Parkinson's Disease

Question 1

This is the immediate precursor to dopamine. It is the gold standard for treatment of Parkinson’s. Crosses the BBB

Answer 1

Levodopa

Question 2

This drug inhibits aromatic L-amino acid decarboxylase in the periphery

Answer 2

Carbidopa

Question 3

What are 3 strategies to address wearing off of Levodopa/Carbidopa

Answer 3

• increase dose or dose number
• add a dopamine agonist
• use a COMT inhibitor

Question 4

ADRS are N/V/anorexia, tachycardia, arrhythmias, visual and auditory hallucinations, depression, mania, anxiety, dyskinesia

Answer 4

Levodopa/Carbidopa

Question 5

Drug interactions with vitamin B6 (pyridoxine), MAO inhibitors, antipsychotics

Answer 5

Levodopa/Carbidopa

Question 6

This class of drugs have reduced risks of motor complications and dyskinesias compared to Levodopa/Carbidopa

Answer 6

Dopamine agonists

Question 7

These two dopamine agonists are FDA indicated as monotherapy

Answer 7

Pramipexole

Ropinirol

Question 8

This class of drugs can be neuroprotective. It decreases autooxidation and free radical formation in the brain. Reduces levodopa requirements

Answer 8

Dopamine agonists

Question 9

ADRs include N/V, orthostasis, psychosis, narcolepsy

Answer 9

Dopamine agonist

Question 10

Can cause increased risk of compulsive gambling due to stimulation of dopamine release in the mesolimbic pathway

Answer 10

Dopamine agonists

Question 11

This dopamine agonist has a 3 hour half life, high first pass metabolism and is highly protein bound

Answer 11

Bromocriptine

Question 12

This dopamine agonist has an 8-12 hour half life and is renally excreted

Answer 12

Pramipexole

Question 13

Adverse effects include sedation, hypotension, delusions or psychosis, dyskinesias, N/V, and leg edema

Answer 13

Dopamine agonists

Question 14

This dopamine agonist is transdermal, has a high affinity for DA receptor subtypes, and can be used as monotherapy or adjunct therapy

Answer 14

Rotigotine

Question 15

AEs of this dopamine agonist include application site rxns, nausea, somnolence, sudden onset of sleep, and brief LOC while driving

Answer 15

Rotigotine

Question 16

This MAOB inhibitor can extend the time before l-dopa is needed by 9 months and can extend its action for up to an hour

Answer 16

Selegiline

Question 17

ADRs include insomnia, jitteriness, HTN, worsen preexisting hallucinations and delusions. Can cause a rare serotonin syndrome with concomitant SSRI treatment

Answer 17

Selegiline

Question 18

This is transdermal Selegiline

Answer 18

Emsam

Question 19

This is a selective, irreversible MAO-B inhibitor that is 5x more potent than Selegiline

Answer 19

Rasagiline

Question 20

2 Parkinsons drugs metabolized by CYP 1A2

Answer 20

Ropinirole, Rasagiline

Question 21

This drug is used as an adjunct to L-dopa, is more efficacious than anticholinergic agents, and relieves symptoms of bradykinesia, rigidity, and tremor

Answer 21

Amantidine

Question 22

This drug has fewer side effects than L dopa or anticholinergic agents. Can cause hallucinations. confusion, and nightmares when administered with an anticholinergic

Answer 22

Amantidine

Question 23

ADRs include insomnia, dizziness, and slurred speech. CAUTION in patients with renal disease

Answer 23

Amantidine

Question 24

Indicated for tx in pts with PD experiencing end of dose wearing off with l-dopa

Answer 24

COMT inhibitors

Question 25

These agents have NO ROLE AS MONOTHERAPY

Answer 25

COMT inhibitors

Question 26

This COMT I is highly protein bound and readily absorbed. You need to do strict LFT monitoring, DC if signs of liver failure (there is even an informed consent on package insert)

Answer 26

Tolcapone

Question 27

Can cause delayed onset diarrhea and brownish orange fluid discoloration, and orthostasis

Answer 27

Tolcapone

Question 28

This COMT I causes diarrhea and orthostasis, brownish-orange urine discoloration, but NO evidence of hepatotoxicity

Answer 28

Entacapone

Question 29

This drug is a combo of carbidopa, levodopa, and entacapone

Answer 29

Stalevo

Question 30

These 2 anticholinergic drugs arent as effective as l-dopa but CAN be effective against tremor and dystonic features. Ineffective against bradykinesia

Answer 30

Trihexphenidyl

Benzotropine

Question 31

ADRS: dry mouth, blurred vision, constipation, urinary retention, sedation memory impairment, confusion, dysphoria, hallucinations

Answer 31

Anticholinergics