Movement Disorders Pharm

Question 1

name the Monoamine oxidase inhibitors

Answer 1

Selegiline (Eldepyrl), Rasagiline (Azilect)

Question 2

name the Dopamine agonists

Answer 2

Ropinirole (Requip), Pramipexole (Mirapex), Pergolide (Permax), Bromocriptine (Parlodel)

Question 3

name the Catechol-o-methyltransferase inhibitor

Answer 3

Entacapone (Comtan)

Question 4

name the Acetylcholine-blocking agents

Answer 4

Benzotrpine mesylate (Cogentin), Biperiden (Akineton), Trihexyphenidyl (Artane)

Question 5

name the N-Methyl-D-aspartate (NMDA) receptor inhibitor

Answer 5

Apomorphine (Apokyn)

Question 6

Gold standard of Parkinson tx

Answer 6

Levadopa/Carbidopa (Sinemet)

Question 7

Completely or partially relieves akinsesia, rigidity and tremor in about 80% in Parkinson’s

Answer 7

Levadopa/Carbidopa (Sinemet)

Question 8

For what drug does the effectiveness substantially decreases after 3rd year of treatment and may return to pretreatment levels in 6-7 years

Answer 8

Levadopa/Carbidopa (Sinemet)

Question 9

Preferred initial treatment in patients over 70, particularly those with dementia

Answer 9

Levadopa/Carbidopa (Sinemet)

Question 10

Why should you delay the use of Levadopa/Carbidopa (Sinemet)?

Answer 10

may directly hasten the degeneration of dopamine neurons in the substantia nigra by promoting the generation of free radicals and oxidative stress

Question 11

Major physical adverse effect of Levadopa/Carbidopa (Sinemet)

Answer 11

Dyskinesias (80%)

Question 12

When might the wearing off effect of Levadopa/Carbidopa (Sinemet) occur?

Answer 12

occur within 4-6 years of treatment

Question 13

CI to Levadopa/Carbidopa (Sinemet)

Answer 13

Concurrent use with MAOI’s, Psychotic patients, Angle-closure glaucoma, Hx of melanoma

Question 14

unpredictable, alternating periods of dyskinesia and immobility

Answer 14

on-off effect

Question 15

If a patient is experiencing the wear-off effect, what can be added to their regimen to improve efficacy?

Answer 15

dopamine agonists, MAOB’s and COMT inhibitors

Question 16

Stops the breakdown of dopamine and Enhances peak levadopa levels

Answer 16

MAO-B inhibitors

Question 17

Major adverse effect of MAO-B inhibitors

Answer 17

insomnia

Question 18

Medication CI to MAO-B inhibitors

Answer 18

Concurrent use with TCA’s, SSRI’s and Demerol

Question 19

Often 1st line in patients with mild disease to slow progression and delay need for levadopa or
as adjunctive therapy to decrease “wearing off”.

Answer 19

MAO-B inhibitors

Question 20

MOA of dopamine agonists

Answer 20

Stimulate dopamine receptors in the substantia nigra

Question 21

Effective in delaying motor complications during the first 1-2 years of treatment

Answer 21

Dopamine agonists

Question 22

CI to dopamine agonists

Answer 22

psychotic illness, recent MI, PUD, PVD

Question 23

To treat acute episodes of “hypermobility” or “freezing”

Answer 23

Apomorphine (Apokyn)- dopamine agonist

Question 24

What does Apomorphine (Apokyn) need to be given with?

Answer 24

antiemetic due to profound nausea as SE but can’t use Zofran or Kytril

Question 25

Increases concentration of existing dopamine in the brain by inhibiting its breakdown

Answer 25

COMT Inhibitors

Question 26

Potentiates dopaminergic function by influencing the synthesis, release or reuptake of dopamine. favorably influences akinesia, rigidity. Not really effective with tremor

Answer 26

Amantadine

Question 27

Type of drug used primarily for tremor

Answer 27

Anticholinergic Acetylcholine-blocking Drugs

Question 28

CI to Anticholinergic/Acetylcholine-blocking Drugs

Answer 28

BPH, Obstructive GI disease, Angle closure glaucoma

Question 29

Antioxidant important for cellular energy

Answer 29

Coenzyme Q

Question 30

Drug that has neuroprotective effect

Answer 30

Selegiline