[PCOL] Part 5.3 - Central Nervous System Drugs - Drugs for Parkinsonism, Anti-seizure Agents

a. I, II, III, IV

Parkinsonism.

I. Condition that causes a combination of the movement abnormalities.

II. Tremor, slow movement, impaired speech or muscle stiffness.

III. Low level of DA in substantia nigra

IV. High level of ACh

a. I, II, III, IV

b. I, II, III

c. II, III, IV

d. III, IV

f. All

True statements.

a. GABA is responsible for the inhibitory effect which prevent movement

b. Acetylcholine is necessary to support the activity of GABA

c. Dopamine inhibits Acetylcholine action towards GABA to promote movement

d. a and b

e. b and c

f. All

c. Both

Therapeutic goal of antiparkisonism drugs.

a. To increase Dopaminergic activity

b. To reduce excitatory interneuron Acetylcholine activity

c. Both

d. None

a. Substantia nigra

Site of origin of dopaminergic neurons.

a. Substantia nigra

b. Corpus striatum

b. Corpus striatum

Site of GABAergic output by cholinergic neurons.

a. Substantia nigra

b. Corpus striatum

a. I, II, III, IV, V

Antiparkinsonism Agents.

I. Levodopa

II. DA2 agonist

III. MAOB inhibitor

IV. COMT Inhibitor

V. Acetylcholine Antagonist

a. I, II, III, IV, V

b. I, II, III, IV

c. II, III, IV, V

d. I, II, III

e. III, IV, V

b. Amantadine

Antiviral agent with antiparkinsonism activity.

a. Levodopa

b. Amantadine

c. Selegiline

d. Pergolide

e. I, II, III, IV, V, VI, VII

Levodopa.

I. By mouth

II. Metabolic precursor of dopamine

III. Penetrate the Blood Brain Barrier unlike dopamine

IV. L-DOPA decarboxylase in the brain covert levodopa to dopamine

V. Levodopa gets prematurely metabolized in the GIT

VI. Carbidopa block Peripheral GIT L-DOPA decarboxylase

VII. Levodopa + Carbidopa is then used for its potentiated action (1+0=3)

a. I, II, IV, V, VI, VII

b. I, III, IV, V, VI, VII

c. I, II, III, IV, V

d. I, II, III, VI, VII

e. I, II, III, IV, V, VI, VII

Bromocriptine

Pramipexole

Pergolide

Ropinirole

Dopamine-agonist

d. a and b

Pergolide is D2 agonist.

MAOB inhibitors.

a. Selegiline

b. Rasagiline

c. Pergolide

d. a and b

e. b and c

f. All

d. a and b

Rasagiline is MAOB inhibitor.

COMT inhibitors.

a. Tolcapone

b. Entacapone

c. Rasagiline

d. a and b

e. b and c

f. All

BBT

Benztropine

Biperiden

Trihexyphenidyl

Centrally-acting acetylcholine antagonists

a. Seizure

Abnormal excitation of neurons.

a. Seizure

b. Parkinsonism

c. SLE

d. EPS

a. I, II, III, IV

Mechanisms of anti-seizure agents.

I. Na+ channel inhibition

II. Calcium channel blockade

III. Increase GABA

IV. Decrease glutamate

a. I, II, III, IV

b. I, II, III

c. II, III, IV

d. III, IV

f. Vigabatrin - this is newer agents.

Classical anti-seizure agents except:

a. Carbamazepine

b. Phenytoin

c. Valproic acid

d. Phenobarbital

e. Ethosuximide

f. Vigabatrin

e. I, II, III, IV, V, VI

Newer anti-seizure agents.

I. Vigabatrin

II. Felbamate

III. Gabapentin

IV. Pregabalin

V. Tiagabine

VI. Lamotrigine

a. III, IV, V

b. I, II, VI

c. II, III, IV, V, VI

d. I, II, III, IV, V

e. I, II, III, IV, V, VI

Carbamazepine

Phenytoin

Valproic acid

Na+ channel blockers anti-seizure agents

Valproic acid

Ethosuximide

Ca2+ channel blockers anti-seizure agents

Valproic acid

Phenobarbital

GABA increasing anti-seizure agents

c. Valproic acid

Classic anti-seizure agent that block Na+ channel, block calcium channel, and increase GABA.

a. Carbamazepine

b. Phenytoin

c. Valproic acid

d. Phenobarbital

e. Ethosuximide

a. Vigabatrin

Newer anti-seizure agent that increase GABA by inhibiting GABA aminotransferase.

a. Vigabatrin

b. Felbamate

c. Gabapentin

d. Pregabalin

e. Tiagabine

f. Lamotrigine

b. Felbamate

Newer anti-seizure agent that increase GABA by inhibiting N-methyl-D-aspartate (NMDA).

a. Vigabatrin

b. Felbamate

c. Gabapentin

d. Pregabalin

e. Tiagabine

f. Lamotrigine

e. Tiagabine

Newer anti-seizure agent that increase GABA by inhibiting GABA reuptake.

a. Vigabatrin

b. Felbamate

c. Gabapentin

d. Pregabalin

e. Tiagabine

f. Lamotrigine

f. Lamotrigine

Anti-seizure agent that inhibit both Na+ and Ca2+ channel, increase GABA, and decrease glutamate.

a. Vigabatrin

b. Felbamate

c. Gabapentin

d. Pregabalin

e. Tiagabine

f. Lamotrigine

c. Gabapentin

Anti-seizure agent that is analogue of GABA but does not act on GABA receptor.

a. Vigabatrin

b. Felbamate

c. Gabapentin

d. Pregabalin

e. Tiagabine

f. Lamotrigine

d. Pregabalin

Anti-seizure agent that is analogue of Gabapentin.

a. Vigabatrin

b. Felbamate

c. Gabapentin

d. Pregabalin

e. Tiagabine

f. Lamotrigine

d. a and b

Anti-seizure agent with unknown mechanism of action.

a. Gabapentin

b. Pregabalin

c. Phenytoin

d. a and b

e. b and c

f. All

e. Ethosuximide

Agents generally used for Grand Mal and partial seizures except:

a. Carbamazepine

b. Phenytoin

c. Valproic acid

d. Phenobarbital

e. Ethosuximide

f. None

c. Valproic acid

First line for Grand Mal seizures.

a. Carbamazepine

b. Phenytoin

c. Valproic acid

d. Phenobarbital

e. Ethosuximide

e. Ethosuximide

First line for Petit Mal or absence seizures.

a. Carbamazepine

b. Phenytoin

c. Valproic acid

d. Phenobarbital

e. Ethosuximide

a. Carbamazepine

DOC for partial seizure; also potentiates postsynaptic action of GABA.

a. Carbamazepine

b. Phenytoin

c. Valproic acid

d. Phenobarbital

e. Ethosuximide

f. Oxcarbazepine

b. Phenytoin

May cause megaloblastic anemia, endocrine disturbances (DM, glycosuria, osteomalacia), fetal hydantoin syndrome.

a. Carbamazepine

b. Phenytoin

c. Valproic acid

d. Phenobarbital

e. Ethosuximide

f. Oxcarbazepine

a. Carbamazepine

May cause diplopia and ataxia.

a. Carbamazepine

b. Phenytoin

c. Valproic acid

d. Phenobarbital

e. Ethosuximide

f. Oxcarbazepine

f. Oxcarbazepine

Has fewer side effects and D/I than Carbamazepine.

a. Carbamazepine

b. Phenytoin

c. Valproic acid

d. Phenobarbital

e. Ethosuximide

f. Oxcarbazepine

c. Zonisamide

Sulfonamide derivative effective against partial and Generalized Tonic Chronic (GTC) seizures.

a. Carbamazepine

b. Phenytoin

c. Zonisamide

d. Phenobarbital

e. Ethosuximide

f. Oxcarbazepine

e. Ethosuximide

Reduce the T-type Calcium channel in thalamic neurons.

a. Carbamazepine

b. Phenytoin

c. Zonisamide

d. Phenobarbital

e. Ethosuximide

f. Oxcarbazepine

a. Benzodiazepines, Barbiturates

Other anti-seizure agents:

Potentiate inhibitory effects of GABA.

a. Benzodiazepines, Barbiturates

b. Lorazepam

c. Clonazepam

d. Phenobarbital

e. Acetazolamide

b. Lorazepam (now)

Before: diazepam

Other anti-seizure agents:

For short-term status epilepticus.

a. Benzodiazepines, Barbiturates

b. Lorazepam

c. Clonazepam

d. Phenobarbital

e. Acetazolamide

c. Clonazepam

Other anti-seizure agents:

Used in absence seizure, infantile spasm, myoclonic seizure, and atonic seizures.

a. Benzodiazepines, Barbiturates

b. Lorazepam

c. Clonazepam

d. Phenobarbital

e. Acetazolamide

d. Phenobarbital

Other anti-seizure agents:

First-line for neonatal seizure and maintenance of status epilepticus.

a. Benzodiazepines, Barbiturates

b. Lorazepam

c. Clonazepam

d. Phenobarbital

e. Acetazolamide

e. Acetazolamide

Other anti-seizure agents:

For catamenial seizure experienced by women during menstruation.

a. Benzodiazepines, Barbiturates

b. Lorazepam

c. Clonazepam

d. Phenobarbital

e. Acetazolamide