Parkinsons

Question 1

Safinamide MOA

Answer 1

• inhibits voltage activated Na channels
• inhibits glutamate release
• is a reversible MAO B inhibitor
• modulation of Ca channels
• It improves motor sx when given with levodopa

Question 2

Amantidine MOA

Answer 2

• NMDA blocker
• Anticholinergic effects
• enhance DA release/or reuptake inhibtion
• is an antiviral, dizzy, lethargy, nausea, vomiting

Question 3

parkinson tremor is

Answer 3

rest tremor, goes away with voluntary movement

Question 4

where are lewy bodies found

Answer 4

intracellulary, they are alpha synuclein aggregates

Question 5

Levodopa MOA and SE

Answer 5

• it is a dopamine precursor which can cross the BBB
  SE:
• involuntary choreiform or dystonic movements
• anorexia, nausea
• paranoid ideation
• depression
  LONG TERM THERARY RESUTLS IN MOTOR FLUCTUATIONS AND DYSKINESIA

Question 6

DA receptor agonists examples

Answer 6

ERGOT DA:
- bromocriptine
- cabergoline
- lisuride
- pergolide
NON ERGOT DA:
- pramipexole
- ropinorole
- piribedil

Question 7

Whats wrong with using ergot derivatives for parkinsons

Answer 7

they induce nausea and fatigue, valvular disease and you need to increase the dose with time.

Question 8

ROPINIROLE MOA

Answer 8

• D2, D3, D4 agonist

- metabolised by the liver

Question 9

PRAMIPEXOLE MOA

Answer 9

• D2, D3 agonist
• excite the direct striatopallidal pathway by D3 stimulation
• inhibit the indirect striatopallidal pathway by D2 stimulation

Question 10

APOMORPHINE MOA and SE

Answer 10

• is a dopaminergic agonist
• given via subcutaneous injection
• for rescue therapy for acute intermittent off episodes
  SE: highly emetogenic, QT prolongation, can be abused, increased dose can lead to hallucinations, dyskinesia, and abnormal behavior

Question 11

important side effect of dopaminergic therapy

Answer 11

impulse control disorders

Question 12

inhibitors of dopamine degradation

Answer 12

COMT inhibitors

Selective MAO-B inhibitors

Question 13

Selective MAO-B inhibitors examples

Answer 13

selegiline
- does not inhibit peripheral metabolism of catecholamines
- does not cause lethal potentiation of catecholamine action
- well toleration
- metabolites include amphetamine nad methamphetamine which can cause anxiety, insomnia
(RASAGILINE does not form the unwanted metabolites)

Question 14

COMT inhibitors example

Answer 14

• TOLCAPONE
• ENTACAPONE
  enta is short acting, tolcapone is long acting
• tolcapone causes hepatotoxicity (fulminant hepatic failure) - are used in fluctuating pts who have failed other therapies