Parkinson's Disease

Question 1

Name the 5 types of drugs used in the treatment of Parkinson’s disease

Answer 1

Levodopa 
Dopamine receptor agonists 
MAO-B Inhibitors 
Catechol-o-methytransferase inhibitors (COMT)
Miscellaneous

Question 2

Levodopa - 4 different drugs

Answer 2

IR: Sinemet (l-dopa + c-dopa)
Madopar (l-dopa + benserazide)

SR: Sinemet CR,
Madopar CR

Question 3

Dopamine receptor agonists: 5 types

Answer 3

Ergoline derivatives: Bromocriptine (selective D2 ra + partial D1 ra)
Pergolide Mesylate: directly stimulate both D1 and D2 receptors
Ropinirole + Pramipexole: D2 affinity
Rotigotine: early symptoms (TD patch)
Apomorhphine: potent da agonist (D4)

Question 4

MAO-B inhibitors: 2 types

Answer 4

Selegiline

Rasagiline

Question 5

Catecol-o-methyltransferase inhibitors (COMT): 3 types

Answer 5

Tolcapone
Entacapone
Opicapone

Question 6

Miscellaneous: 2 types

Answer 6

Anticholinergics

Amantadine

Question 7

Side effects: Levodopa

Bonus Q: how do we make it better?

Answer 7

N+V – made better by adding DOPA decarboxylase inhibitors (Carbidopa)

Dry mouth, drowsiness, dyskinesia, confusion, insomnia

Question 8

Side effects: Dopamine-Receptor antagonists

Answer 8

GIT, arrhythmias, postural hypotension, drowsiness, sudden onset of sleep, dyskinesia, confusion, insomnia
*impulse control disorder

Question 9

Levodopa: Interactions

Answer 9

Increased risk of postural hypotension with anti-HPT

Question 10

Side Effects: MAO-B inhibitors

Answer 10

Lower tyramine levels, can block MAOA at high doses = HPT

Question 11

Mechanism of action: MAO-B inhibitors

Answer 11

Prevent break down of DA (naturally occurring or from LDOPA) = increase levels

Question 12

Interactions: MAO-B inhibitors

Answer 12

Fatal hyperthermia with meperidine, cocaine, fluoxetine

Question 13

Side Effects: Catechol-o-methyltransferase inhibitors

Answer 13

N+D, confusion, sleep disorders, orange urine, dyskinesias, abdominal pain

Question 14

Mechanism of action - Catechol-o-methyltransferase

Answer 14

Diminish peripheral metabolism of levodopa

Question 15

Side effects: Anticholinergics

Answer 15

Constipation, blurred vision, dry mouth, urinary retentions, confusion, memory loss

Question 16

Side effects: Amantadine

Answer 16

Confusion, insomnia, nightmares, leg swelling, hallucinations, can’t concentrate

Question 17

Mechanism of Actions: Anticholinergics

Answer 17

Decrease ACh activity

Question 18

Mechanism of action: Amantadine

Answer 18

Increase DA release in striatum, blocks NMDA glutamate receptors