Parkinson's Disease

Question 1

Patho of Parkinson’s Disease?

Answer 1

degeneration of substantia nigra

loss of DA producing neurons (opposite of SZP)

Question 2

As DA decreases, ACh….

Answer 2

increases

Question 3

What is the classic triad?

Answer 3

bradykinesia, rigidity, tremor

Question 4

What is the on-off phenomenon?

Answer 4

On - periods of dyskenesia

Off - hypokinesia

Question 5

What is the treatment?

Answer 5

much with DA or ACh

Question 6

What is Levodopa?

Answer 6

naturally occuring amino acid precursor of DA

Question 7

Why can DA not be given to these patients?

Answer 7

rapidly metabolized in the gut, blood, and liver by COMT and MAO, and it will not cross the BB

Question 8

Why can’t you give IV DA?

Answer 8

it cannot cross the BBB – poor lipophilicity

Question 9

Is L dopa rapidly absorbed across the gut? Then what?

Answer 9

Yes. Reaches CNS and is converted to DA by an enzyme

Question 10

What enzyme converts Ldopa to DA?

Answer 10

dopa decarboxylase

Question 11

Can Ldopa be converted to DA in the periphery? Why is a problem to consume too much Vitamin B6?

Answer 11

yes! its converted by Vitamin B6. if pts take in too much Vitamin B6 then it can cause their Ldopa to convert to DA in the periphery, NOT the CNS where they need it.

Question 12

What are decarboylase inhibitors used for? What is an example?

Answer 12

co-administration with L-dopa to avoid peripheral conversion of Ldopa
Carbidopa (won’t cross BBB)

Question 13

What is the drug that combines Ldopa and decarboxylase inhibitor?

Answer 13

Sinemet

Question 14

interactions of ldopa?

Answer 14

non-selective MAOIs - HTN urgency/emergency

antipsychotics- decrease DA

Question 15

what are MAO inhibitors used for?

Answer 15

anti-depressants – inhibits MAO that chews up NTs like DA, serotonin…

Question 16

Bromocriptine (Parlodel) was what MOA? what is a downside?

Answer 16

D2 agonist

it has to be dosed several times a day - rapidly absorbed in the gut

Question 17

Bromocriptine is often dose with what other drug?

Answer 17

l-dopa

Question 18

AEs of bromocriptine?

Answer 18

N/V at low doses

hallucinations and confusion at high doses

Question 19

What is another use of bromocriptine?

Answer 19

hyperprolactinemia and galactorrhea (DA antagonizes Prolactin)

Question 20

Bromocriptine is used in the emergent treat of what life threatening condition?

Answer 20

Nueroleptic Malignant Syndrome - side effect from anti-psych meds like Haladol used to sedate people - decreases DA

Question 21

What are the S/S of NMS?

Answer 21

high fever 104.5
increased CPK
Rhabdo
rigidity

Question 22

What is another drug used to treat hyperprolactinemia that is easier to dose?

Answer 22

Cabergoline (Dostinex)

Question 23

Pramipexole (Mirapex) is a non-ergot ______. what is it highly effective in treating?

Answer 23

D2 agonist

tremor

Question 24

What is another indication of pramipexole?

Answer 24

Restless leg syndrome (RLS)

Question 25

What is AE of taking pramipexole?

Answer 25

reward seeking behavior - gambling, binge eating, sexual urges

Question 26

Rompinirole is a non-ergot..... How does it compare to pramipexole?

Answer 26

D2 agonist | more D2 affinity than P

Question 27

Rotigotine (Neupro) is a.... how is it available?

Answer 27

non-ergot DA agonist | transdermal patch available in many strengths

Question 28

AEs of rotigotine?

Answer 28

psychosis, acute compulsive behavior

Question 29

Entacapone (Comtan) has what MOA?

Answer 29

COMT inhibitor that crosses the BBB and prolongs the activity of L-dopa

Question 30

How is entacapone specifically helpful?

Answer 30

adjunct in patients with early l-dopa end of dose phenomenon

Question 31

AE of entacapone?

Answer 31

increase incidence of dyskenesia

Question 32

Tolcapone is stimilar to Entacapone but with... why is rarely used?

Answer 32

greater lipophilicty and CNS penetration | risk of hepatic necrosis

Question 33

How does Amantidine work? Was it effective for Parkinson's?

Answer 33

Increases the synthesis and release of DA and may also block reuptake. Not as effective as l-dopa

Question 34

What other use did Amantidine have? What was it called?Was it effective?

Answer 34

Anti-viral agent for Influenza A Rimantidine - hydrophilic analogue Limited efficacy

Question 35

What are the AEs of Amantidine?

Answer 35

insomnia and hallucinations

Question 36

What are some examples of anticholinergic drugs used for parkinsons? What is the father of them all?

Answer 36

Diphenhydramine Benztropine (Cogentin) Trihexyphenidyl (Artane) Atropine - father

Question 37

What are some anticholinergic side effects?

Answer 37

``` Tachycardia dry mouth constipation urinary retention sedation ```

Question 38

What drug can treat essential/benign tremor?

Answer 38

propanolol

Question 39

What drug treats restless leg syndrome?

Answer 39

ropinirole, pramipexole

Question 40

what drug is used to treat MS?

Answer 40

corticosteroids, interferon-Beta