EXAM II Parkinson's Drugs

Question 1

Dopamine Receptor (D2) Agonists

Answer 1

Ergot Derivative

Bromocriptine

(Less Selective, Not common, CYP 3A4 Metabolized)

Non-Ergot DA Agonists

Pramipexole

Ropinirole

Rotigotine (Transdermal Patch)

Question 2

Dopa Replacement for Parkinson’s

Answer 2

Levodopa (pre-dopamine)

Carbidopa (DOPA-decarboxylase inhibitor)

Combo called Sinamet

Question 3

Catechol-O-Methyltransferase (COMT) Inhibitors

Answer 3

Tolcapone (Hepatotoxicity)

Entacapone (Levodopa / Carbidopa / Entacapone - Stalevo)

Question 4

Monoamine Oxidase (MAO-B (DA selective))

Answer 4

Selegiline (Irreversible, not very B selective at high dose, Dietary restriction)

Rasagiline (Irreversible, More selective, Less Dietary restriction)

Safinamide (Reversible, Least Dietary Restriction)

Question 5

Other Adjunct Parkinson’s Medications

Answer 5

AntiMuscarinics (Benztropine; Trihexyphenidyl)

Apomorphine (DA Agonist for rescue from off-periods)

Amantadine (Antiviral with Antiparkinsonian properties)

Pimavanserin (Atypical antipsychotic (5HT2A, C), Possible QT prolong)

Question 6

Tremor Treatment

Answer 6

Benztropine (Also for EPS Dystonia / pseudo-parkinsonism)

Propanolol (Also EPS akathisia)

Question 7

Restless Leg Syndrome

Answer 7

Non-Ergot DA Agonists

Pramipexole

Ropinirole

Rotigotine (Transdermal Patch)

and

Gabapentin

Question 8

Huntington’s Disease treatment

Answer 8

Reserpine (inhibits VMAT)

(Many ADRs (also effects NE & 5HT): Hypotension, depression. sedation, diarrhea, nasal congestion)

Tetrabenazine

(More selective than Reserpine for DOPA, antagonism D2, less ADRs)

Deutetrabenazine (Newer Tetrabenazine)