Drugs for Parkinsonism

Question 1

Primary signs of Parkinson’s Disease

Answer 1

It's a TRAP!
Tremor
Rigidity
Akinesia/Bradykinesia
Postural Instability

Question 2

Drugs that can induce Parkinsonism

Answer 2

Typical Antipsychotics
Reserpine
Methylphenyltetrahydropyridine

Question 3

Dopamine precursor and inhibitor of peripheral metabolism via Dopa decarboxylase
Primary drug for Parkinson’s
SE: Emesis, dyskinesia, on-off phenomena, wearing-off phenomena
Contraindicated in pxs with history of psychosis
Hypertensive crisis occurs when used with MAOI

Answer 3

Levodopa-Carbidopa

Can cross BBB

Question 4

Alternating periods of improved mobility and akinesia in Parkinson’s

Answer 4

On-Off Phenomena

Question 5

Deterioration of drug effect in between medication doses

Answer 5

Wearing-Off Phenomena

Question 6

Partial agonist at D2 receptors in brain
Drug for Parkinson’s, Levodopa intolerance, Hyperprolactinemia
SE: Erythromelalgia, pulmonary fibrosis

Answer 6

Bromocriptine
(Pergolide)
Bro 2

Question 7

Rare burning pain & warmth on extremities

Answer 7

Bromocriptine

Pergolide

Question 8

Partial agonist at D3 receptors in brain
Drug for Restless legs syndrome, Parkinson’s disease
SE: Compulsive gambling, hypersexuality, overeating, uncontrolable tendency to fall asleep
Contraindicatedin pxs with active PUD, psychotic illness or recent MI

Answer 8

Pramipexole
(Ropinirole)

WEIRD TOXICITY

Question 9

Partial agonist at D3 receptors, antagonist at 5HT and alpha adrenoceptors
Drug for off periods of Parkinson’s
SE: Severe nausea, can be prevented by premedicating with Trimethobenzamide

Answer 9

Apomorphine

Question 10

MAO Type B Inhibitor
Drug for Parkinson’s
Combination with Meperidine causes agitation, delirium and death
Serotonin syndrome occurs when used with SSRIs

Answer 10

Selegiline

Rasagiline

Question 11

COMT inhibitor
Blocks L-dopa metabolism by inhibiting Catechol-O-Methyltransferase in periphery and CNS (only Tolcapone), Prolongs response to Levodopa
Drug for Parkinson’s
SE: Sleep Disturbance, Orange Urine, Hepatotoxicity (Tolcapone), Neuroleptic Malignant Syndrome, Rhabdomyolysis

Answer 11

Entacapone

Tolcapone

Question 12

Antiviral
Antagonizes Adenosine A
Drug for Parkinson’s Disease, Influenza
SE: Acute toxic psychosis, (Mottling in adults) Livedo reticularis, Peripheral Edema

Answer 12

Amantadine

Question 13

Drugs that can cause Livedo Reticularis (Blue-Red Lacy pattern, like mottling)

Answer 13

AMAN reads fHM and GQ
Amantadine
Hydroxyurea
Minocycline
Gemcitabine
Quinidine

Question 14

Anticholinergic
Drug for Parkinson’s, EPS caused by anti-psychotics
SE: Atropine like effects
Exacerbates tardive dyskinesias that result from prolonged use of antipsychotic drugs

Answer 14

Benztropine

Biperiden, Trihexyphenidyl