Parkinson------------------------------------------------EXAM 2

Question 1

Comp inhibitor
Uses for acting in periphery ( not enter CNS)
Levodopa inc brain penetr

Answer 1

Tolcapone & entacapone

Question 2

Int: MAOI’s, catecholamines, methyldopa

MCM

Answer 2

Tolcapone & entacapone

Question 3

ADR: (HDHD URINE CNS)

Hepatotoxicity, diarrhea
Hypotension, dyskinesia
Urine discolor,
Cramps, nausea, stomach upset

Answer 3

Tolcapone & entacapone

Question 4

Inc Levodopa response time

Answer 4

Tolcapone & entacapone

Question 5

Need to monitor w/ liver function tests

Answer 5

Tolcapone & entacapone

Question 6

Metabolized in pheriphery by L-aminoacid decarboxylase.

Answer 6

Levodopa

Question 7

Uses for cornerstone therapy for parkinson

Answer 7

Levodopa

Question 8

Doesnt stop progression of parkinson’s ds

Answer 8

Levodopa

Question 9

Int

Phenytoin, phenothiazine- dec effect
B6- inc peripheral conversion
MAOI- inc BP

Answer 9

Levodopa

Question 10

AD: (Hi My Bloody GONADDS)
Gastrointestinal, cardiovascular, behavioral

Halluci
Mydriasis, Blood dyscrasias,
Gout, Orthostatic hypotension, Nausea ,Arrhythmia, Dyskinesia, Depression, Sleep disorders,

Answer 10

Levodopa

Question 11

1/3 respond well, 1/3 not respond well

Best if given early

Answer 11

Levodopa

Question 12

Response to drug decreases after 3-4 yrs

Answer 12

Levodopa

Question 13

Best at bradykinesia

Answer 13

Levodopa

Question 14

Antipsychotic agents

Answer 14

Clozapine, quetiapine, risperidone

Question 15

Used in ratio w Levodopa to allow more to cross BBB

Answer 15

Levodopa

C:L=1:4, 1:10

Question 16

Prevent GI symptoms in 80% of pt

Answer 16

Carbidopa

Question 17

Take more often in smaller dose

Add Bromocriptine, selegiline, or decrease protein, drug holiday doesnt work

Answer 17

Carbidopa

Question 18

MAO-B inhibitor

Blocks dopamine breakdown (prolongs Levodopa effect)

Answer 18

Selegrilline, Rasagilline

Question 19

Int: ( flut meperidine general street)

Fluoxetine, TCA, Genanaes, meperidine, St. John

Answer 19

Selegrilline, Rasagilline

Question 20

AD: (JIA)

Jitteriness, insomnia, inc AD of Levodopa

Answer 20

Selegrilline, Rasagilline

Question 21

NMDA ant
Anti Ch
Anti viral

Answer 21

Amantadine

Question 22

Helps w tremor

Answer 22

Amantadine

Question 23

Increase dopamine, blocks D reuptake, inc syn D recptor

Answer 23

Amantadine

Question 24

AD:

Anti-ch(dry mouth, sedation, vivid dreams)
CNS(depression, halluc, anxiety, dizz, psych, confusion)

Answer 24

Amantadine

Question 25

Int: (CHAAT) Cns stim, hydrochlorothiazide, anti-ch, amiloride, triamiterene Not use in seizure or CHF pt

Answer 25

``` Trihexyphenidyl Procyclidine Benztropine Biperidine Diphenhydramine ```

Question 26

Anti-ch use for rigidity, dystonia, tremor/ not help for bradykinesia

Answer 26

``` Trihexyphenidyl Procyclidine Benztropine Biperidine Diphenhydramine ```

Question 27

AD Older-> worsen Dry mouth, urinary retention, confusion

Answer 27

``` Trihexyphenidyl Procyclidine Benztropine Biperidine Diphenhydramine ```

Question 28

Anti-ch

Answer 28

``` Trihexyphenidyl Procyclidine Benztropine Biperidine Diphenhydramine ```

Question 29

Not helpful for bradykinesis

Answer 29

``` Trihexyphenidyl Procyclidine Benztropine Biperidine Diphenhydramine ```

Question 30

Ergot dopamine agonist

Answer 30

Bromocriptine

Question 31

Bind to post-synaptic dopamine receptors and enhance transmission Not increase dopamine concentration Prolongs effective treatment period for levodopa

Answer 31

Bromocriptine

Question 32

Int: Tolcapone causes hepatotoxicity (black box warning) & neuroleptic malignant syndrome

Answer 32

Bromocriptine

Question 33

Int MAOI- can cause neuroleptic malignant syndrome

Answer 33

Bromocriptine

Question 34

Dont use in pts w MI or in psychotic pt

Answer 34

Bromocriptine

Question 35

AD: (DOHA RIP CARDD) Diarrhea, orthostatic hypotension, hallucination, anorexia, rhabdomyolysis, impulse problem(add like), pleural fibrosis, cardiac arrhythmias, digital vasopasms, dyskinesias

Answer 35

Bromocriptine

Question 36

Decrease incidence of dyskinesias than Levodopa

Answer 36

Bromocriptine

Question 37

Can be given w carbidopa, levodopa, or to refractory pt

Answer 37

Bromocriptine

Question 38

1st line drug for parkinson

Answer 38

Bromocriptine+ Levodopa

Question 39

Non-ergot agonist

Answer 39

Ropinirole A P

Question 40

Prolongs effective treatment period for Levodopa

Answer 40

Ropinirole

Question 41

Uses for restless leg syndrome

Answer 41

Ropinirole Pramipexole

Question 42

Int: (CEO) Ciprofloxacine, estrogen, omeprazole

Answer 42

Ropinirole

Question 43

AD: DOH(a) RI(p) Diarrhea, ortho hypo, halluc, rhabdo, impulse

Answer 43

Ropinirole Apomorphine Pramipexole

Question 44

Decrease risk of dyskinesia for pts on Levodopa

Answer 44

Ropinirole

Question 45

Used early in course as monotherapy or w Levodopa

Answer 45

Ropinirole

Question 46

Use for acute treatment of severe rigidity or inability to move Used as a rescue therapy-injectable and fast-acting

Answer 46

Apomorphine

Question 47

Int: Tolcapone- MAOI's- Ondansetron-

Answer 47

Apomorphine

Question 48

Int: Tolcapone-causes hepatoxicity(black box warning) & neuroleptic malignant syndrome MAOI's- can cause neuroleptic malignant syndrome Ondansetron-causes hypotension

Answer 48

Apomorphine

Question 49

It's emetic agent (induces vomiting) so pts need an antiemetic - trimethobenzamide (antiemetic given w apomorphine)

Answer 49

Apomorphine

Question 50

Bind to post-syn D receptors; potent at D2,D3, D4 Prolongs levodopa period

Answer 50

Pramipexole

Question 51

Int: Tolcapone MAOI

Answer 51

Pramipexole

Question 52

No systemic metabolism When use w Levodopa, can decrease Levodopa 30%

Answer 52

Pramipexole

Question 53

Parkinson's

Answer 53

TEL MA BRO to RAP and TRI PRO BENZ BIDI TEL- tolcapone, entacapone/ levodopa MAO- B inh: selegrilline, rasagilline Amantadine Bromocriptine Ropinirole Apomorphine Pramipexole Trihexyphenidyl, procyclidine, benztropine, biperidine, diphenhydramine