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Pharmacology of Parkinson and Psychotic Disorders
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Pharmacology of Parkinson and Psychotic Disorders
Pharmacology of Parkinson and Psychotic Disorders
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1
Question
What is the primary goal of medications used to treat Parkinson's disease?
Page 1
Answer
Raise dopamine levels and/or decrease or block acetylcholine due to loss of dopamine and excess acetylcholine in Parkinson's disease.
2
Question
What common instruction applies to all Parkinson's disease medications regarding discontinuation and onset of action?
Page 1
Answer
Do not abruptly stop these medications; they take weeks to become effective.
3
Question
Why should patients on most Parkinson's medications avoid certain activities?
Page 1
Answer
Most Parkinson's drugs cause sedation, so avoid activities requiring alertness.
4
Question
What is the mechanism of action of dopamine agonists like Pramipexole, Bromocriptine, Ropinirole, and Apomorphine?
Page 1
Answer
Activate dopamine receptors.
5
Question
Why are dopamine agonists preferred for younger patients with Parkinson's disease?
Page 1
Answer
Younger patients are less sensitive to psychosis and movement side effects.
6
Question
What are the indications for dopamine agonists in Parkinson's disease management?
Page 1
Answer
Monotherapy in early-stage disease or combined with carbidopa/levodopa in late stage.
7
Question
What are key complications associated with dopamine agonists in Parkinson's treatment?
Page 1
Answer
Extreme sleepiness, orthostatic hypotension, dyskinesias, psychosis, impulse control problems, nausea.
8
Question
Why is Bromocriptine used less frequently among dopamine agonists?
Page 1
Answer
Due to risk of valvular heart disease.
9
Question
What patient education is essential for those taking dopamine agonists?
Page 1
Answer
Avoid activities requiring alertness, notify provider if unable to stay awake, avoid sudden position changes, take with food for nausea, do not abruptly stop, takes weeks to work.
10
Question
What is the mechanism of action of carbidopa/levodopa in Parkinson's disease?
Page 1
Answer
Carbidopa prevents levodopa breakdown before crossing the blood-brain barrier; levodopa converts to dopamine in the brain to restore dopamine-acetylcholine balance.
11
Question
Why is carbidopa/levodopa considered the most popular treatment for Parkinson's disease?
Page 1
Answer
It is the most popular Parkinson's drug; know the wearing-off phenomenon where effectiveness fades before the next dose, causing symptom reemergence.
12
Question
What are major complications of carbidopa/levodopa therapy?
Page 1
Answer
Nausea/vomiting, drowsiness, dyskinesias, orthostatic hypotension, cardiovascular effects, psychosis, discoloration of sweat and urine, activation of malignant melanoma.
13
Question
What specific patient screening is recommended before starting carbidopa/levodopa?
Page 2
Answer
Question patients with cardiovascular problems and undiagnosed skin lesions.
14
Question
What dietary restrictions apply to patients on carbidopa/levodopa?
Page 2
Answer
Avoid foods high in vitamin B6 such as wheat germ, green vegetables, bananas, whole grain cereals, liver, legumes.
15
Question
What is the mechanism of action of COMT inhibitors like Entacapone and Tolcapone?
Page 2
Answer
Enhance levodopa effect by blocking its breakdown.
16
Question
What is the indication for COMT inhibitors in Parkinson's therapy?
Page 2
Answer
Used in combination with carbidopa/levodopa to inhibit its metabolism in intestines and peripheral tissues.
17
Question
What serious complication requires monitoring with COMT inhibitors?
Page 2
Answer
Liver failure; know signs including right upper quadrant pain, jaundice, nausea, fatigue, elevated AST/ALT.
18
Question
What patient education points are critical for COMT inhibitors?
Page 2
Answer
Warn about urine discoloration, do not abruptly stop, takes weeks to be effective, watch for liver failure signs.
19
Question
What distinguishes Selegiline from Rasagiline among MAO-B inhibitors?
Page 2
Answer
Selegiline is effective for only 1-2 years and converts to amphetamine; Rasagiline is not converted to amphetamine in the brain.
20
Question
What is the mechanism of action of MAO-B inhibitors like Selegiline and Rasagiline?
Page 2
Answer
Prevent dopamine breakdown.
21
Question
What is the primary indication for MAO-B inhibitors in Parkinson's disease?
Page 2
Answer
First-line combination with carbidopa/levodopa to decrease wear-off effect.
22
Question
What unique side effect does Selegiline cause compared to other Parkinson's drugs?
Page 3
Answer
Insomnia due to conversion to amphetamine in the brain.
23
Question
What complication arises from tyramine foods with Selegiline?
Page 2
Answer
Hypertensive crisis because these are MAOIs.
24
Question
What timing and dietary advice applies to Selegiline administration?
Page 2
Answer
Administer no later than noon, avoid tyramine-containing foods, take with meals to prevent GI upset.
25
Question
What is the mechanism of action of Amantadine as a dopamine releaser?
Page 3
Answer
Prevents dopamine reuptake, releases stored dopamine from neurons, blocks cholinergic and glutamate receptors.
26
Question
For what specific purpose is Amantadine indicated in Parkinson's management?
Page 3
Answer
Combination with carbidopa/levodopa for off episodes or to manage dyskinesia side effects.
27
Question
What are contraindications for Amantadine based on its anticholinergic effects?
Page 3
Answer
Not for patients with benign prostatic hyperplasia, urinary retention, or glaucoma.
28
Question
What skin change occurs with Amantadine and its reversibility?
Page 3
Answer
Discoloration of skin known as livedo reticularis; resolves once medication is discontinued.
29
Question
What is the mechanism of centrally acting anticholinergics like Benztropine and Trihexyphenidyl?
Page 3
Answer
Block muscarinic receptors to balance dopamine and acetylcholine in the brain.
30
Question
What general patient advice applies to anticholinergic Parkinson's medications?
Page 3
Answer
Avoid activities requiring alertness, chew sugarless gum, increase fluids and fiber intake.