Neurodegnerative Diseases

Question 1

Which drugs cause Parkinson like symptoms

Answer 1

Haloperidol
Metoclopramide
Valproate
Chlorpromazine

Question 2

What is the first line drug for Parkinson’s disease

Answer 2

L-DOPA

Question 3

What converts L DOPA to dopamine in the substantia nigra

Answer 3

It gets decarboxylated by DOPA decarboxylase

Question 4

L DOPA side effects

Answer 4

Nausea, vomiting, cardiac arrhythmias, hypotension

CNS: anxiety confusion and hallucinations

Question 5

What is wearing off syndrome

Answer 5

Happens in chronic use of LDOPA and can cause dyskaniesia and akaniesia

Question 6

What happens over time with L DOPA use

Answer 6

The therapeutic window narrows leading to on and off phenomenon

Question 7

Who is L DOPA contraindicated in

Answer 7

Psychotic patients

Question 8

How to improve bioavailability of L DOPA

Answer 8

we administer it with Carbidopa -> drops peripheral side effects

Question 9

What’s the % of L dopa reaching the brain with and without Carbidopa

Answer 9

Without 1-3%

With 5-10%

Question 10

What’s the major peripheral pathway of L DOPA breakdown after

Answer 10

COMT

Question 11

What are the COMT inhibitors

Answer 11

Tolcapone and entacapone

Question 12

Which COMT inhibitor enters the CNS

Answer 12

tolcapone

Question 13

Which COMT INHIBITR has long half life

Answer 13

Tolcapone

Question 14

What are the adverse effects of tolcapone

Answer 14

Hepatotoxic

Question 15

What are the MAO B inhibitors

Answer 15

selegiline and rasagiline

Extra safinamide

Question 16

Which MAO B inhibitor is more potent

Answer 16

Rasagiline

Question 17

What happens when selegiline is metabolised

Answer 17

It is converted to amphetamines

Question 18

What is the initiation therapy for Parkinson’s disease

Answer 18

Dopamine receptor agonist

Question 19

What’s the drug combination in advanced Parkinson’s

Answer 19

Carbidopa/LDOPA + D2 agonist

Question 20

Which D2 agonist isn’t used any more

Answer 20

Bromocriptine as it has a lot of side effects

Question 21

Which D2 agonist is used for restless leg syndrome

Answer 21

Ropinirole

Question 22

Long term use of bromocriptine side effects

Answer 22

Vasospasm in patients with peripheral vascular disease

Pulmonary and retroperitoneal fibrosis

Question 23

Which anti muscarinic agents are used in the treatment of Parkinson’s

Answer 23

Benztropine and trihexphnidyl

Question 24

What are Benztropine and trihexphnidyl contraindications

Answer 24

BPH and GLUCOMA

Question 25

What’s the mechanism of action of amantadine

Answer 25

Enhances effects of endogenous dopamine and inhibits cholinergic receptors

Question 26

When is LDOPA TAKEN

Answer 26

30 mins before food to avoid food competing with L DOPA. Absorption

Question 27

L DOPA drug interactions

Answer 27

With Vitamin B6 it increases peripheral breakdown

Question 28

What happens in Alzheimer’s disease

Answer 28

Neuronal loss in the temporal lobe including entraorhinal cortex and hippocampus

Question 29

What ACHE inhibitors are used in Alzheimer’s

Answer 29

Donepezil Galantamine Rivastigmine

Question 30

Which ACHE inhibitor is given oral and indicated for Parkinson’s dementia

Answer 30

Rivastigmine (only one not metabolised by CYP 450)

Question 31

Which ACHE inhibitor is given as a transdermal patch for people who can’t with the side effects

Answer 31

Rivastigmine

Question 32

ACHE inhibitors side effects

Answer 32

Bradycardia and bronchoconstriction | Nause, vomiting and diarrhoea

Question 33

Mechanism of action of NMDA antagonist

Answer 33

Prevent NMDA receptors excite toxicity

Question 34

Which NMDA inhibitor is used for Alzheimer’s

Answer 34

MEMANTINE

Question 35

MEMANTINE mechanism of action

Answer 35

Non competitive NMDA type glutamate receptor antagonist blocking Ca2+ influx into neurons

Question 36

NMDA antagonist can it be used as monotherapy

Answer 36

Yes or with ACHE Inhibitors

Question 37

What is Huntington’s disease

Answer 37

It’s an inherited neurological disorder | -Movement disorder due to defect in basal ganglia

Question 38

What happens in Huntington’s disease

Answer 38

Over activity of dopamine due to imbalance decrease of ACH and GABA which antagonise DOPAMINE

Question 39

Drugs that deplete the central dopamine store by blocking entry to neurone storage vesicles

Answer 39

Roseripine and tetrabanzine

Question 40

Drugs that block dopaminergic receptors

Answer 40

Phenothiazines and butyrophenones and haloperidol | AE : Parkinsonism and restlessness

Question 41

What is bipolar disorder

Answer 41

Mood shift between two extremes depression and mania (euphoria)

Question 42

What’s used in the treatment of bipolar disorder

Answer 42

Mood stabilisers mainly LITHIUM

Question 43

What anticonvulsants are used to treat bipolar disorder

Answer 43

Carbamazepine Valproate Gabapentin Lamotrigine

Question 44

When are anticonvulsants used instead of lithium

Answer 44

When lithium does not work or is not sutiable

Question 45

Lithium onset of action

Answer 45

7-10 days

Question 46

Is lithium eliminated by the liver

Answer 46

No it’s not

Question 47

What is mediated lithium effect

Answer 47

IP3 and DAG

Question 48

Lithium indications

Answer 48

Acute mania Prophylaxis of BPD mania/hypo mania- depression

Question 49

Lithium therapeutic index

Answer 49

Narrow | Can cause goiter (hypothyroidism) edema, teratogenic

Question 50

What’s an alternative to lithium

Answer 50

Carbamazepine-P450 inducer

Question 51

Carbamazepine side effects

Answer 51

Can cause agranulocytosis leukopenia

Question 52

What’s the most sedating antidepressant

Answer 52

Doxepin