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(3) Pharmacology > S3_L4: Drugs for Parkinson's Disease > Flashcards

S3_L4: Drugs for Parkinson's Disease Flashcards

1
Q

This is a disorder of the extrapyramidal system, presenting with resting tremor, rigidity, postural instability, and bradykinesia

A

Parkinson’s Disease

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2
Q

TRUE OR FALSE: In PD, there is a reduction in number of cells in substantia nigra. A decrease in DA content is also seen, with too much activity of ACh.

A. Both statements are false
B. Both statements are true
C. Only the 1st statement is true
D. Only the 2nd statement is true

A

B. Both statements are true

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3
Q

TRUE OR FALSE: L-Dopa acts on the CNS

A

False

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4
Q

TRUE OR FALSE: In the periphery, Levodopa is converted into dopamine by the peripheral dopa decarboxylase. This protein is also known as aromatic L-amino-acid decarboxylase.

A. Both statements are false
B. Both statements are true
C. Only the 1st statement is true
D. Only the 2nd statement is true

A

C. Only the 1st statement is true

aromatic L-amino-acid decarboxylase is an enzyme

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5
Q

TRUE OR FALSE: Dopamine itself does not cross the blood-brain barrier and is not effective as a drug.

A

True

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6
Q

TRUE OR FALSE: PD pts may also present with non-motor s/sx and affect other organs

A

True

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7
Q

TRUE OR FALSE: Non-motor s/sx includes cognitive impairment, mood disturbances sensory disorders, autonomic dysfunctions, sleep disturbances, and psychotic symptoms

A

True

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8
Q

The motor sx of PD are attributed to loss of
(1)_____ neurons in the (2)_____

A
  1. dopaminergic
  2. substantia nigra
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9
Q

TRUE OR FALSE: L-Dopa is an immediate precursor of dopamine. It only comes and is administered in 3 forms.

A. Both statements are false
B. Both statements are true
C. Only the 1st statement is true
D. Only the 2nd statement is true

A

B. Both statements are true

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10
Q

TRUE OR FALSE: Dopamine has effects that are both excitatory and inhibitory.

A

True

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11
Q

How may dopamine be administered?

A

Through oral, inhalational, or IV

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12
Q

Abrupt withdrawal of L-Dopa results in what syndrome?

A

Neuroleptic Malignant Syndrome

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13
Q

TRUE OR FALSE: Neuroleptic Malignant Syndrome present with involuntary movements and muscle rigidity. It may also present with high fever.

A. Both statements are false
B. Both statements are true
C. Only the 1st statement is true
D. Only the 2nd statement is true

A

B. Both statements are true

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14
Q

TRUE OR FALSE: Levodopa can cross the BBB when given an adjunct medication called carbidopa

A

True

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15
Q

The following are classic s/sx of PD, EXCEPT:

A. Stooped posture
B. Back rigidity
C. Flexed elbows & wrists
D. Trendelenburg gait
E. None

A

D. Trendelenburg gait

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16
Q

TRUE OR FALSE: Neurotransmitters may be reuptaken back to the post-synaptic neuron

A

False, it may go back to the presynaptic neuron

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17
Q

The following are classic s/sx of PD, EXCEPT:

A. Hypomimia
B. Tremors in the head
C. Masked face
D. Forward tilt of trunk
E. Reduced arm swing

A

B. Tremors in the head

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18
Q

The following are classic s/sx of PD, EXCEPT:

A. Hand tremor
B. Bradykinesia
C. Intention tremor
D. Short stepped gait
E. Shuffling gait

A

C. Intention tremor

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19
Q

This drug blocks dopamine reuptake in the presynaptic neuron

A

Amantadine

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20
Q

Enumerate at least 3 pharmacological management used to alleviate PD s/sx.

A
  1. Levodopa
  2. Carbidopa
  3. Mao-B inhibitors
  4. COMT inhibitors
  5. Dopamine agonist
  6. Amantadine
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21
Q
  1. Inhibits dopa decarboxylase
  2. Inhibits the metabolism of dopamine to
    3-Methoxytyramine
  3. Inhibits metabolism of dopamine to DOPAC

A. Levodopa
B. Carbidopa
C. Mao-B inhibitors
D. COMT inhibitors
E. Dopamine agonist
F. Amantadine

A
  1. B
  2. D
  3. C
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22
Q
  1. Entacapone
  2. Selegiline
  3. Bromocriptine

A. Levodopa
B. Carbidopa
C. Mao-B inhibitors
D. COMT inhibitors
E. Dopamine agonist
F. Amantadine

A
  1. D
  2. C
  3. E
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23
Q
  1. Pramipexole
  2. Ropinirole
  3. Rasagiline

A. Levodopa
B. Carbidopa
C. Mao-B inhibitors
D. COMT inhibitors
E. Dopamine agonist
F. Amantadine

A
  1. E
  2. E
  3. C
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24
Q

TRUE OR FALSE: Carbidopa acts on the periphery

A

True

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25
Q

TRUE OR FALSE: Dopamine agonist ↑ the binding of dopamine in the synaptic cleft & mimic dopamine

26
Q

TRUE OR FALSE: Dopamine agonist ↑ dopamine in the cellular level

27
Q

TRUE OR FALSE: Entacapone is the most popularly prescribed dopamine agonist. However, it may induce nausea, vomiting, and OH

A. Both statements are false
B. Both statements are true
C. Only the 1st statement is true
D. Only the 2nd statement is true

A

D. Only the 2nd statement is true

Entacapone is a COMT inhibitor. Bromocriptine is the most popularly prescribed dopamine agonist

28
Q

Choose the following effects that may be seen upon intake of Amantadine.

A. OH
B. Hypertension
C. Syncope
D. Nausea
E. Dizziness

29
Q

Choose the following effects that may be seen upon intake of levodopa.

A. somnolence
B. postural hypotension
C. dizziness
D. confusion
E. headache

30
Q

The following are adverse effects of Amantadine, EXCEPT:

A. constipation
B. xerostomia
C. peripheral edema
D. falls
E. vomiting

A

E. vomiting

31
Q

The following are adverse effects of dopamine agonists, EXCEPT:

A. headache
B. syncope
C. dizziness
D. cardiac arrhythmias
E. none

A

B. syncope

32
Q

Choose the following adverse effects that may be seen upon intake of MAO-B inhibitors.

A. nausea
B. lightheadedness
C. xerostomia
D. dry mouth
E. constipation

33
Q

Choose the following adverse effects that may be seen upon intake of COMT inhibitors. except:

A. dyskinesia
B. anxiety
C. hallucinations
D. sleep disorders
E. none

A

B. anxiety

34
Q

Dopamine is metabolized by?

A
  • MAO enzyme
  • COMT

As such, we give medication that inhibit the MAO & COMT enzymes

35
Q

This non-pharmacological management involves implanting electrodes in the brain, which are controlled by neurostimulators

A

Deep brain stimulators

36
Q

The following are possible s/sx of PD, EXCEPT:

A. Orthostatic hypotension
B. Impulse control disorders
C. Restless legs syndrome
D. REM behavior disorder
E. None

37
Q

The following are possible s/sx of PD, EXCEPT:

A. Impaired judgment
B. Depression
C. Identity confusion
D. Anxiety
E. Nystagmus

A

E. Nystagmus

38
Q

The following are possible s/sx of PD, EXCEPT:

A. Hallucinations
B. Hypertension
C. Sleep apnea
D. Sexual dysfunction
E. GI disturbances

A

B. Hypertension

39
Q

The following are possible s/sx of PD, EXCEPT:

A. Apathy
B. Ageusia
C. Pain & paresthesia
D. Anosmia
E. None

40
Q

TRUE OR FALSE: Some pts do not tolerate intake of carbidopa and have an allergic reaction

41
Q

TRUE OR FALSE: Delusions and hallucinations are seen as a side effect of amantadine. This may also be seen in older pts consuming levodopa.

A. Both statements are false
B. Both statements are true
C. Only the 1st statement is true
D. Only the 2nd statement is true

A

B. Both statements are true

42
Q

Choose the following effects that may be seen upon intake of levodopa.

A. psychosis
B. depression
C. anxiety
D. sleep disturbance
E. agitation

A

A, E

NOTE: These are seen in older adults only

43
Q

Choose the following effects that may be seen upon intake of carbidopa.

A. darkening of urine or sweat
B. decreased appetite
C. headache
D. confusion
E. syncope

44
Q

Choose the following effects that may be seen upon intake of carbidopa.

A. constipation
B. anxiety
C. agitation
D. blurred vision
E. double vision

45
Q

TRUE OR FALSE: Levodopa and carbidopa can be taken without food

46
Q

Why is COMT inhibited?

A

COMT may be converted to 3-OMD which competes with Levodopa in crossing the BBB; thus, increased metabolization rate of Levodopa the longer it is in the GI tract. This lessens its effectivity

47
Q

What happens if dopamine gets stuck in the GI tract?

A

It induces CV complications (e.g. increased heart rate, vomiting)

48
Q

What is the other name for Levodopa?

A

Sinemet or Madopar

49
Q

TRUE OR FALSE: Only symptoms may be treated in PD, not the disease itself

50
Q

This is an direct-acting dopamine agonist derived from synthetic ergots

A

Bromocriptine

51
Q

This is the mainstay of therapy or first line of defense

A

Levodopa and carbidopa

52
Q

Long term use of Levodopa leads to what side effect?

A

dyskinesias and motor response fluctuations (on-off phenomenon)

53
Q

These were the first effective medications used for PD

A

anti-cholinergic (antimuscarinic drugs)

54
Q

This was initially used as an anti-viral drug but presents with the most effective treatment for tremor

A

Amantadine

55
Q

TRUE OR FALSE: When MAO-B inhibitors & COMT inhibitors are given, decrease dosage of Levodopa to inhibit side effects. MDs must choose only one inhibitor with L-Dopa

A. Both statements are false
B. Both statements are true
C. Only the 1st statement is true
D. Only the 2nd statement is true

A

B. Both statements are true

56
Q

TRUE OR FALSE: Using COMT and DDC inhibitor drugs together with Levodopa creates the opposite symptoms of PD

57
Q

TRUE OR FALSE: Carbidopa can only work on the periphery, not the central DDC

58
Q

The presence of _______ is a contraindication to use anticholinergic drugs.

A

angle closure glaucoma

59
Q

L-dihydrophenylalanine is also known as?

60
Q

TRUE OR FALSE: DDC & COMT is present in the GI tract

61
Q

TRUE OR FALSE: Entacapone works peripherally and centrally

(3) Pharmacology (12 decks)

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