Parkinson's & Alzheimer's

Question 1

4 Major clinical features of Parkinson’s

Answer 1

1. Bradykinesia, 2. muscular rigidty (cogwheel), 3. resting tremor, 4. impairment of postural balance/gait

Question 2

Parkinson’s etiology

Answer 2

1. Idiopathic, 2. Parkin (alpha-synuclein gene), 3. MPTP

Question 3

Drugs and DA target

Answer 3

1. Increase brain dopamine levels
2. Inhibit dopamine metabolism in the brain (MAO-B & COMT)
3. Stimulate brain DA D2 receptors
4. In the periphery, inhibit the conversion of L-dopa to dopamine & Inhibit the metabolism of L-dopa (COMT)

Question 4

Peripheral effects of L-DA

Answer 4

N/V

Question 5

Pt came in taking haloperidol and complaining of Parkison-like sxs, can you treat her with some L-dopa?

Answer 5

No mami

Question 6

Is L-dopa a good mono drug choice for long-term use

Answer 6

No, it will eventually lose it’s affect because DA neurons will continue to degenerate

Question 7

Why combine carbidopa and L-dopa

Answer 7

Carbidopa inhibts dopa-decarboxlase –> conversion of L-dopa to DA is inhibited in periphery –> decrease dose of L-dopa needed and decrease peripheral effects

Question 8

Which SE more common with L-dopa/carbidopa combination and can be treated by reducing L-dopa

Answer 8

Dyskinesias

Question 9

On-Off phenomenon

Answer 9

Fluctuations in clinical response in patients on successful l-dopa therapy
“On” = Improved mobility (w/dyskinesias)
“Off” = Akinesia due to falling drug levels

Question 10

Rescue for on and off phenomenon

Answer 10

Apomorphine

Question 11

L-dopa drug interactions w/

Answer 11

MAO-AI (hypertensive crisis); pyridoxine/vitB6 - increase peripheral metabolism of I-dopa

Question 12

MAOI for parkinson’s inhibits MAO-A or B?

Answer 12

BB

Question 13

COMT inhibitor in CNS and peripheral

Answer 13

Tolcapone

Question 14

COMT inhibitor in pierphery only

Answer 14

Entacapone

Question 15

SE: orange color in urine

Answer 15

COMT inhibitors (Tolcapone, entacapone)

Question 16

COMT inhibitor w/ hepatotoxicity

Answer 16

Tolcapone

Question 17

Which drugs are effective even as disease progresses?

Answer 17

DA receptor agonists (bromocriptine, ropinirole, pramipexole, apomorphine)

Question 18

First line for PD

Answer 18

DA receptor agonist

Question 19

SE: Erythromelagia

Answer 19

Bromocriptine

Question 20

DOC for restless leg syndrome

Answer 20

Ropinirole

Question 21

Drug w/ possible heart failure warning

Answer 21

Pramipexole

Question 22

What do you give w/ apomorphine due to its SE

Answer 22

Nausea; given antiemetic (trimethobenzamide)

Question 23

Avoid antiemetics that targets ______ when using apomorphine

Answer 23

5HT sytsem (ondansetron) and DA D2 receptor (prochlorperazine)

Question 24

Antipsychotic ____ and DA agonist ____ prolactin

Answer 24

increases, decreases

Question 25

SE: Livedo reticularis (red/blue spots)

Answer 25

Amantadine

Question 26

Overdose of amantadine will cause

Answer 26

toxic psychosis and convulsions

Question 27

Restores DA/ACh balance in striatum

Answer 27

Anticholinergics

Question 28

Sxs: Anticholinergics improves ____, while L-dopa improves ___

Answer 28

rigidity, tremor……… bradykinesia

Question 29

Alternative tx of parkinson’s

Answer 29

Neuroprotection (antioxidants, anti-apoptotic agents); pallidotomy; transplant of fetal neurons or pt-derived stem cells; gene therapy; deep brain stimulation

Question 30

Dz w/ b-amyloids and tau proteins

Answer 30

Alzheimers

Question 31

Alzheimer’s pathophysio

Answer 31

degeneration of cholinergic neurons in nucleus of Meynert (–> cortex and hippocampus)

Question 32

Tx of Alzheimer’s

Answer 32

Cholinesterase inhibitors (donepezil, rivastigmine, galantamine)

Question 33

Blocks both AChE and Ach autoreceptor

Answer 33

Galantamine

Question 34

Memantine CI

Answer 34

Meperidine and dextromethorphan

Question 35

Drug acts on NMDA receptor to improve sxs of Alzheimer’s

Answer 35

Memantine

Question 36

Peripheral cholinergic side effects

Answer 36

N/V/D, stomach cramps