PD- Dopamine Agonists DI

Question 1

Dopamine agonists purpose in PD

Answer 1

Used as adjunctive agents in case of deterioration of response to L-Dopa, but can be used as monotherapy in younger patients

Question 2

Dopamine agonists used in PD

Answer 2

Pramipexole, ropinirole, bromocriptine, rotigotine (Neupro) TD patch, apomorphine

Question 3

Pramiprexole needs renal dose adjustment with what CrCl?

Answer 3

<60ml/min

Question 4

Pramiprexole DDI

Answer 4

Cimetidine (inhibitor of renal tubular secretion)

Question 5

Ropinirole CIs

Answer 5

Abrupt D/C, hepatic disease

Question 6

Ropinirole is metabolized by what enzyme?

Answer 6

1A2

Question 7

Ropinirole DDIs

Answer 7

CYP1A2 substrates and inducers

Substrates: cimetidine, cipro, clarithromycin, diltiazem, enoxacin, erythromycin, fluvoxamine, mexiletine, norfloxacin, omeprazole, ritonavir, troleandomycin

Inducers: CBZ, PB, phenytoin, rifampin, cigarette smoking

Question 8

Bromocriptine is an ergot: true or false

Answer 8

True

Question 9

Bromocriptine being an ergot means it’s what?

Answer 9

A potent vasoconstrictor

Question 10

Bromocriptine ADEs

Answer 10

CNS, GI effects, pulmonary fibrosis

Question 11

Bromocriptine DDIs

Answer 11

Antihypertensive agents, erythromycin, 3A4 inhibitors

Question 12

Rotiogine precautions

Answer 12

Heat, MRI

Question 13

Rotiogine ADEs

Answer 13

CNS, GI, peripheral edema, application site reactions

Question 14

Rotiogine DDIs

Answer 14

Dopamine antagonists (APS and metoclopromide)

(The “ro” and “do” in the pronunciation of rotiogine and and dopamine rhyme)

Question 15

Apomorphine route of administration

Answer 15

SQ injection that has to be done under medical supervision

Question 16

When is apomorphine used?

Answer 16

Advanced PD PRN for OFF symptoms

Question 17

Before taking apomorphine, what should you be pretreated with?

Answer 17

An antiemetic 3 days before

Question 18

What type of antiemetic should you be pretreated with?

Answer 18

Tigan (but literally anything that’s not a 5-HT3 antagonist or antidopaminergic)

Question 19

Apomorphine ADEs

Answer 19

N/V (that’s why you need to pretreat with Tigan), somnolence, chest pain/pressure, dyskinesia, falls, yawning, rhinorrhea

Question 20

Apomorphine DDIs

Answer 20

CI’ed with 5-HT3 antagonists!

DDIs with QTc prolongating agents, dopamine antagonists (APS!) may decrease its effectiveness