Antiparkinson Agents

Question 1

what are the 4 big symptoms of Parkinson’s disease?

Answer 1

bradykinesia
rigidity
resting tremor
impaired balance

Question 2

most Parkinson Syndromes are associated with ______ ______ ______

Answer 2

idiopathic Parkinson’s Disease

Question 3

how is idiopathic Parkinson’s disease described? (2)

Answer 3

chronic
slowly progressive

Question 4

what is a definite risk factor for Parkinson’s disease?

Answer 4

old age

Question 5

what are 2 possible protective effects of Parkinson’s disease?

Answer 5

drinking alcohol
smoking

Question 6

besides old age, what are 2 other risk factors for Parkinson’s disease?

Answer 6

MZ twin with early PD
family history

Question 7

what are 4 pesticides known to have neurotoxic effects on dopamine neurons, leading to PD?

Answer 7

rotenone
maneb
dieldren
paraquate

Question 8

what increases the life expectancy in PD patients? (2)

Answer 8

non-demented PD cases
L-dopa use

Question 9

what are the 4 most common causes of death associated with PD?

Answer 9

pulm infection/aspiration
UTI
pulm embolism
fall/fracture complications

Question 10

what symptom does the severity of dopamine loss best correlate with?

Answer 10

bradykinesia

Question 11

what are the 2 dopaminergic agents for PD?

Answer 11

levodopa
carbidopa

Question 12

what is the most effective drug for parkinsonian symptoms?

Answer 12

Levodopa

Question 13

which drug is a dopamine precursor that crosses the BB and is converted into dopamine by dopa decarboxylase?

Answer 13

levodopa

Question 14

what are the 4 ADR of Levodopa?

Answer 14

nausea
postural hypotension
motor fluctuations
dyskinesias

Question 15

peripheral decarboxylase inhibitor used with levodopa

Answer 15

carbidopa

Question 16

why is carbidopa combined with levodopa? (2)

Answer 16

decrease ADR from peripheral formation of catecholamines

increase levodopa into brain

Question 17

drug class that inhibits an enzyme which degrades dopamine; given with levodopa to inhibit its degradation and prolong its effects

Answer 17

COMT inhibitors

Question 18

-capone

Answer 18

COMT inhibitors

Question 19

COMT inhibitor that does not cross the BBB, but blocks levodopa metabolism in the periphery

Answer 19

entacapone

Question 20

COMT inhibitor that cross the BBB and has a long half-life

Answer 20

tolcapone

Question 21

combination drug of levodopa, carbidopa, and entacapone

Answer 21

stalevo

Question 22

what is an ADR of tolcapone?

Answer 22

liver toxicity

Question 23

levodopa treats _____, rather than _____

Answer 23

symptoms
disease

Question 24

levodopa therapy for 1 year can cause:

Answer 24

dyskinesia

Question 25

levodopa therapy for 3 years can cause:

Answer 25

on-off effects; mobility + immobility

Question 26

levodopa therapy past 5 years has:

Answer 26

poor prognosis

Question 27

what are 3 reversible, acute ADR of levodopa?

Answer 27

N/V orthostatic hypotension arrhythmias

Question 28

what are 2 reversible, chronic ADR of levodopa?

Answer 28

dyskinesia psych disturbance

Question 29

patients experiencing psychosis with levodopa treatment can be treated with that?

Answer 29

clozapine

Question 30

what are 2 irreversible ADR of levodopa therapy?

Answer 30

akinesia on-off effect

Question 31

what can treat the on-off effect of levodopa therapy? (5)

Answer 31

smaller doses/more frequent intervals drug holidays dopamine agonists MAO-B inhibitors SR formulations

Question 32

what 2 drugs does levodopa interact with?

Answer 32

phenothiazines epi in local anesthetic

Question 33

what can occur if levodopa is used with local anesthetic Epi?

Answer 33

heart arrhythmias

Question 34

what are the 3 dopamine receptor agonists?

Answer 34

pergolide bromocriptine pramipexole

Question 35

what are 2 features of dopamine agonists?

Answer 35

longer half-life than levodopa no absorption delay d/t amino acids

Question 36

what drug class can delay or reduce motor fluctuations and dyskinesias associated with levodopa?

Answer 36

dopamine agonists

Question 37

what are the 5 ADR of dopamine agonists?

Answer 37

N/V/dizziness postural hypotension headache dyskinesia hallucination/paranoia/confusion *(same as levodopa, but add CNS symptoms)*

Question 38

what are the 2 dopaminergic agents?

Answer 38

selegiline amantadine

Question 39

irreversible MAO-B (mitochondrial enzyme that metabolizes dopamine) inhibitor that works in the brain

Answer 39

selegiline

Question 40

what is the use of selegiline?

Answer 40

adjunct therapy to levodopa to diminish on-off effect

Question 40

what are the 3 ADR of selegiline?

Answer 40

insomnia hallucinations nausea (rare)

Question 41

what drugs can selegiline interact with?

Answer 41

tricyclics SSRIs

Question 42

an antiviral agent that promotes the release and delays uptake of dopamine

Answer 42

amantadine

Question 43

what are the 4 uses of amantadine?

Answer 43

tremor bradykinesia rigidity dyskinesia

Question 44

what are the 2 ADR of amantadine?

Answer 44

autonomic psych

Question 45

why are anticholinergics used for PD?

Answer 45

dopamine depletion lead to overactive acetylcholine; used to treat cholinergic symptoms

Question 46

what are the 3 anticholinergics?

Answer 46

"**Ben(ztropine) Tri(hexyphenidyl)** to treat **cholinergic** symptoms in **Ethan (Ethopropazine)**" benztropine trihexyphenidyl ethopropazine

Question 47

what are the uses of anticholinergics?

Answer 47

initial stages adjunctive

Question 48

what 2 symptoms do anticholinergics treat?

Answer 48

tremor rigidity

Question 49

what are 5 ADR of anticholinergics?

Answer 49

dry mouth sedation delirium constipation urinary retention