Parkinson Disease

Question 1

MOA: directly stimulates dopamine receptors

Answer 1

Dopamine Agonist: Bromocriptine, Pramipexole, Ropinorole

Question 2

What type of patient would you consider dopamine agonist?

Answer 2

Young patient to delay use of levodopa.

**fewer side effects than levodopa

Question 3

Why are carbidopa and levodopa mixed?

Answer 3

Carbidopa reduces amount of Levodopa needed–>reducing the SE from Levodopa

Question 4

Which two conditions are anticholinergics contraindicated for Parkinson Disease?

Answer 4

1. BPH

2. Glaucoma

Question 5

What are the side effects of anticholinergics?

Answer 5

Dry mouth, constipation, blurred vision, tachycardia, urinary retention

“blind as a bat, red as a beet, mad as a hatter, dry as a bone”

Question 6

Who are anticholinergics (Trihexyphenidyl, Benztropine) indicated for?

Answer 6

<70 years old with tremor predominance

doesn’t improve bradykinesia

Question 7

Amantadine MOA

Answer 7

Increases presynaptic dopamine release

Blocks glutamatergic N-methyl-D-aspartate (NMDA) receptors

Question 8

Amatadine effect

Answer 8

improves long-term levodopa induced dyskinesias. May help early on with mild symptoms.

Question 9

What does MAO-B do?

Answer 9

MAO-B breaks down dopamine

Question 10

MAO-B Inhibitors (Selegiline, Rasagiline) MOA

Answer 10

Prevent MAO-B from breaking down dopamine–>increasing dopamine

Question 11

Treatment of choice for a PD patient with bradykinesia/rigidity under 65 years of age?

Answer 11

Dopamine agonist (Bromocriptine, Pramipexole, Ropinirole)

Question 12

What are the 2 main adverse effects from the dopamine agonists?

Answer 12

1. Impulsive behaviors

2. Postural hypotension

Question 13

When are the two times Amantidine is helpful?

Answer 13

1. Young patient/early in disease progression with mild symptoms
2. When dyskinesia becomes problematic

Question 14

What is the first line treatment to treat tremor in PD for a patient under 65 years?

Answer 14

Anticholinergics (Trihexyphenidyl, Benztropine)

Question 15

What are the potential fixes for “wearing off bradykinesia”

Answer 15

• increase frequency of Cabidopa/levodopa
• Switch to extended release
• Add COMT inhibitor
• Add MAO-B inhibitor
• Add dopamine agonist

Question 16

What are the potential fixes for “delayed” response

Answer 16

• give levodopa/carbidopa on empty stomach
• Avoid CR
• Use apomorphine sub Q

Question 17

Start hesitation “freezing”

Answer 17

• Increase levodopa/carbidopa
• Add dopamine agonist or MAO-B inhibitor
• Sensory cues
• Physical therapy

Question 18

Peak-dose dyskinesia

Answer 18

• lower dose of carbidopa/levodopa

- Add amantadine

Question 19

What is important to monitor with Catechol-O-Methlytransferase (COMT) inhibitors?

Answer 19

COMT inhibitors (Entacapone, Tolcapone) can be hepatoxic, so need to monitor LFTs

Question 20

If the patient is on Antidiarrheals or COMT inhibitors, what needs to be done to the L-Dopa dose?

Answer 20

L-dopa dose needs to be lowered

Question 21

Who are anticholinergic medications (Benztropine, Trihexyphenidyl) helpful for?

Answer 21

• Mild, tremor-predominant PD
• <70 years (monotherapy)
• Advanced disease with persistent tremor despite levadopa or dopamine agonists

Question 22

What is a common adverse drug reaction with MAO-B inhibitors (Selegiline, Rasagiline)?

Answer 22

insomnia

Question 23

Which two PD drugs prevent the breakdown of Dopamine?

Answer 23

COMT inhibitors (Entacapone, Tolcapone)

MAO-B inhhibitors (Selegiline, Rasagiline)