NU553 Unit 3 Parkinsons Disease Advanced Pharmacology and Pharmacotherapeutics Exam 2

What is the mean age of onset for Parkinson’s disease?

65 years

What is the male to female ratio for Parkinson’s disease?

1.4 to 1

Which brain region degenerates in Parkinson’s disease?

Substantia nigra pars compacta

What percentage of dopaminergic neurons are lost at diagnosis?

At least 50 percent

What are Lewy bodies composed of?

Alpha synuclein and ubiquitin

What is required for diagnosis of parkinsonism?

Bradykinesia plus tremor rigidity or both

List the four cardinal motor symptoms of Parkinson’s disease.

Bradykinesia resting tremor rigidity postural instability

What environmental exposure increases Parkinson’s disease risk?

Chronic pesticide exposure

Are tobacco and caffeine protective for Parkinson’s disease?

TRUE

Drug-induced parkinsonism is typically what after stopping the drug?

Reversible

Most common cause of drug-induced parkinsonism?

First generation antipsychotics

Which antipsychotics have lowest risk of drug-induced parkinsonism?

Clozapine and quetiapine

Which gastrointestinal drug can cause drug-induced parkinsonism?

Metoclopramide

Which antiepileptic drug can cause drug-induced parkinsonism?

Valproic acid

How long can drug-induced parkinsonism take to resolve?

Up to 2 years

What imaging differentiates Parkinson’s disease from drug-induced parkinsonism?

Dopamine transporter imaging

What is the goal of Parkinson’s disease treatment?

Improve quality of life and symptoms

Which scale monitors Parkinson’s disease progression?

Unified Parkinson’s Disease Rating Scale

Anticholinergics are best for which symptoms?

Tremor and drooling

Mechanism of anticholinergics in Parkinson’s disease?

Decrease acetylcholine activity

Examples of anticholinergics used in Parkinson’s disease.

Trihexyphenidyl benztropine

Why avoid anticholinergics in older adults?

Cognitive impairment and poor tolerance

Which condition contraindicates anticholinergics?

Narrow angle glaucoma

Mechanism of amantadine?

N methyl D aspartate receptor inhibition

Unique side effect of amantadine?

Livedo reticularis

What requires dose adjustment for amantadine?

Creatinine clearance

Serious risk when combining amantadine and memantine?

QT prolongation and psychosis

What do monoamine oxidase B inhibitors do?

Prevent dopamine breakdown

Examples of monoamine oxidase B inhibitors.

Selegiline rasagiline safinamide

Why does selegiline cause insomnia?

Metabolized to amphetamines

Diet caution with monoamine oxidase B inhibitors?

Tyramine

Which monoamine oxidase B inhibitor uses CYP1A2 metabolism?

Rasagiline

First-line for patients younger than 60 with mild symptoms?

Monoamine oxidase B inhibitor

Dopamine agonists compared to levodopa have what dyskinesia risk?

Lower

Examples of dopamine agonists.

Pramipexole ropinirole rotigotine

Which dopamine agonist is a patch?

Rotigotine

Which dopamine agonist is used for rescue?

Apomorphine

Major psychiatric adverse effect of dopamine agonists?

Impulse control disorders

Safety warning for dopamine agonists?

Sleep attacks

Gold standard treatment for Parkinson’s disease?

Levodopa

Why combine carbidopa with levodopa?

Prevents peripheral conversion

Effect of high protein on levodopa?

Decreases absorption

What is wearing off?

Return of symptoms before next dose

What are dyskinesias?

Involuntary movements from long-term levodopa

What is on time versus off time?

Medication working versus symptoms returning

When should levodopa be taken with respect to meals?

1 hour before or 2 hours after

Mechanism of catechol O methyltransferase inhibitors?

Prevent levodopa breakdown

Catechol O methyltransferase inhibitors are used with what?

Carbidopa levodopa

Which catechol O methyltransferase inhibitor has hepatotoxicity warning?

Tolcapone

What urine change occurs with catechol O methyltransferase inhibitors?

Dark orange brown urine

First-line for patients 60 or older?

Levodopa

Preferred in younger patients to delay dyskinesia?

Dopamine agonists

Preferred antipsychotics in Parkinson’s disease?

Quetiapine clozapine

Why avoid risperidone and olanzapine?

Worsen motor symptoms

What treats drooling in Parkinson’s disease?

Atropine drops or glycopyrrolate

Orthostatic hypotension is caused by what?

Disease or dopamine agonists and levodopa

Which gastrointestinal issue reduces levodopa absorption?

Constipation

Drug for neurogenic orthostatic hypotension?

Droxidopa

Speech therapy intervention for Parkinson’s disease?

Lee Silverman Voice Treatment

Why separate iron from levodopa?

Decreases absorption

What is deep brain stimulation?

Surgical placement of leads in brain

Starting dose of carbidopa levodopa?

25 100 milligrams three times daily

What is contraindicated with apomorphine?

5 hydroxytryptamine 3 antagonists

What drugs cannot be combined with monoamine oxidase B inhibitors?

Meperidine and tramadol

Onset of levodopa compared to dopamine agonists?

Faster onset

Amantadine contraindicated in what renal condition?

End stage renal disease

Initial options for mild postural instability?

Monoamine oxidase B inhibitor or amantadine

Which dopamine agonist needs test dose?

Apomorphine

Maximum levodopa daily dose?

2000 milligrams

How manage wearing off?

Increase frequency or add adjunct

Which neurotransmitters besides dopamine are affected?

Norepinephrine serotonin acetylcholine

Which patients should avoid dopamine agonists?

Those with dementia

Are there disease modifying drugs for Parkinson’s disease?

No

What supplement contains levodopa?

Mucuna pruriens

Diet change for orthostatic hypotension?

Increase salt and fluids

Which monoamine oxidase B inhibitor has longest half-life?

Safinamide

Amantadine dose in renal impairment?

100 milligrams daily

Maximum entacapone dose?

1600 milligrams

Which brain region produces dopamine?

Substantia nigra pars compacta

Who is highest risk for psychiatric side effects?

Older adults with cognitive impairment

What cognitive effects occur with trihexyphenidyl?

Memory impairment confusion

Smoking effect on rasagiline?

Decreases levels via enzyme induction

If first-line drug fails what next?

Switch drug class

Which drug helps dyskinesia?

Amantadine

Why avoid dopamine agonists in older adults?

Hallucinations sleep attacks hypotension impulse issues

What do catechol O methyltransferase inhibitors treat?

Wearing off

Why not start monoamine oxidase B inhibitors with certain drugs?

Risk of serotonin syndrome

Why is levodopa still gold standard?

Strongest symptom control

Counseling for dopamine agonists behavior?

Monitor for gambling shopping hypersexuality

Role of apomorphine?

Rescue for off episodes

Counseling for levodopa and protein?

Protein decreases effectiveness