parkinson's: DA precursor, ergot/nonergots

Question 0

Drug that’s taken orally and absorbed in small bowel

Answer 0

levodopa

Question 1

Dopamine precursor drug?

Answer 1

Levodopa (L-DOPA)

Question 2

drug that is usually given with carbidopa, is the first line tx for parkinson unless pt is young, in which case you want to delay tx with this drug for as long as possible.

Answer 2

levodopa

Question 3

drug that has these side effects: 
hallucinations
dyskinesias
on/off phenomenon
neuroleptic malignant syndrome (NMS)
psychosis possible with chronic use

Answer 3

levodopa

Question 4

what are some important and other side effects of levodopa?

Answer 4

important ADRs:
hallucinations
dyskinesias
on/off phenomenon
NMS
psychosis with chronic use

Other: GI distress, hypoTN, dizziness

Question 5

what is levodopa given with? and does it accelerate PD?

Answer 5

carbidopa, yes

Question 6

aromatic aa decarboxylase inhibitor

Answer 6

carbidopa

Question 7

what is carbidopa used in combo with and what is it used to tx?

Answer 7

levodopa, parkinsons

Question 8

drug with these side effects:
dyskinesias
on/off phenomenon
NMS
psychosis

Answer 8

carbidopa

Question 9

is Carbidopa contradicated with MAO-A inhib or MAO-B inhib?

Answer 9

MAO-A, MAO-B only hits DA (prevents DA breakdown)

Question 10

2 ergot derivatives

Answer 10

1. Bromocriptine

2. pergolide

Question 11

which of the ergot derivatives tx mild parkinson’s; does DA agonism in NMS, hyperprolactinemia?

Answer 11

Bromocriptine

Question 12

what are some side effects of bromocriptine (ergot derivative)

Answer 12

pleural effusions, cough, SOB, pul fibrosis

peripheral DA-like effects

Question 13

which two drugs must be titrated slowly due to hypoTN

Answer 13

bromocriptine, pergolide

Question 14

which one of the ergot derivatives is no longer used to tx parkinson’s bc it has side effects like bromocriptine, in addition to having cardiac valve regurgitation?

Answer 14

pergolide

Question 15

4 non-ergot DA receptor agonist:

hint: Pram jumps rope, rots aPOM

Answer 15

1. pramipexole
2. ropinorole
3. Rotigotine
4. Apomorphine

Question 16

how do the nonergot DA receptor agonists work?

Answer 16

selective D2 agonist

Question 17

t/f: carbidopa prevents peripheral L-DOPA –> DA conversion and does not cross BBB.

Answer 17

T

Question 18

how does bromocriptine work?

Answer 18

D1 antagonist

D2 agonist

Question 19

What are the selective D2 agonists?

Answer 19

pramipexole
ropinorole
rotigotine

Question 20

which of the non-ergot DA receptor agonists is 1st line tx for mild parkinson’s and in doing so, delays L-Dopa tx

Answer 20

pamipexole

Question 21

what is pramipexole used in combo with?

Answer 21

ropinorole

Question 22

ADRs: psychosis, nausea/GI, edema, compulsive behavior (nucleus accumbens, D3)

Answer 22

pramipexole

Question 23

3 non-ergot derivatives that are less effective with motor sx’s of PD

Answer 23

1. pramipexole
2. ropinorole
3. rotigotine (transdermal patch)

Question 24

which 3 nonergot DA receptor agonists have these as ADRs: psychosis, nausea/GI, edema

Answer 24

pramipexole
ropinorole
rotigotine

Question 25

ADR: compulsive behavior (nucleus accumbens, D3)

Answer 25

pramipexole

Question 26

ADR: daytime sleep attacks

Answer 26

ropinorole

Question 27

non-ergot DA receptor agonist that’s given as a rescue therapy for “off” periods (immobility)

Answer 27

apomorphine

Question 28

which non-ergot DA receptor agonist is injectable only, CI - serotonin receptor antagonists (ondansetron); and have the follow ADRs:
psychosis, drowsiness, hypersexuality (inc erections), emesis (pre-admin trimethobenzamide or domiperidone), hypoTN if used with serotonin receptor antagonists, and have peripheral DA effects?

Answer 28

apomorphine