Movement

Question 1

What are the most notorious anti-psychotic drug classes for drug induced parkinsonism?

Answer 1

Butyrophenones and phenothiazines

Question 2

What are the 2 reasons why dopamine is not effective for PD in its pure form?

Answer 2

1. Dopamine has low bioavailability

2. Dopamine does not readily cross the BBB

Question 3

What enzyme does carbidopa inhibit?

Answer 3

Dopa decarboxylase in the peripheral tissues

Question 4

What are the 2 enzymes in the periphery are inhibited by Entacapone and Carbidopa to prevent metabolism of Levodopa before it makes it into the brain?

Answer 4

Entacapone and tolcapone: COMT Catecholamine-O-methyltransferase
Carbidopa: Dopa decarboxylase

Tolcapone acts in both the central and peripheral compartments. Entacapone acts only in the periphery similar to carbidopa

Question 5

How does pramipexole affect the sleep pattern of PD patients?

Answer 5

They may cause an uncontrollable urge to sleep

Question 6

Indicate which dopamine agonist receptor the following drugs act on

1. Bromocriptine
2. Pramipexole
3. Ropinirole

Answer 6

1. D2
2. D3
3. D2

Question 7

Why is bromocriptine not a first line medication for PD?

Answer 7

It is an ergot and can causes erythromelalgia and pulmonary infiltrates.

Question 8

What PD medication has onset of action in 10 minutes?

Answer 8

Apomorphine

Question 9

What are the two commonly used MAO-B inhibitors, which of them is more potent and which is known to cause serotonin syndrome when used with SSRI’s

Answer 9

Rasagiline more potent

Selegiline serotonin syndrome

Question 10

Which COMT inhibitor can act both centrally and peripherally?

Answer 10

Tolcapone. Entacapone periphery only

BUT tolcapone causes liver damage– need consent prior to use out of many markets already

Question 11

Which group of PD drugs causes the urine to turn orange?

Answer 11

Entacapone

Question 12

What are the 3 theoretical MOA of amantadine?

Answer 12

1. Increase in dopamine synthesis and release
2. Inhibition of dopamine uptake
3. NMDA antagonist

Question 13

What are the two adverse effects that are specific to amantadine among PD drugs?

Answer 13

Peripheral edema and livedo reticularis

Question 14

What is the MOA of the following drugs, benztropine, biperiden and ophenadrine? What PD symptoms/ signs do they address the best?

Answer 14

Anticholinergics address tremor and rigidity but very little effect on bradykinesia

Question 15

What movement disorder can be treated by the following: haloperidol, clonidine and pimozide?

Answer 15

Tics

Question 16

What are the top 2 first line medications for essential tremor?

Answer 16

Beta blockers

Primidone

Question 17

What is the first line treatment of Wilson Disease?

Answer 17

Penicillamine a chelating agent

Question 18

What medication can be given for restless legs syndrome?

Answer 18

Pramipexole and Ropinirole (Dopaminergic therapy)

Question 19

What CA may be

activated by levodopa?

Answer 19

Melanoma

Question 20

What eye condition is levodopa a relative contraindication?

Answer 20

Because of its mydriatic action it can cause increase in IOP therefore relative CI to open angle glaucoma but ABSOLUTE CONTRAINDICAITON TO ANGLE CLOSURE GLAUCOMA

Question 21

Why would tetrabenzine and haloperidol be considered medications for Huntington’s disease?

Answer 21

T: Deplete dopamine
H: Block dopaminergic receoptors