Exam 1: Parkinson's (PD)

Question 1

Class: Dopamine replacement (1st line)
Drugs:

Answer 1

• levodopa (L-dopa)

- levodopa-carbidopa (Sinemet, Parcopa)

Question 2

Class: Dopamine replacement (1st line)
Drug: levodopa (L-dopa)
MOA:

Answer 2

• Converted to DA in CNS

Question 3

Class: Dopamine replacement (1st line)
Drug: levodopa (L-dopa)
Indications:

Answer 3

• Typically 1st line of trmt (Most effective)
• Bradykinesia
• Tremor
• rigidity

Question 4

Class: Dopamine replacement (1st line)
Drug: levodopa (L-dopa)
Contraindications:

Answer 4

• Less effective w/standing + coordination

Question 5

Class: Dopamine replacement (1st line)
Drug: levodopa (L-dopa)
Side effects:

Answer 5

• N/V
  **give on empty stomach
• Orthostats
  ↑SE @ 5-10 yrs (1/2 pts)
  • On-Off effect → may improve w/ “drug holiday” ~10 days
  • Dyskinesia
  • BENEFIT VS SE

Question 6

Class: Dopamine replacement (1st line)
Drug: levodopa (L-dopa)
Toxicity/AE:

Answer 6

• DDS (4%)

Question 7

Class: Dopamine replacement (1st line)
Drug: levodopa-carbidopa (Sinemet, Parcopa)
MOA:

Answer 7

• Carbidopa combined w/several formulations of l dopa

* *C-dopa alone = no benefit

Question 8

Class: Dopamine replacement (1st line)
Drug: levodopa-carbidopa (Sinemet, Parcopa)
Indications:

Answer 8

↓ s/s

↑efficiency

Question 9

Class: Dopamine replacement (1st line)
Drug: levodopa-carbidopa (Sinemet, Parcopa)
Contraindications:

Answer 9

• *over time loses benefit

- Usually by yr 5

Question 10

Class: Dopamine replacement (1st line)
Drug: levodopa-carbidopa (Sinemet, Parcopa)
Side effects:

Answer 10

• Confusion
• Hallucinations - Delusions
• Agitation
• Psychosis
• DDS (4%)
• N/V
• Fatigue
• Dizziness
• HA

Question 11

Class: Dopamine replacement (1st line)
Drug: levodopa-carbidopa (Sinemet, Parcopa)
Route/dosing:

Answer 11

1. Small doses
2. Titrated ↑ over several weeks → ↓ SE
   - Sinemet - PO (slow-release: CR)
   - Parcopa - sublingual

Question 12

Class: Dopamine agonist (1st line)
Drugs:

Answer 12

• Bromocriptine (Parlodel)
• pramipexole (Mirapex)
• ropinirole (Requip)
• apomorphine (Apokyn)

Question 13

Class: Dopamine agonist (1st line)
MOA:

Answer 13

• stimulate dopamine (DA) receptors in brain

Question 14

Class: Dopamine agonist (1st line)
Indications:

Answer 14

• monotherapy in early PD
  • Esp <65
  • Need to add l-dopa after a few yrs
• combination therapy in advanced PD

Question 15

Class: Dopamine agonist (1st line)
Contraindications:

Answer 15

**Won’t work if pts already don’t respond to l-dopa

Question 16

Class: Dopamine agonist (1st line)

Side effects:

Answer 16

• Sedation
• leg swelling
• Visual hallucinations
• Orthostats
• confusion

Question 17

Class: monamine oxidase B (MAO-B) inhibitors (1st line)
Drugs:

Answer 17

• selegiline (Eldepryl)

- rasagiline (Azilect)

Question 18

Class: monamine oxidase B (MAO-B) inhibitors (1st line)
MOA:

Answer 18

• Block enzymes that inactivate DA

Question 19

Class: monamine oxidase B (MAO-B) inhibitors (1st line)
Indications:

Answer 19

**benefit usually small if any

Question 20

Class: monamine oxidase B (MAO-B) inhibitors (1st line)

Side effects:

Answer 20

• Nausea
• HA
• Difficulty falling asleep

Question 21

Class: monamine oxidase B (MAO-B) inhibitors (1st line)
Interactions:

Answer 21

Antidepressants = ↑ BP

Question 22

Class: COMT inhibitors (2nd line)
Drugs:

Answer 22

• tolcapone (Tasmar)

- entacapone (Comtan)

Question 23

Class: COMT inhibitors (2nd line)
MOA:

Answer 23

• ↓ catechol-O-methyl transferase
  • Usually breaks down NTs
  • ↑T1/2 l-dopa

Question 24

Class: COMT inhibitors (2nd line)
Indications:

Answer 24

↑ effectiveness l-dopa

- on-off effect

Question 25

Class: COMT inhibitors (2nd line) Contraindications:

Answer 25

**not effective when taken alone

Question 26

Class: COMT inhibitors (2nd line) | Side effects:

Answer 26

- Dyskinesias - Hallucinations - Confusion - n/v/d - Orange urine - Orthostats * *Tamsar may ↑ liver enzymes → monitor 1st yr

Question 27

Class: Dopamine releasing/antiviral Drug:

Answer 27

amantadine (Symmetrel)

Question 28

Class: Dopamine releasing/antiviral Drug: amantadine (Symmetrel) MOA:

Answer 28

- Improves S/S in advanced dx - ANTIVIRAL | - Benefit may be temporary

Question 29

Class: Dopamine releasing/antiviral Drug: amantadine (Symmetrel) Indications:

Answer 29

- Combo w/l-dopa | • ↓ dyskinesia

Question 30

Class: Dopamine releasing/antiviral Drug: amantadine (Symmetrel) Side effects:

Answer 30

- Visual hallucinations - Confusion - Ankle-swelling - Livedo reticularis (Blotchy-purple skin)

Question 31

Class: Anti-cholinergic Drugs:

Answer 31

- benztropine (Cogentin) | - trihexyphenidyl

Question 32

Class: Anti-cholinergic MOA:

Answer 32

- Blocks cholinergic receptors in brain | • Restore DA/ACh balance

Question 33

Class: Anti-cholinergic Indications:

Answer 33

- ↓ tremor | - <70 yo w/o significant difficulties walking

Question 34

Class: Anti-cholinergic | Side effects:

Answer 34

Hot as a hare, blind as a | bat, dry as a bone, red as a beet, mad as a hatter "can't see, can't pee, can't spit, can't shit"