Parkinsons

Question 1

What balances with dopamine in the CNS?

Answer 1

Acetylcholine

Question 2

What is the triad of Parkinson’s?

Answer 2

Bradykinesia, rigidity, tremor

Question 3

Explain the on-off phenomenon

Answer 3

Periods of dyskinesia (on) and hypokinesia (off)

Question 4

List six methods of Parkinson’s therapy

Answer 4

Replenish dopamine, agonize dopaminergic stimulation, inhibit dopamine metabolism, release stored dopamine, inhibit dopamine reuptake, reduce cholinergic overplay

Question 5

Explain the pathophysiology behind Parkinson’s

Answer 5

Degeneration of substantia nigra causes loss of dopamine producing neurons (in back of brain)

Question 6

What is levodopa?

Answer 6

Naturally occurring amino acid precursor of dopamine

Question 7

Why can’t dopamine be pharmacologically administered?

Answer 7

ASIDE FROM INABILITY TO CROSS BBB, IT IS RAPIDLY METABOLIZED IN THE GUT/BLOOD/LIVER BY COMT AND MAO

Question 8

What effect does IV dopamine have on the body?

Answer 8

RBA (renal artery dilation, beta-1 agonist, alpha-1 agonist)

Question 9

How is l-dopa converted to dopamine?

Answer 9

Central dopa decarboxylase in the CNS

Question 10

What is the cofactor and peripheral conversion of l-dopa?

Answer 10

Vitamin B6 (pyridoxine)

Question 11

What happens when l-dopa alone is administered?

Answer 11

90% is metabolized by peripheral dopa decarboxylase

Question 12

What is commonly administered with l-dopa to prevent peripheral metabolic conversion?

Answer 12

Decarboxylase inhibitors

Question 13

What is carbidopa?

Answer 13

Decarboxylase inhibitor commonly co-administered with l-dopa

Question 14

Name a drug interaction of levodopa

Answer 14

Interacts with nonselective MAO inhibitory – can cause hypertension emergency

Question 15

What is Bromocriptine?

Answer 15

D2 agonist dosed in combination with l-dopa, rapidly absorbed PO

Question 16

List adverse effects of bromocriptine

Answer 16

Nausea, vomiting, hallucinations, confusion

Question 17

Name an alternative use for bromocriptine

Answer 17

Treats hyperprolactinemia (dopamine opposes prolactin)

Question 18

Who is most likely to suffer from hyperprolactinemia?

Answer 18

Postpartum mothers and pituitary adenoma patients

Question 19

What emergent condition is bromocriptine partly used to treat?

Answer 19

NMS neuroleptic malignant syndrome (an antipsychotic induced hyperthermia)

Question 20

List signs of neuroleptic malignant syndrome

Answer 20

rhabdo (lead pipe), temperature of 105°

Question 21

Name the QD form of bromocriptine only used to treat hyperprolactinemia

Answer 21

Cabergoline (Dostinex)

Question 22

What is pramipexole (Mirapex)?

Answer 22

D2 agonist indicated for restless leg syndrome

Question 23

Just an adverse effect of pramipexole

Answer 23

Reward seeking behavior like gambling, binge eating, sexual urges

Question 24

Which 3 drugs are indicated for RLS?

Answer 24

Pramipexole, Rotigotine and ropinirole

Question 25

What is Rotigotine?

Answer 25

Dopamine agonist indicated for Parkinson's and RLS

Question 26

What form does Rotigotine come in?

Answer 26

QD transdermal patch

Question 27

List adverse affects of Rotigotine

Answer 27

Psychosis, compulsive behavior

Question 28

What is Entacapone?

Answer 28

COMT inhibitor that prolongs activity of l-dopa when dosed together

Question 29

Which patients require entacapone with l-dopa dose?

Answer 29

Patients with end of dose phenomenon

Question 30

Name an adverse effect of entacapone

Answer 30

Increased incidence of dyskinesias

Question 31

What is the drug similar to Entacapone with greater lipophilicity? Is it used often?

Answer 31

Tolcapone – rarely used due to risk of hepatic necrosis

Question 32

What is amantadine?

Answer 32

Drug that increases synthesis and release of dopamine, blocks dopamine reuptake

Question 33

What is the primary use of amantadine?

Answer 33

Antiviral agent (neuroamindase inhibitor) against influenza A

Question 34

Name two adverse effects of amantadine

Answer 34

Insomnia, hallucinations

Question 35

Name the hydrophilic analog of amantadine

Answer 35

Rimantidine

Question 36

Which drug is Tamiflu most similar to?

Answer 36

Amantadine

Question 37

Which strains of flu are covered by Tamiflu?

Answer 37

A and B

Question 38

List three anticholinergics

Answer 38

Diphenhydramine (Benadryl), benztropine (Cogentin), trihexyphenidyl (Artane)

Question 39

How are anti-Cholinergics used to treat Parkinson's?

Answer 39

Help address issue of dopamine/acetylcholine imbalance

Question 40

What drug is used to treat benign essential tremor

Answer 40

Propanolol (nonspecific BB)

Question 41

Which two drugs are used to treat movement disorders associated with MS?

Answer 41

Corticosteroids, interferon-B

Question 42

List potential adverse effects of anti-cholinergics

Answer 42

Sedation, dry mouth, urinary retention, tachycardia