Drugs Used in Parkinsonism

Question 1

4 Ways to Address Pathology of Parkinsonism

Answer 1

Increase level of Levodopa
Dopamine Agonist
Increase availability by Inhibiting Degrading Enzymes
Curb the Cholinergic Excess

Question 2

The pathological hallmark of Parkinson’s disease

Answer 2

loss of the pigmented neurons of the substantia nigra pars compacta

Question 3

Intracellular inclusions in Parkinson’s disease

Answer 3

LEWY BODIES

Question 4

Principal component of the Lewy bodies

Answer 4

a-synuclein

Question 5

Primary signs of Parkinson’s Disease

Answer 5

TRAP

Tremor
Rigidity
Akinesia - loss of ability to move your muscles voluntarily
Postural instability

Question 6

Occurrence of reversible Parkinsonian symptoms in patients taking the ff drugs

TYPICAL antipsychotic drugs - dopamine antagonist
RESERPINE - depletes catecholamine stores
MPTP (methylphenyltetrahydropyridine) - protoxin damaging dopaminergic neurons

Answer 6

Drug Induced Parkinsonism

Question 7

DOC for Parkinson’s Disease

Answer 7

Levodopa-Carbidopa (SINEMET)

Question 8

Inhibits peripheral metabolism via DOPA DECARBOXYLASE

Answer 8

Carbidopa

Question 9

Alternating periods of improved mobility and akinesia occurring over a few hours to days during treatment

UNRELATED TO TIMING OF DOSES

Answer 9

On-Off Phenomena

Question 10

Deterioration of drug effect in between medication doses

d.t. progressive destruction of nigrostriatal neurons that occurs w/ disease progression

RELATED TO TIMING OF DOSES

Answer 10

Wearing-Off Phenomena

Question 11

DOPAMINE AGONISTS

Answer 11

PRAMIPEXOLE
ROPINIROLE
APOMORPHINE
ROTIGOTINE
BROMOCRIPTINE

Question 12

Partial agonists at dopamine D2 receptors in brain

D2 agonism – inhibition of prolactin release

Answer 12

BROMOCRIPTINE
Pergolide
Cabergoline
Piribedil

Question 13

Partial agonists at dopamine D2 receptors in brain and D3 receptors

Answer 13

PRAMIPEXOLE (D2)

ROPINIROLE (D3)

Question 14

MOA of APOMORPHINE (Opioids)

Answer 14

AGONIST at dopamine D2 receptors

ANTAGONIST of 5-HT and alpha adrenoreceptors

Question 15

Used for RESCUE TREATMENT for off periods of Parkinson’s disease

Answer 15

APOMORPHINE

Premedicate w/ TRIMETHOBENZAMIDE to prevent severe nausea

Question 16

COMT (-)

block L dopa metabolism by (-) COMT

for ON and OFF phenomena

Answer 16

ENTACAPONE - blood only
TOLCAPONE - blood and brain

SE - hepatotoxicity (tolcapone)
orange urine

Question 17

MAO-B (-)

Answer 17

RASAGILINE
SELEGILINE
SAFINAMIDE

Question 18

MOA of SELEGILINE

Answer 18

selective inhibitors of monoamine oxidase type B (MAO-B) – decreased degradation of dopamine

does NOT cause CHEESE effect (hypertensive crisis seen with ingestion of tyramine rich food (CHEESE) while taking a nonselective MAO (-)

Question 19

Adjunct for WANING EFFECT treatment to Levodopa of Parkinson’s disease, wearing off or on-and-off phenomenon

Answer 19

Selegiline

Rasagiline

Question 20

Occurs when MAO-B (-), SSRIs, TCA and Meperidine are used simultaneously

Answer 20

Serotonin syndrome

Question 21

MOA of AMANTADINE

Answer 21

Potentiate dopaminergic function by influencing the synthesis, release or reuptake of dopamine

Antagonizes the effects of adenosine at adenosine A2a receptors

Question 22

Adverse Effect of Amantadine

Answer 22

LIVEDO RETICULARIS

Question 23

Antimuscarinic Agents (Anticholinergics) Parasympatholytic

Answer 23

BENZTROPINE
BIPERIDEN
TRIHEXYPHENIDYL
PROCYCLIDINE

Question 24

MOA of ROTIGOTINE

Answer 24

Dopamine agonist

Question 25

Levodopa + MAOI

Answer 25

EKIS

HPN crisis

Question 26

Levodopa + Carbidopa

Answer 26

CHECK

Question 27

Levodopa + Vitamin B6

Answer 27

EKIS

induces of decarboxylase

Question 28

Levodopa + Antipsychotics

Answer 28

EKIS

decreased dopamine

Question 29

Anticholinergics for Parkinsonism

Answer 29

Benztropine
Biperiden
Trihexyphenidyl
Procyclidine

Question 30

Non Selective MAO (-)

Answer 30

Tranylcypromine
Isocarboxazid
Phenelzine