BB1a

Question 1

Which PD treatment can be prescribed as a transdermal patch? [1]

State the MoA [1]

Answer 1

b. Rotigotine
Dopamine agonist: directly activates indirect pathway

Question 2

Which drugs are Madopar are combination of? [2]

Answer 2

levodopa and benserazide.

Question 3

MoA of benserazide? [1]

Answer 3

peripheral decarboxylase inhibitor

Question 4

1. 95% of neurons in the striatum use which NT? [1]

Answer 4

GABA

Question 4

The dorsal striatum is comprised of which two structures? [2]

Answer 4

Caudate nucleus and putamen

Question 5

The dorsal striatum is comprised of which two structures? [2]

Answer 5

b. Caudate nucleus and putamen

Question 6

Which basal ganglia nuclei are the intrinsic nuclei? [2]

Answer 6

Located between the input and output nuclei in the relay of information
b. Globus pallidus externus
c. Substantia nigra pars compacta

Question 7

Which basal ganglia structures are the output [2] and input nuclei? [2]

Answer 7

1. Input nuclei:
a. Receive information from different sources (cortical, thalamic and nigral)
b. Caudate nucleus and putamen (aka dorsal striatum)

2. Output nuclei:
a. Send basal ganglia information to the thalamus
b. Globus pallidus internus
c. Substantia nigra pars reticulata

Question 8

Describe the direct, indirect and hyper-direct pathway :)

Answer 8

Question 9

Describe the differences between D1 and D2 receptor inputs to the direct and indirect pathways

Answer 9

Question 10

Describe the pathophysiology of Parkinson’s disease [4]

Answer 10

Question 11

Describe the link between PD and depression [2]

Answer 11

b. Thought to be due to the reduction in dopamine levels
c. Also due to levodopa wearing off before next dose is due

Question 12

Selegiline should not be treated alongside which drug class? [1]

Answer 12

SSRIs

Question 13

Describe why the patient’s symptoms got worse

Answer 13

Question 14

Describe the symptoms of L-dopa induced dyskinesia [6]

Answer 14

a. Dystonia:
i. This is where excessive muscle contraction leads to abnormal postures or exaggerated movements.

b. Chorea:
i. These are abnormal involuntary movements that can be jerking and random.

c. Athetosis:
i. These are involuntary twisting or writhing movements usually in the fingers, hands or feet.

d. Depression

e. Psychosis

f. Insomnia

Question 15

Describe MoA of L-Dopa [1]

Which drug class is it commonly combined with? [1] Give two examples [2]

Answer 15

i. Synthetic dopamine
ii. Combined with peripheral decarboxylase inhibitors:
1. Carbidopa
2. Benserazide

Question 16

Describe the MoA of Rotigotine [1]
How is it prescribed? [1]
What symptom can it specifically treat? [1]

Answer 16

i. Dopamine agonist: directly activates indirect pathway
1. Transdermal patch
2. Treats restless leg syndrome

Question 17

State the MoA of Selegiline [1]

Answer 17

i. Monoamine Oxidase-B inhibitor
1. Inhibits the breakdown of dopamine secreted by dopaminergic neurons

Question 18

State the MoA of Selegiline [1]

Answer 18

i. Monoamine Oxidase-B inhibitor
1. Inhibits the breakdown of dopamine secreted by dopaminergic neurons

Question 19

Describe the advantage of prescribing Selegiline [2]

Answer 19

ii. Used for patients taking Levodopa combinations
iii. Reduces the dose needed for Levodopa combinations to control symptoms and reducing the on/off effect

Question 20

What drug class is Citalopram from? [1]

Answer 20

i. Selective serotonin reuptake inhibitor:

Question 21

Describe the MoA of citalopram [3]

Answer 21

1. Increases amount of serotonin by reducing the reuptake of serotonin from synaptic cleft into the presynaptic neuron
2. Antagonise serotonin transporter (SERT) on presynaptic membrane
3. Allows more serotonin to bind to 5HT receptors on post synaptic membrane

Question 22

State 4 AEs of using citalopram and other SSRIs [4]

Answer 22

1. Sexual dysfunction
2. Sleep disturbance
3. Anxiety
4. GI distress
5. Suicide ideation & self harm
   a. Review within a week

Question 23

What drug class is Mirtazapine? [1]

Answer 23

i. Tricyclic antidepressant

Question 24

Describe the MoA of Mirtazapine [1]

Answer 24

inhibits the central presynaptic alpha-2-adrenergic receptors, which causes an increased release of serotonin and norepinephrine.