Parkinsons

Question 1

Answer 1

dopamine

Question 2

Answer 2

carbidopa

Question 3

Answer 3

L-DOPA

Question 4

Answer 4

selegiline

Question 5

PD symptoms

Answer 5

tremor
rigidity
akinesia (slow movement)
postural instability

Question 6

PD is characterized by ___

Answer 6

loss of dopamine neurons in substantia nigra

Question 7

studies suggest that 50% of ______ or 70-80% of ____ in striatum are lost before patients present with motor symptoms

Answer 7

dopamine neurons
nerve terminals

Question 8

PD can be characterized by presence of what ?

Answer 8

Lewey bodies

Question 9

what is a Lewey body

Answer 9

spherical protein deposit that is enriched with protein alpha synuclein

Question 10

where are Lewey bodies found

Answer 10

substantia nigra, cortex

Question 11

stages of Braak and what is it

Answer 11

Braak is measure of spreading aloha synuclein
1. brainstem
2. raphe
3. substantia nigra
4.meocortex/thalamus
5. neocortex/prefrontal cortex
6. entire neocortex

Question 12

basal ganglia includes what

Answer 12

striatum and globus pallidus

Question 13

striatum includes what

Answer 13

caudate nucleus and putamen

Question 14

signaling from the substantia nigra to ______ receptors in the striatum favors ____

Answer 14

D1 and D2 receptors
thalamocortical signaling
(this is disrupted in PD)

Question 15

antimuscarinic used in PD

Answer 15

benztropine

Question 16

loss of dopamine results in ____ activity the cholinergic pathway

Answer 16

excess

Question 17

why is there a bioavailability difference in L-DOPA and dopamine

Answer 17

L-DOPA can cross BBB
dopamine positive at pH 7

Question 18

L-DOPA side effects

Answer 18

nausea, hypertension, psychosis

Question 19

how can we lower a dose of L-DOPA?

Answer 19

add carbidopa which is peripherally acting DDC inhibitor

Question 20

carbidopa MOA

Answer 20

inhibits Dopa decarboxylase in periphery, does not penetrate BBB

Question 21

we can eliminate on/off ausciltations with L-DOPA therapy how

Answer 21

continuous administration of L-DOPA with infusion

Question 22

if we cant convert L-DOPA to dopamine what can we use?

Answer 22

dopamine agonists - postsynaptic dopamine receptors are still present in striatum

Question 23

what is apomorphine

Answer 23

D1/D2 dopamine agonist

Question 24

apomorphine MOA

Answer 24

relieves off state rapidly but causes vomitting

Question 25

non-ergoline dopamine agonists

Answer 25

ropinirole, pramipexole, rotigotine

Question 26

non-ergolines are what

Answer 26

D2/D3 agonists with fewer side effects than ergolines

Question 27

dopamine agonist that is a patch

Answer 27

rotigotine

Question 28

MAO-B inhibitors irreversible

Answer 28

selegiline rasagiline

Question 29

MAO-B inhibitor reversible

Answer 29

safinamide

Question 30

COMT inhibitors

Answer 30

entacapone tolcapone opicapone

Question 31

COMT inhibitors MOA

Answer 31

inhibit methylation 3-OH group of dopamine

Question 32

which drugs inhibit COMT to decrease metabolism of L-DOPA in the periphery

Answer 32

entacapone opicapone

Question 33

which drugs inhibit COMT in CNS to keep CNS dopamine levels high

Answer 33

tolcapone

Question 34

L-DOPA, carbidopa, and entacapone combo drug

Answer 34

Stalevo

Question 35

cardinal sign of parkinsons

Answer 35

bradykinesia (slow movement)

Question 36

non motor symptoms of parkinsons

Answer 36

anxiety, depression constipation dementia insomnia orthostatic hypotension psychosis / delirium sexual dysfunction

Question 37

1st line before adding an agent

Answer 37

rule out drug induced PD

Question 38

drugs that could worsen/cause sx of PD

Answer 38

antipsychotics, metoclopramide, prochlorperazine, promethazine

Question 39

dopamine precursors hold a higher risk of what?

Answer 39

dyskinisias (abnormal movement)

Question 40

first line agents

Answer 40

dopamine precursors dopamine agonists MOA inhibitors

Question 41

when to use dopamine agonist as first line

Answer 41

if < 60 years and high risk for dyskinesias

Question 42

when to avoid dopamine agonists

Answer 42

>70 history CID, cognitive impairment, daytime sleepiness, hallucinations

Question 43

therapy should be initiated with ___ dosage form at ____ dose

Answer 43

IR, lowest dose

Question 44

dopamine precursors and side effects

Answer 44

levodopa and carbidopa motor fluctuations, dyskinesias, hallucinations

Question 45

carbidopa/levodopa dosing

Answer 45

25/100 mg PO BID-TID with meals increase to 5-6 x per day

Question 46

dopamine agonists drugs and side effects

Answer 46

ropinirole, pramipexole, rotigatone se: ICD, hallucination, edema fewer motor fluctuations

Question 47

MAO B inhibitors and side effects

Answer 47

selegiline, rasagiline, safinamide se: n/v, insomnia risk serotonin syndrome

Question 48

which drugs adjunct for PD depression

Answer 48

MAOis

Question 49

selegiline rasagiline safinamide dosing

Answer 49

selegiline 5 mg PO BID rasagiline 0.5 mg PO daily safinamide 50 mg PO daily

Question 50

COMT inhibitors place in therapy

Answer 50

manage symptom fluctuation, wearing offen

Question 51

entacapone side effect

Answer 51

brown urine

Question 52

tolcapone side effect

Answer 52

hepatotoxicity

Question 53

entacapone tolcapone opicapone dosing

Answer 53

entacapone 200 mg PO with CD/LD dose tolcapone 100 mg TID opicapone 50 mg qhs

Question 54

amantadine use

Answer 54

manages peak dose dyskinesias and motor symptoms

Question 55

amantadine dosing

Answer 55

100 mg PO BID

Question 56

when can we use anticholinergics

Answer 56

<65 yo tremor dominant pts

Question 57

starting dose benztropine

Answer 57

0.5 mg PO qhs

Question 58

starting dose trihexphenidyl

Answer 58

1 mg PO daily

Question 59

how to treat psychosis in PD

Answer 59

clozapine or quetiapine avoid: olanzapine, halloperiodol, paliperidone, risperidone