Pharmacology S11

Question 1

Ergot dopamine agonist

Answer 1

Bromocriptine

Pergolide

Question 2

Non ergot DA agonist

Answer 2

Pramipexole

Ropinirole

Question 3

Dopamine efect at
Low
Intermediate
High doses

Answer 3

At low doses it acts on D1 receptors as reno vasodilators can lead to hypotension
At intermediate doses it acts on B1 receptors in the heart causing increase contractility &HR which can lead to arrhythmia
At higher doses it acts on a1 receptors causing vasoconstriction which can lead to HTN

Question 4

Dopamine adverse effect

Answer 4

Nausea vomiting
Hypotension
Cardiac arrhythmia
At higher doses lead to HTN

Question 5

Ergot DA agonist side effects

Answer 5

Peripheral vasoconstriction..
Pulmonary & retroperitoneuim fibrosis ..

Central side effect .. psychosis .. delu… and hallucination

Question 6

Side Effects of L Dopa

Answer 6

• Nausea and vomiting
• Postural hypotension
• Hallucinations and pychosis
• Involuntary movements
• Loss of efficacy

Cardiac arrhythmia ..

Question 7

Formulations of L Dopa

Answer 7

• Co –Beneldopa (madopar)

* Co – Careldopa (sinemet)

Question 8

L Dopa Failure

Answer 8

• Occurs after 5 years on average.
• Cause unknown
• Dyskinesias.
• Wearing off effects
• Motor fluctuations

Question 9

Management of L Dopa Failure.

Answer 9

• Avoidance
• Lower dosages
• More frequent administration
• Additional pharmacotherapy

Question 10

Dopamine Receptor Agonists

Answer 10

• Ropinirole
• Pramipexole
• Pergolide
• Cabergoline
• Bromocryptine
• ( Apomorphine)

Question 11

DA v L Dopa

Answer 11

• Less effective
• More side effects
• More expensive.
• Do not cause dyskinesias.
• May be neuroprotective.

Question 12

When to use DA agonists

Answer 12

Early- to avoid long term complications

• Used for younger patient (< 65-70 )without dementia & hallucinations

Later - to treat motor fluctuations

Question 13

MAOI inhibitors -

Answer 13

selegeline

rasageline

Question 14

COMT inhibitors

Answer 14

entacapone

tolcapone

Question 15

Amantadine

Answer 15

• Inhibits DA reuptake.
• Has weak anti PD effect.
• Moderate effect against dyskinesia.

Question 16

Anticholinergic Therapy & side effect

Answer 16

• Acetyl Choline antagonises DA.
• Anticholinergics effective for tremor.
• Major side effects; Bladder . Vision. Dry mouth. Memory.

Question 17

Complication of Parkinson’s disease

Answer 17

• Sleep disorders
• Neuropsychiatric illness like depression and dementia
• Autonomic dysregulation like orthostatic hypotension Constipation and erectile dysfunction …

Question 18

Prognosis of Parkinson’s disease

Answer 18

• PD is a progressive disease
• Pharmacological treatment may reduce progression
• Mortality ratios are around twice those of unaffected people

Question 19

Multiple system atrophy (MSA)

Answer 19

• Is another neurodegenerative disease
• Occurs in sporadic cases
• Clinical features of PD

– Without tremor

– Autonomic failure

• Neurodegeneration is more widespread involving the cerebellum and extrapyramidal tract.

Question 20

Multiple system atrophy

ttt

Answer 20

Levodopa for parkinsonian features
Na,fluff intake ,pressure stockings ,midodrine, fludrocortison foe orthostatic hypotension
Oxybutinine or tolterodine for urinary incontenence or frequency
Sildenafil ( vigra ) for impotence
Selective serotonin reuptake inhibitors for depression
No good ttt of ataxia or dementia