Treatment Of Neurodegenerative Diseases

Question 1

Examples of neurodegenerative diseases :

Answer 1

Parkinson’s disease (PD)

Alzheimer’s disease (AD)

Question 2

Causes of apoptosis and necrosis in Brain cells :

Answer 2

Excitotoxicity
Oxidative stress
Inflammation

Question 3

Excitotoxicity means :

Answer 3

Excessive activation of NMDA receptors by glutamate leading to intracellular calcium overload

Question 4

Oxidative stress means :

Answer 4

Mitochondrial dysfunction
Ageing
Environmental toxins
Genetic abnormalities

Question 5

Causes of Parkinson’s disease :

Answer 5

‏ Stroke
Virus infection
Genetic mutations
MPTP

Question 6

Drugs that can induce Parkinson’s disease :

Answer 6

Reseprine
Metoclopramide (Antiemetic)
Typical Antipsychotics

Question 7

What is the Pharmacological treatment of Parkinson’s disease :

Answer 7

Dopamine precursor
Dopamine agonists
Monoamine oxidase-B inhibitors (MAO-B)
Muscarinic ACh receptor antagonists

Question 8

What are the surgical treatment of Parkinson’s disease :

Answer 8

A- High-frequency deep brain stimulation of the subthalamic nucleus or globus pallidus by an implanted electrode

B- Stem cells implant

Question 9

Which drug is the first line treatment of motor symptoms in Parkinson’s disease :

Answer 9

Levodopa

Question 10

What’s the name of the substance that convert levodopa into dopamine ?

Answer 10

Dopa decarboxylase (DDC)

Question 11

The absorption of levodopa occurs in ……..

Answer 11

Small intestine

Question 12

Which class of drugs should be combined with levodopa to enhance its effect on central nervous system ?

Answer 12

DDC inhibitors / Carbidopa

Question 13

What are the short-term adverse effects of levodopa ?

Answer 13

Nausea 
Vomiting 
Anorexia 
Postural hypotension 
Schizophrenia like syndrome

Question 14

What’s the treatment of levodopa GIT adverse affects (Nausea, vomiting, anorexia)

Answer 14

Domperidone

Question 15

Long-term adverse effects of levodopa :

Answer 15

Involuntary movement (Dyskinesia)
Response fluctuation

Question 16

Drugs and food interactions of levodopa :

Answer 16

Pyridoxine (vitamin B6) > enhance the extracerebral metabolism.

MAO-A (event after 2 weeks of its stoppage) > Hypertensive crises.

Iron, some Amino Acids, Antacids and Anticholinergics > Delay the absorption.

Question 17

Contraindications of levodopa :

Answer 17

Psychotic patients
Angle-closure glucoma
Active peptic ulcer
History of melanoma
Specious undiagnosed skin lesion

Question 18

Examples of dopamine agonists :

Answer 18

Rotigotine (patches)

Apomorphine (Subcutaneous)

Question 19

Advantages of dopamine agonists :

Answer 19

No need for enzymes like DDCIs
No response fluctuations
No dyskinesia

Question 20

Side effects of dopamine agonists :

Answer 20

Nausea 
Vomiting
Headache
Nasal congestion
Postural hypotension
Hallucinations
Compulsive behavior
Short half life

Question 21

Contradictions of dopamine agonists :

Answer 21

Psychotic patients
Myocardial infarction
Active peptic ulceration

Question 22

Which receptor does rotigotine activate :

Answer 22

D2 and D3

Question 23

Usage of Apomorphine :

Answer 23

Control the “off effect” of levodopa (Rapid onset)

Question 24

Side effects of Apomorphine :

Answer 24

Powerful emetic action (must be combined with orally antiemetic)

Mood and behavioural changes

Cardiac dysrhythmias

Hypotension

Question 25

Example of MAO-B inhibitors :

Answer 25

Rasagiline

Question 26

Advantages of Rasagiline :

Answer 26

Does not convert to amphetamine (no CNS stimulation) Retard disease progression

Question 27

Mechanism of action of MAO-B inhibitors :

Answer 27

Enhance the action of levodopa By preventing dopamine metabolism.

Question 28

Example of muscarinic ACh receptor antagonist :

Answer 28

Biperiden

Question 29

Adverse effects of muscarinic ACh receptor antagonist :

Answer 29

Dry mouth Constipation Impaired vision Urinary retention

Question 30

What's the class of amantadine :

Answer 30

Anti-viral

Question 31

What's mechanism action of amantadine regarding Parkinson's disease :

Answer 31

Increases dopamine release Inhibition of amine uptake Direct action on dopamine receptors Block of NMDA receptors

Question 32

Which symptom of Parkinson's disease does amantadine reduce :

Answer 32

Dyskinesia induced by prolonged levodopa treatment

Question 33

Adverse side-effects of amantadine :

Answer 33

``` CNS stimulation Restlessness Depression Irritability Insomnia Agitation Excitement Hallucinations Confusion ```

Question 34

Contradictions of amantadine :

Answer 34

Seizures | Heart failure

Question 35

Treatment for schizophrenia like syndrome in Parkinson's disease :

Answer 35

Clozapine (Atypical antipsychotics )

Question 36

Treatment for depression in Parkinson's disease :

Answer 36

SSRIs

Question 37

Treatment for dementia, cognitive decline and hallucinations in Parkinson's disease :

Answer 37

Rivastigmine (Cholinestrase inhibitor)

Question 38

Treatment for excessive daytime sleepiness in Parkinson's disease :

Answer 38

Modafinil (CNS stimulant)

Question 39

Treatment of postural hypotension in Parkinson's disease :

Answer 39

Increases salt intake Fludrocortisone (Minralocorticoids) Midodrine (Alpha 1 agonist) Desmopressin (ADH Analouge)

Question 40

The treatment of Parkinson's disease should start ..........

Answer 40

Gradually

Question 41

Never stop and antiparkinsonian drug ................

Answer 41

Suddenly

Question 42

Try to ....... the use of Levodopa/Carbidopa for .......

Answer 42

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