Sketchy Quizes Flashcards
A 60-year-old man is diagnosed with Parkinson’s disease and started on ropinirole monotherapy. Over the next year, his family states that his personality has changed significantly and he has been gambling more frequently and making large, impulsive purchases such as a boats and luxury watches. T2*/SWI weighted MRI of the brain reveals loss of hyperintensity within the posterior third of the substantia nigra as well as age-related volumetric changes in the gray and white matter. What is the most likely explanation for this patient’s behavioral changes?
A. Depressive disorder due to Parkinson’s disease
B. Medication side effect
C. Bilateral amygdala brain lesions
D. Degeneration of the frontotemporal lobe
B. Medication side effect
Which of the following Parkinson’s disease medications is correctly paired with its mechanism of action?
A. Ropinirole - D2 dopamine receptor antagonist
B. Selegiline - Monoamine oxidase-A inhibitor
C. Pramipexole - D3 dopamine receptor agonist
D. Amantadine - Catechol-O-methyltransferase inhibitor
C. Pramipexole - D3 dopamine receptor agonist
If entacapone were used as monotherapy for a Parkinson’s disease patient, which of the following results would be most likely to occur?
A. Immediate relief of resting tremor
B. Gradual improvement of cogwheel rigidity
C. No appreciable change in Parkinsonian features
D. Gradual improvement of bradykinesia
C. No appreciable change in Parkinsonian features
Regarding long-term use of levodopa in patients with Parkinson’s disease, which of the following statements is least accurate?
A. Therapeutic window narrows with disease progression
B. Dyskinesias are uncommon
C. Response fluctuations develop over time
D. Gastrointestinal side effects tend to improve
B. Dyskinesias are uncommon
Which of the following statements regarding entacapone and tolcapone is most accurate?
A. Only tolcapone inhibits central COMT
B. Only entacapone carries a risk of fatal hepatotoxicity
C. Only tolcapone should be administered in combination with levodopa
D. Entacapone decreases the bioavailability of levodopa
A. Only tolcapone inhibits central COMT
A 40-year-old man was recently diagnosed with Parkinson’s disease, but he has not yet started pharmacotherapy. In addition to resting tremor in his left hand and often unsteady and slow movement, he also complains of an irresistible urge to move his legs because of an uncomfortable tingling sensation as he rests in bed at night. Which of the following medications would be most appropriate initial therapy for this patient?
A. Carbidopa
B. Selegiline
C. Entacapone
D. Pramipexole
D. Pramipexole
A man with Parkinson’s disease who is taking levodopa begins to experience hallucinations and severe agitation. Which of the following management strategies would be least likely to alleviate this patient’s psychiatric symptoms?
A. Reduce the dose of levodopa
B. Add carbidopa to levodopa
C. Minimize environmental stimuli and provide verbal reassurance
D. Initiate low-dose quetiapine
B. Add carbidopa to levodopa
When treating Parkinson’s disease patients, it is standard clinical practice to prescribe levodopa in combination with carbidopa. How does carbidopa increase the effectiveness of levodopa therapy?
A. Direct agonism of D2 dopaminergic receptors
B. Peripheral inhibition of catechol-O-methyltransferase
C. Central inhibition of catechol-O-methyltransferase
D. Peripheral inhibition of DOPA decarboxylase
D. Peripheral inhibition of DOPA decarboxylase
A patient with Parkinson’s disease has been taking carbidopa/levodopa for 7 years. Over the past year, he has begun to experience worsening tremors. He does not complain of significant bradykinesia or gait disturbance. Based on recommendations from another friend with Parkinson’s disease, the patient inquires about taking trihexyphenidyl. Should this patient be prescribed trihexyphenidyl?
A. Yes, trihexyphenidyl can improve symptoms of tremor
B. Yes, but carbidopa/levodopa therapy should be discontinued if the patient is taking trihexyphenidyl
C. No, trihexyphenidyl may precipitate or worsen bradykinesia
D. No, because benztropine is the preferred antimuscarinic agent for Parkinson’s disease
A. Yes, trihexyphenidyl can improve symptoms of tremor
Levodopa is known to precipitate all of the following side effects EXCEPT:
A. Emesis
B. Visual hallucinations
C. Hyperphagia
D. Cardiac arrhythmias
C. Hyperphagia
