IPS2: Pharmacology - Part 5.3 - Central Nervous System Drugs - Drugs for Parkinsonism, Anti-seizure Agents

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

a. I, II, III, IV

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

f. All

Therapeutic goal of antiparkisonism drugs.

a. To increase Dopaminergic activity

b. To reduce excitatory interneuron Acetylcholine activity

c. Both

d. None

c. Both

Site of origin of dopaminergic neurons.

a. Substantia nigra

b. Corpus striatum

a. Substantia nigra

Site of GABAergic output by cholinergic neurons.

a. Substantia nigra

b. Corpus striatum

b. Corpus striatum

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

a. I, II, III, IV, V

Antiviral agent with antiparkinsonism activity.

a. Levodopa

b. Amantadine

c. Selegiline

d. Pergolide

b. Amantadine

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

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

Dopamine agonist except:

a. Pramipexole

b. Ropinirole

c. Bromocriptine

d. Pergolide

e. Selegiline

f. None

e. Selegiline - this is MAOB inhibitor

MAOB inhibitors.

a. Selegiline

b. Rasagiline

c. Pergolide

d. a and b

e. b and c

f. All

d. a and b

Pergolide is D2 agonist.

COMT inhibitors.

a. Tolcapone

b. Entacapone

c. Rasagiline

d. a and b

e. b and c

f. All

d. a and b

Rasagiline is MAOB inhibitor.

Centrally-acting acetylcholine antagonists.

a. Benztropine

b. Trihexyphenidyl

c. Biperiden

d. a and b

e. b and c

f. All

f. All

Abnormal excitation of neurons.

a. Seizure

b. Parkinsonism

c. SLE

d. EPS

a. Seizure

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

a. I, II, III, IV

Classical anti-seizure agents except:

a. Carbamazepine

b. Phenytoin

c. Valproic acid

d. Phenobarbital

e. Ethosuximide

f. Vigabatrin

f. Vigabatrin - this is newer agents.

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

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

Na+ channel blockers anti-seizure agents.

I. Carbamazepine

II. Phenytoin

III. Valproic acid

IV. Phenobarbital

V. Ethosuximide

a. I, II, III

b. III, V

c. III, IV

d. I, III

e. I, II, IV, V

a. I, II, III

Ca2+ channel blockers anti-seizure agents.

I. Carbamazepine

II. Phenytoin

III. Valproic acid

IV. Phenobarbital

V. Ethosuximide

a. I, II, III

b. III, V

c. III, IV

d. I, III

e. I, II, IV, V

b. III, V

GABA increasing anti-seizure agents.

I. Carbamazepine

II. Phenytoin

III. Valproic acid

IV. Phenobarbital

V. Ethosuximide

a. I, II, III

b. III, V

c. III, IV

d. I, III

e. I, II, IV, V

c. III, IV

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

c. Valproic acid

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

a. Vigabatrin

b. Felbamate

c. Gabapentin

d. Pregabalin

e. Tiagabine

f. Lamotrigine

a. Vigabatrin

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

b. Felbamate

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

a. Vigabatrin

b. Felbamate

c. Gabapentin

d. Pregabalin

e. Tiagabine

f. Lamotrigine

e. Tiagabine

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

f. Lamotrigine

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

c. Gabapentin

Anti-seizure agent that is analogue of Gabapentin.

a. Vigabatrin

b. Felbamate

c. Gabapentin

d. Pregabalin

e. Tiagabine

f. Lamotrigine

d. Pregabalin

Anti-seizure agent with unknown mechanism of action.

a. Gabapentin

b. Pregabalin

c. Phenytoin

d. a and b

e. b and c

f. All

d. a and b

Agents generally used for Grand Mal and partial seizures except:

a. Carbamazepine

b. Phenytoin

c. Valproic acid

d. Phenobarbital

e. Ethosuximide

f. None

e. Ethosuximide

First line for Grand Mal seizures.

a. Carbamazepine

b. Phenytoin

c. Valproic acid

d. Phenobarbital

e. Ethosuximide

c. Valproic acid

First line for Petit Mal or absence seizures.

a. Carbamazepine

b. Phenytoin

c. Valproic acid

d. Phenobarbital

e. Ethosuximide

e. Ethosuximide

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

a. Carbamazepine

b. Phenytoin

c. Valproic acid

d. Phenobarbital

e. Ethosuximide

f. Oxcarbazepine

a. Carbamazepine

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

b. Phenytoin

May cause diplopia and ataxia.

a. Carbamazepine

b. Phenytoin

c. Valproic acid

d. Phenobarbital

e. Ethosuximide

f. Oxcarbazepine

a. Carbamazepine

Has fewer side effects and D/I than Carbamazepine.

a. Carbamazepine

b. Phenytoin

c. Valproic acid

d. Phenobarbital

e. Ethosuximide

f. Oxcarbazepine

f. Oxcarbazepine

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

a. Carbamazepine

b. Phenytoin

c. Zonisamide

d. Phenobarbital

e. Ethosuximide

f. Oxcarbazepine

c. Zonisamide

Reduce the T-type Calcium channel in thalamic neurons.

a. Carbamazepine

b. Phenytoin

c. Zonisamide

d. Phenobarbital

e. Ethosuximide

f. Oxcarbazepine

e. Ethosuximide

Other anti-seizure agents:

Potentiate inhibitory effects of GABA.

a. Benzodiazepines, Barbiturates

b. Lorazepam

c. Clonazepam

d. Phenobarbital

e. Acetazolamide

a. Benzodiazepines, Barbiturates

Other anti-seizure agents:

For short-term status epilepticus.

a. Benzodiazepines, Barbiturates

b. Lorazepam

c. Clonazepam

d. Phenobarbital

e. Acetazolamide

b. Lorazepam

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

c. Clonazepam

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

d. Phenobarbital

Other anti-seizure agents:

For catamenial seizure experienced by women during menstruation.

a. Benzodiazepines, Barbiturates

b. Lorazepam

c. Clonazepam

d. Phenobarbital

e. Acetazolamide

e. Acetazolamide