Drugs for Movement Disorders - Parkinson

Question 1

What is the MOA for Amantadine?

Answer 1

Unknown

– weak NMDA receptor antagonist

Question 2

What drug can be used for the treatment of drug-induced extrapyramidal symptoms?

Answer 2

Amantadine

Question 3

MOA-B inhibitors are used for early Parkinson Disease. Which of the 3 drugs are irreversible/reversible inhibitors?

Answer 3

Selegiline = irreversible
Rasagiline = irreversible
Safinamide - REVERSIBLE

Question 4

Which MAO-B Inhibitor has a greater potency?

Answer 4

Rasagiline

Question 5

Which MAO-B inhibitor has the highest selectivity?

Answer 5

Safinamide

Question 6

What is a possible adverse effect of Selegiline?

Answer 6

Antidepressants increased suicidal ideation in young kid patients

Question 7

Ropinirole is a ____ agonist

Answer 7

D2/D3

Question 8

Which of the Dopamine Receptor Agonists are DA agonists?

Answer 8

Apomorphine

Bromocriptine

Question 9

Besides Ropinirole, which of the Dopamine Receptor Agonists are also D2 Agonists?

Answer 9

Pramipexole

Rotigotine

Question 10

Apomorphine can be given how to quickly treat “off” episodes?

Answer 10

Sublingual or SubQ

Question 11

Which Dopamine Receptor Agonist is an ergot alkaloid derivative?

Answer 11

Bromocriptine

Question 12

How is Rotigotine given?

Answer 12

24 hour transdermal patch

Question 13

What are some of the unique side effects of Ropinirole?

Answer 13

• Increased risk of melanoma
• Orthostatic Hypotension
• Somnolence
• Headaches, N/V, constipation

Question 14

Compared to some of the side effects of Ropinirole, how does Pramipexole compare?

Answer 14

• LESS hypotension and somnolence

- MORE hallucinations

Question 15

What is a serious side effect of Tolcapone?

Answer 15

Fatal acute fulminant LIVER FAILURE

Question 16

When should Tolcapone be used?

Answer 16

ONLY in patients that are on levodopa/carbidopa with symptom fluctuations and are NOT responding satisfactorily to other agents!

Question 17

What is a COMT inhibitor that has a shorter half life and cannot cross the BBB?

Answer 17

Entacapone

Question 18

What is the most potent Parkinson treatment option?

Answer 18

Levodopa combinations

Question 19

What are some unique side effects of Levodopa + Carbidopa?

Answer 19

GI effects
HTN
Cardiac arrhythmias
Wearing off/ on and off phenomena

Question 20

When Levodopa is given with Carbidopa, the SAME amount of Levodopa reaches the brain… so why is Carbidopa given with it?

Answer 20

DECREASES GI metabolism and effects by (-) DOPA Decarboxylase in the periphery to stop metabolism to Dopamine in the periphery

Question 21

When should Benztropine be used?

Answer 21

• Tremor/dystonia in younger people

- To treat excessive drooling

Question 22

In what patients should you avoid using Benztropine?

Answer 22

• In the elderly

- In those with cognitive impairment

Question 23

This drug is used for tremors/dystonia in younger people and to treat excessive drooling

Answer 23

Benztropine

Question 24

This drug is a DOPA Decarboxylase Inhibitor in the periphery to stop L-dopa from metabolizing to Dopamine in the periphery

Answer 24

Carbidopa

Question 25

This drug is a COMT inhibitor in the periphery that stops L-Dopa from metabolizing to 3-OMD in the periphery

Answer 25

Entacapone

Question 26

This drug can cause fulminant liver failure

Answer 26

Tolcapone

Question 27

What drug can cause levido reticularis (purple skin of legs)?

Answer 27

Amantadine

Question 28

What are some of the adverse effects seen with these drugs that are used to treat Parkinson Disease?

Answer 28

``` CNS depression Impulse control issues Psychosis Suicidal ideation Dyskinesias Orthostatic Hypotension ```

Question 29

What are some of the adverse effects seen with these drugs that are used to treat Parkinson Disease?

Answer 29

``` CNS depression Impulse control issues Psychosis Suicidal ideation Dyskinesias Orthostatic Hypotension ```

Question 30

The goal of Parkinson Disease treatment is to increase what molecule?

Answer 30

Dopamine