Parkinsonism

Question 1

Pathophysiology of Parkinson’s

Answer 1

basal ganglia regulates body mvmt
DA is inhibitor
Ach is exciter
lack of Da causes excitement, causing increased muscle tone, rigidity, tremor

Question 2

Levodopa

Answer 2

first line for Parkinson’s

most effective

Question 3

Pharmacokinetics of Levodopa

Answer 3

cross BBB

breaks down to dopamine by aromatic amino acid decarboxylase (AAAD)

Question 4

Carbidopa

Answer 4

dopa decarboxylase inhibitor

formulated with levodopa to decrease GI problems and decrease levodopa peripheral metabolism

Question 5

SE of Levodopa

Answer 5

GI effects
orthostatic hypotension tachycardia
dyskinesia
On-Off effect

Question 6

Levodopa should not be taken with….

Answer 6

pyridoxine (B6)

MAOI-A

Question 7

Examples of Dopamine Receptor Agonists

Answer 7

Pramipexole

Ropinirole

Question 8

Pramipexole

Answer 8

D3 dopamine receptor agonist

first line and adjunct to levodopa

Question 9

Ropinirole

Answer 9

D2 dopamine receptor agonist

first line and adjunct to levodopa

Question 10

SE of Pramipexole and Ropinirole

Answer 10

GI effects
hypotension
dyskinesia

Question 11

Contraindications of Ropinirole and Pramipexole

Answer 11

history of psychotic illness

recent MI or peptic ulcer

Question 12

Monoamine Oxidase B Inhibitors Examples

Answer 12

-giline

Selegiline, Rasagiline

Question 13

MoA of Monoamine Oxidase B Inhibitors

Answer 13

inhibit monoamine oxidase B, an enzyme that metabolizes dopamine

Question 14

Use of Selegiline

Answer 14

adjunct to levodopa

Question 15

Selegiline and Rasagiline cannot be used with…..

Answer 15

meperidine

causes agitation, delirium, mortality

Question 16

Examples of Catechol-o-methyltransferase (COMT) Inhibitors

Answer 16

-capone

tolcapone, entacapone

Question 17

MOA of COMT Inhibitors

Answer 17

inhibit COMT, which normally converts levodopa to 3-O-methyldopa

Question 18

Use of Tolcapone and Entacapone

Answer 18

adjunct to levodopa

prolongs “on” time

Question 19

SE of Entacapone and Tolcapone

Answer 19

dyskinesia
brown urine
postural hypotension
hepatic failure for tolcapone

Question 20

Example of Ach blocker

Answer 20

benztropine

Question 21

MoA of Benztropine

Answer 21

blocks muscarininc receptors

Question 22

Use of Benztropine

Answer 22

adjunct to levodopa

improves tremor and rigidity

Question 23

SE of Benztropine

Answer 23

CNS toxicity- drowsiness, inattention, confusion, delusions, hallucinations

Question 24

Donepezil

Answer 24

reversibly inhibits Ach-ase

Alzheimers

Question 25

Rivastigmine

Answer 25

inhibits butyryl and Ach-ase

Alzheimers

Question 26

Memantine

Answer 26

NMDA receptor agonist

Alzheimers