Parkinson's

Question 1

Three classifications of parkinson’s disease?

Answer 1

1) idiopathic
2) iatrogenic
3) post-traumatic

Question 2

In PD, dopamine neurons die off, causing less dopamine release in the ___

Answer 2

striatum

Question 3

In the striatum, there’s an association between ___ and ___-producing neurons

Answer 3

dopamine, ach

Question 4

When dopaine > Ach what occurs?

Answer 4

Parkinsonism

Question 5

When Ach>dopamine what occurs?

Answer 5

Choreiform movements

Question 6

Presently available drugs are thought to alleviate symptoms by restoring the functional balance between ___ and ___ systems in the striatum

Answer 6

dopaminergic and cholinergic

Question 7

What three drugs enhance dopaminergic activity?

Answer 7

1) L-Dopa
2) Selegiline
3) Entacapone

Question 8

_____ inhibits the metabolism of dopamine by MAO-B

Answer 8

Selegiline

Question 9

____ inhibits COMT and slows the metabolism of dopamine near the synaptic cleft

Answer 9

Entacapone

Question 10

____ is a dopamine pre-cursor that is converted to dopamine

Answer 10

L-Dopa

Question 11

What three drugs are dopamine agonists and stimulate post-synaptic dopamine receptors?

Answer 11

1) Bromocryptine
2) Pergolide
3) Pramipexole

Question 12

What three drugs reduce cholinergic activity and are centrally acting muscarinic antagonists?

Answer 12

1) Benztropine
2) Trihexiphenidyl
3) Diphenhydramine

Question 13

Why is L-dopa typically not used to treat symptoms alone?

Answer 13

L-dopa converts to dopamine in periphery, which can cause cardiovascular effects

Question 14

What is L-dopa commonly used with?

Answer 14

Carbidopa

Question 15

Carbiodopa acts in the peripheral to inhibit L-dopa from becoming ___

Answer 15

dopamine

Question 16

How long does it take to see therapeutic effects of L-dopa?

Answer 16

3-4 weeks

Question 17

True or False:
L-Dopa becomes more effective as Parkinson’s Disease Progressive

Answer 17

False
L-Dopa becomes LESS effective as disease progresses

Question 18

Why is nausea and vomiting a common side effect of L-Dopa?

Answer 18

Stimulates chemoreceptor trigger zone (CRTZ)

Question 19

What are three ways that L-Dopa can affect the heart?

Answer 19

-Postural hypotension
-Arrhythmias
-Tachy

Question 20

What is the most effective drug for managing the psychiatric side effects of L-Dopa?

Answer 20

Clozapine

Question 21

Why are there psychiatric side effects with use of L-Dopa?

Answer 21

Acts on mesolimbic and mesocortical pathways

Question 22

True or False:
L-Dopa can cause extrapyramidal motor symptoms/choreiform movements

Answer 22

True

Question 23

True or False:
L-dopa can increase prolactin levels

Answer 23

False
L-Dopa can decrease prolactin levels

Question 24

The ___ ___ ____ phenomenon appears to be related to decline in blood levels of L-Dopa near the end of the dosage interval

Answer 24

End of Dose phenomenon

Question 25

The ____ phenomenon can occur at any time in the dosage interval and appears to be related to disease progression

Answer 25

on-off phenomenon

Question 26

How can you minimize the end of dose phenomenon?

Answer 26

1) Use SR
2) Add dopaminergic agonist/COMT inhibitor to cocktail

Question 27

Contra-indications for L-dopa?

Answer 27

Glaucoma
Active peptic ulcer disease
Melanoma
Psychosis
Cardiac stuff

Question 28

____ inhibits DOPA decarboxylase in the periphery but does not enter the brain

Answer 28

Carbidopa

Question 29

____ is a non-specific dopamine receptor agonist that can decrease severity of on off phenomenon

Answer 29

bromocryptine

Question 30

What two drugs are newer dopaminergic agonists that may preferentially target D2/D3 receptors?

Answer 30

1) Ropinirole
2) Pramipexole

Question 31

____stimulates release of dopamine from nerve ends, but may also inhibit reuptake

Answer 31

Amantadine

Question 32

Selegiline selectively inhibits ___ and prevents breakdown of dopamine in CNS

Answer 32

MAO-B

Question 33

_____inhibits metabolism of dopamine and L-Dopa by COMT

Answer 33

Entacapone