Parkinson's Disease

Question 1

Symptoms of Parkinson’s

Answer 1

Tremor
Rigidity
Akinesia
Postural instability

Question 2

Which symptom is the most responsive and debilitating?

Answer 2

Bradykinesia

Question 3

Which symptom is the most difficult to treat and appears late in PD?

Answer 3

Postural instability

Question 4

Initial treatment

Answer 4

Treat bradykinease and disability, control symptoms

Question 5

Second stage treatment

Answer 5

Patient now has dyskinesia, need to treat with L-DOPA

Question 6

Prodrug metabolized to DA by L-amino acid decarboxylase in the brain

Answer 6

L-DOPA

Question 7

Transporter of L-DOPA

Answer 7

L-amino transporter

Question 8

Main symptom that L-DOPA treats

Answer 8

Bradykinesia, restless leg syndrome

Question 9

Side effect of L-DOPA

Answer 9

Impulsive behavior (worsened by carbidopa), off and on phenomenon (fluctuation between dykinesia with longterm use)

Question 10

What is the MOA of Carbidopa?

Answer 10

Prevent metabolism of L-dopa in the periphery

Question 11

Benefit of carbidopa

Answer 11

Increases L-DOPA reaching brain by 10%

Allow reduction of L-DOPA by 75%

Question 12

Side effects of carbidopa

Answer 12

Increased CNS side effects of L-DOPA

Question 13

Which dopamine receptor agonist is a direct D2 receptor that does not require any metabolism?

Answer 13

Pramipexole

Question 14

Which DA receptor agonist is used to rapidly treat “Motor fluctuation” syndrome and hypomobility in advanced PD?

Answer 14

Apomorphine

Question 15

Which PD drug is associated with a strong-emetic reaction?

Answer 15

Apomorphine

Question 16

What is the MOA of Selegiline?

Answer 16

MOA-B selective irreversible inhibitor

Prevent degradation of DA in the CNS, prolong effects of L-DOPA

Question 17

Which PD drug is associated with having possible disease modifying effects?

Answer 17

Selegiline

Question 18

Which drug is used in combination with L-DOPA and Carbidopa to reduce motor fluctuations?

Answer 18

Selegiline

Question 19

Is Selegiline associated with HTN crisis?

Answer 19

No

Question 20

What is the MOA of Entacapone

Answer 20

Reversible inhibitor of COMT

Prolong effects of L-DOPA and carbidopa

Question 21

How must Entacapone be administered?

Answer 21

In combination with L-DOPA and carbidopa

Cannot be administered alone

Question 22

Which drug is used for patients with tremor and lacking bradykinesia?

Answer 22

Trihexyphenidyl

Question 23

Which drug is associated with cognitive dysfunction?

Answer 23

Trihexyphenidyl

Question 24

Which drug blocks the M3 receptors to improve symptoms in tremor patients?

Answer 24

Trihexyphenidyl

Question 25

Which PD drug is an anti-viral?

Answer 25

Amantidine

Question 26

Which PD drug is associated with cognitive impairment, livedo reticularis (purple skin), and ankle edema?

Answer 26

Amantidine