinirole.
C. Carbidopa.
D. Tolcapone.
E. Pramipexole.
Correct answer = C. Carbidopa inhibits the peripheral
decarboxylation of levodopa to dopamine, thereby dimin-
ishing the gastrointestinal and cardiovascular side effects of
levodopa. The other agents listed do not ameliorate adverse
effects of levodopa.
8.3 Which of the following antiparkinsonian drugs may cause
vasospasm?
A. Amantadine.
B. Bromocriptine.
C. Carbidopa.
D. Entacapone.
E. Ropinirole
Correct answer = B. Bromocriptine is a dopamine receptor
agonist that may cause vasospasm. It is contraindicated in
patients with peripheral vascular disease. Ropinirole directly
stimulates dopamine receptors, but it does not cause vaso-
spasm. The other drugs do not act directly on dopamine
receptors.
8.4 Modest improvement in the memory of patients with
Alzheimer’s disease may occur with drugs that increase
transmission at which of the following receptors?
A. Adrenergic.
B. Cholinergic.
C. Dopaminergic.
D. GABAergic.
E. Serotonergic.
Correct answer = B. AChE inhibitors, such as rivastigmine,
increase cholinergic transmission in the CNS and may
cause a modest delay in the progression of Alzheimer’s dis-
ease. Increased transmission at the other types of recep-
tors listed does not result in improved memory.
8.5 Which medication is a glutamate receptor antagonist that
can be used in combination with an acetylcholinesterase
inhibitor to manage the symptoms of Alzheimer’s disease?
A. Rivastigmine.
B. Ropinirole.
C. Fluoxetine.
D. Memantine.
E. Donepezil.
Correct answer = D. When combined with an acetylcholin-
esterase inhibitor, memantine has modest efficacy in keep-
ing patients with Alzheimer’s disease at or above baseline
for at least 6 months and may delay disease progression.
8.6 Which of the following agents is available as a patch
for once-daily use and is likely to provide steady drug
levels to treat Alzheimer’s disease?
A. Rivastigmine.
B. Donepezil.
C. Memantine.
D. Galantamine.
E. Glatiramer.
Correct answer = A. Rivastigmine is the only agent avail-
able as a transdermal delivery system for the treatment of
Alzheimer’s disease. It may also be used for dementia asso-
ciated with Parkinson’s disease.
8.7 Which of the following is the only medication that is
approved for the management of amyotrophic lateral
sclerosis?
A. Pramipexole.
B. Selegiline.
C. Galantamine.
D. Riluzole.
E. Glatiramer.
Correct answer = D. Riluzole continues to be the only agent
FDA approved for the debilitating and lethal illness of ALS.
It is used to, ideally, delay the progression and need for ven-
tilator support in severe patients.
8.8 Which of the following medications reduces immune
system–mediated inflammation via inhibition of
pyrimidine synthesis to reduce the number of activated
lymphocytes in the CNS?
A. Riluzole.
B. Rotigotine.
C. Teriflunomide.
D. Dexamethasone
Correct answer = C. Teriflunomide is believed to exert its
disease modifying and anti-inflammatory effects by inhibit-
ing the enzyme dihydro-orotate dehydrogenase to reduce
pyrimidine synthesis.
8.9 Which of the following agents may cause tremors as
a side effect and, thus, should be used with caution in
patients with Parkinson’s disease, even though it is also
indicated for the treatment of dementia associated with
Parkinson’s disease?
A. Benztropine.
B. Rotigotine.
C. Rivastigmine.
D. Dimethyl fumarate.
Correct answer = C. Though rivastigmine is an acetyl-
cholinesterase inhibitor, which can cause tremors as an
adverse effect, its use is not contraindicated in patients with
Parkinson’s disease, as this agent is also the only medi-
cation approved for dementia associated with Parkinson’s
disease. It should be used with caution, as it may worsen
the parkinsonian-related tremors. A risk–benefit discussion
should occur with the patient and the caregiver before riv-
astigmine is used.
8.10 Which of the following agents exerts its therapeutic
effect in multiple sclerosis via potassium channel
blockade?
A. Dalfampridine.
B. Donepezil.
C. Riluzole.
D. Bromocriptine.
Correct answer = A. Dalfampridine is a potassium channel
blocker and is the only agent that is indicated to improve
walking speed in patients with MS.
