Antiparkinsons Drugs

Question 1

How common is Parkinson’s disease? Which gender is affected more? What’s the ratio?

Answer 1

#2 most common neurodegenerative 
disease

Men> women

3:2

Question 2

What is MOA of PD? What percent of neurons die before Sx are seen?

Answer 2

Degeneration of DA neurons in substantial nigra

80%

Question 3

What causes Parkinson’s? Give example for each?

Answer 3

Genetics
-mutations in several genes

Environment

• toxins
• head injuries

Question 4

Where does ACh come from in the mid brain?

Answer 4

Striatum

• caudate
• putamen

Question 5

What does The substantia nigra produce?

Answer 5

DA

Question 6

What does the basal nuclei/ganglia do for the body?

Answer 6

Plans, organizes and coordinates motor movement

Question 7

What are the Sx of PD?

Answer 7

TRAP B

Resting tremor
Rigidity
Akinesia 
Postural instability
Bradykinesia

• speech issues
• swallowing issues

Question 8

What type of Therapy is used to Tx PD?

Answer 8

Physical therapy
Speech therapy
Occupational therapy
Exercise
Medication

Question 9

Which type of therapy for Tx of PD is the most effective in slow progression of the disease?

Answer 9

Exercise

Question 10

What is the precursor for dopamine?

Answer 10

L-dopa

Question 11

What breaks down L-dopa in the periphery?

Answer 11

Dopa-decarboxylase

COMT

Question 12

What inhibits dopa-decarboxylase?

Answer 12

Carbidopa

Question 13

What inhibits COMT in periphery? What inhibits COMT in the brain?

Answer 13

Tolcapone(Tasmar)
Entacapone(Comtan)

Tolcapone(Tasmar)

Question 14

What enzymes break down DA in the brain?

Answer 14

COMT

MAO-B

Question 15

Why drugs inhibit MOA-B?

Answer 15

Selegiline(Eldepryl)
Rasagiline(Azilect)
Safinamide(Xadago)

Question 16

What drugs are D2 receptor agonist and are used for RLS?

Answer 16

Pramipexole(mirapex)
Ropinirole(Requip)
Rotigotine(Neupro)

Question 17

What does increased DA in periphery cause?

Answer 17

N/V

Tachycardia

Question 18

What 3 things do not cross the BBB?

Answer 18

Carbidopa
Dopamine
Entacapone(Comtan)

Question 19

What is the on-off phenomenon of PD? What is the wearing off effect?

Answer 19

On-off phenomenon=Sx switching between mobility and immobility

Wearing off effect=over time Sx begin to appear or worsen

Question 20

If DA levels are too high what occurs? DA levels too low?

Answer 20

Chorea
Dystopias

PD Sx

Question 21

What is amantadine(Symmetrel)? What Sx does it relieve? What is it’s MOA?

Answer 21

DA modulator

Reduces tremors and muscle rigidity

Increase DA release
Blocks reuptake of DA
Anticholinergic properties

Question 22

Why isn’t tolcapon(Tasmar) used very often?

Answer 22

B/c it causes liver issues

Question 23

What ADR can happen with entacapone(comtan)?

Answer 23

Darken urine and sweat

Question 24

What is added to levodopa/carbidopa to reduce on-off phenomenon?

Answer 24

Entacapone(comtan)

Question 25

What is bromocriptine(Parlodel)? What does it do?

Answer 25

Dopamine receptor agonist Decreases PRL

Question 26

What is and ADR for DA agonists?

Answer 26

Delusions | Hullucinations

Question 27

What drugs are used for RLS(restless leg syndrome)?

Answer 27

Ropinirole(requip) Pramipexole(mirapex) Rotigotine(neupro)

Question 28

How long of an effect does carbidopa/levodopa medication have on the body?

Answer 28

Medications lasts about 5 years

Question 29

Why should you not eat a protein containing meal one-half hour before or one hour after taking carbidopa/levodopa?

Answer 29

Because the protein and levodopa compete for the same Amino acid transporter to enter the brain

Question 30

What are the 5 ADR for carbidopa/levodopa?

Answer 30

``` N/V Orthostatic hypotension Tachycardia Psychosis Insomnia ```

Question 31

What does carbidopa/levodopa cause orthostatic hypotension?

Answer 31

Because L-dopa depresses brain stem

Question 32

Why does taking carbidopa/levodopa sometimes cause insomnia? How can you prevent insomnia from occurring?

Answer 32

B/c the meds are stimulatory drugs need to be taken several hours before bed

Question 33

What is benztropine(cogentin)? What Sx does it reduce? What are the ADR of anticholinergics?

Answer 33

Anticholinergic Reduces tremors and muscle rigidity Decreases saliva Tachycardia Miosis

Question 34

What is aphasia?

Answer 34

Difficulty speaking

Question 35

What is dysphagia?

Answer 35

Difficulty swallowing

Question 36

What is the central triad of PD?

Answer 36

Bradykinesia Tremors Rigidity