Other PD Drug Treatments

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Which drug is primarily used as adjunctive treatment to carbidopa/levodopa?

All of the above

Which drug has an indication for monotherapy?

Rasagiline (Azilect)

Which drug blocks the breakdown of dopamine, increasing dopaminergic activity?

All of the above

What is the generic name and brand name of the drug that has an indication for monotherapy?

<p>Rasagiline (Azilect)</p> Signup and view all the answers

Match the following Selective MAO-B inhibitors with their brand names:

<p>Selegiline = Zelapar Rasagiline = Azilect Safinamide = Xadago</p> Signup and view all the answers

Which Selective MAO-B inhibitor is available in an orally disintegrating tablet (ODT) formulation?

<p>Rasagiline</p> Signup and view all the answers

Which Selective MAO-B inhibitor is indicated for depression?

<p>None of the above</p> Signup and view all the answers

What is the recommended starting dose of Safinamide for adjunctive treatment to carbidopa/levodopa in patients experiencing 'off' episodes?

<p>None of the above</p> Signup and view all the answers

True or false: Selegiline can be taken at bedtime if dosed twice daily?

<p>False</p> Signup and view all the answers

True or false: Rasagiline is available in an orally disintegrating tablet (ODT) formulation?

<p>False</p> Signup and view all the answers

True or false: Safinamide is indicated for monotherapy?

<p>False</p> Signup and view all the answers

Match the following Selective MAO-B inhibitors with their dosing instructions:

<p>Selegiline = 5 mg PO BID, with breakfast and lunch Zelapar- ODT = 1.25-2.5 mg daily (not recommended if CrCI &lt; 30 ml/ min) Emsam = Patch; only indicated for depression Safinamide = Start with 50 mg once daily; after 2 weeks may increase to 100 mg once daily</p> Signup and view all the answers

Match the following Selective MAO-B inhibitors with their specific usage:

<p>Selegiline = Can be activating; do not take dose at bedtime; if dosed twice daily, take the 2nd dose at mid-day Zelapar- ODT = Orally disintegrating tablet Emsam = Only indicated for depression Safinamide = Adjunctive treatment to carbidopa/levodopa in patients experiencing &quot;off&quot; episodes</p> Signup and view all the answers

Match the following Selective MAO-B inhibitors with their administration form:

<p>Selegiline = Capsule, tablet Zelapar- ODT = Orally disintegrating tablet Emsam = Patch Safinamide = Oral administration</p> Signup and view all the answers

Which drug should have its dose decreased to 50 mg for one week before discontinuing?

<p>Safinamide</p> Signup and view all the answers

True or false: Selective MAO-B inhibitors decrease dopaminergic activity.

<p>False</p> Signup and view all the answers

True or false: When stopping treatment with Safinamide, the dose should be decreased to 50 mg for one week before discontinuing.

<p>True</p> Signup and view all the answers

Match the following Selective MAO-B inhibitors with their dosing and administration:

<p>Rasagiline (Azilect) = 0.5-1 mg PO daily Safinamide (Xadago) = Decrease the dose to 50 mg for one week before discontinuing</p> Signup and view all the answers

Which of the following is a contraindication for the use of selective MAO-B inhibitors?

<p>Combination with other MAO inhibitors</p> Signup and view all the answers

Which of the following warnings is associated with the use of selective MAO-B inhibitors?

<p>Serotonin syndrome</p> Signup and view all the answers

What should be monitored when using selective MAO-B inhibitors?

<p>Blood pressure</p> Signup and view all the answers

What are the contraindications for the use of selective MAO-B inhibitors?

<p>Use in combination with other MAO inhibitors, opiolds, SNRls, TCAs, others (see Drug Interactions)</p> Signup and view all the answers

What warnings are associated with the use of selective MAO-B inhibitors?

<p>Serotonin syndrome, hypertension, nausea, CNS depression, dyskinesias, impulse control disorders, caution in patients with psychotic disorders (may exacerbate) or ophthalmic disorders</p> Signup and view all the answers

What should be monitored when using selective MAO-B inhibitors?

<p>Blood pressure, signs of serotonin syndrome, visual changes (Xadago)</p> Signup and view all the answers

Match the following Selective MAO-B inhibitors with their side effects:

<p>Selegiline (Zelapar) = Serotonin syndrome, hypertension, nausea, CNS depression, dyskinesias, impulse control disorders Rasagiline (Azilect) = Headache, joint pain, indigestion Safinamide (Xadago) = Visual changes, severe hepatic impairment</p> Signup and view all the answers

Match the following Selective MAO-B inhibitors with their contraindications:

<p>Selegiline (Zelapar) = Use in combination with other MAO inhibitors, opioids, SNRIs, TCAs Rasagiline (Azilect) = Use in combination with other MAO inhibitors, opioids, SNRIs, TCAs Safinamide (Xadago) = Severe hepatic impairment</p> Signup and view all the answers

Match the following Selective MAO-B inhibitors with their usage warnings:

<p>Selegiline (Zelapar) = Serotonin syndrome, hypertension, nausea, CNS depression, dyskinesias, impulse control disorders Rasagiline (Azilect) = Caution in patients with psychotic disorders or ophthalmic disorders Safinamide (Xadago) = Visual changes, severe hepatic impairment</p> Signup and view all the answers

What are the generic and brand names of centrally-acting anticholinergics used for tremor in Parkinson's disease?

<p>Benztropine (Cogentin) and Trihexyphenidyl</p> Signup and view all the answers

What are the primary effects of centrally-acting anticholinergics?

<p>Anticholinergic and antihistamine effects</p> Signup and view all the answers

What symptom of Parkinson's disease are centrally-acting anticholinergics primarily used for?

<p>Tremor</p> Signup and view all the answers

Match the following Parkinson's disease drugs with their primary effects:

<p>Benztropine = Anticholinergic and antihistamine effects Trihexyphenidyl = Anticholinergic and antihistamine effects</p> Signup and view all the answers

Match the following Parkinson's disease drugs with their usage:

<p>Benztropine = Primarily used for tremor Trihexyphenidyl = Primarily used for tremor</p> Signup and view all the answers

Match the following generic drugs with their brand names:

<p>Benztropine = Cogentin Trihexyphenidyl = Artane</p> Signup and view all the answers

Which drug is recommended to be started at a dose of 1 mg at bedtime?

<p>Trihexyphenidyl</p> Signup and view all the answers

What is the recommended dose range for Benztroplne (Cogentln)?

<p>0.5-2 mg TID (start QHS)</p> Signup and view all the answers

What is the recommended dose range for Trihexyphenidyl?

<p>1-5 mg TID (start 1 mg QHS)</p> Signup and view all the answers

Benztroplne (Cogentln) is recommended to be taken once daily at bedtime.

<p>False</p> Signup and view all the answers

Trihexyphenidyl is available in an orally disintegrating tablet (ODT) formulation.

<p>False</p> Signup and view all the answers

Selective MAO-B inhibitors increase dopaminergic activity.

<p>False</p> Signup and view all the answers

Match the following Parkinson's disease drugs with their recommended starting dosages:

<p>Benztroplne (Cogentln) = 0.5-2 mg TID (start QHS) Trihexyphenidyl = 1-5 mg TID (start 1 mg QHS)</p> Signup and view all the answers

Match the following Parkinson's disease drugs with their generic names:

<p>Cogentln = Benztroplne Trihexyphenidyl = Trihexyphenidyl</p> Signup and view all the answers

Match the following Parkinson's disease drugs with their maximum dosages:

<p>Benztroplne (Cogentln) = 2 mg TID Trihexyphenidyl = 5 mg TID</p> Signup and view all the answers

What is the recommended usage of Benztroplne (Cogentln)?

<p>Once daily at bedtime</p> Signup and view all the answers

Which of the following is a common side effect of Benztroplne (Cogentln) and Trihexyphenidyl?

<p>Blurred vision</p> Signup and view all the answers

What is the main reason to avoid using Benztroplne (Cogentln) and Trihexyphenidyl in elderly patients?

<p>Increased risk of falls</p> Signup and view all the answers

True or false: Benztropine (Cogentin) and Trihexyphenidyl are both centrally-acting anticholinergics?

<p>True</p> Signup and view all the answers

True or false: Benztropine (Cogentin) and Trihexyphenidyl have a high incidence of anticholinergic side effects?

<p>True</p> Signup and view all the answers

True or false: Elderly patients should avoid using Benztropine (Cogentin) and Trihexyphenidyl?

<p>True</p> Signup and view all the answers

Match the following Parkinson's disease drugs with their side effects:

<p>Benztropine (Cogentin) = High incidence of peripheral and central anticholinergic effects: dry mouth, constipation, urinary retention, blurred vision, mydriasis, somnolence, confusion, tachycardia Trihexyphenidyl = High incidence of peripheral and central anticholinergic effects: dry mouth, constipation, urinary retention, blurred vision, mydriasis, somnolence, confusion, tachycardia</p> Signup and view all the answers

Match the following Parkinson's disease drugs with their notes:

<p>Benztropine (Cogentin) = Avoid use in elderly patients Trihexyphenidyl = Avoid use in elderly patients</p> Signup and view all the answers

Match the following Parkinson's disease drugs with their generic and brand names:

<p>Benztropine = Cogentin Trihexyphenidyl = Artane</p> Signup and view all the answers

What are the common side effects of Benztroplne (Cogentln) and Trihexyphenidyl?

<p>dry mouth, constipation, urinary retention, blurred vision, mydriasis, somnolence, confusion, tachycardia</p> Signup and view all the answers

What is the recommended usage of Benztroplne (Cogentln)?

<p>once daily at bedtime</p> Signup and view all the answers

Who should avoid using Benztropine (Cogentin) and Trihexyphenidyl?

<p>elderly patients</p> Signup and view all the answers

Which of the following foods should be avoided while taking a MAO-B inhibitor?

<p>Aged or matured cheese</p> Signup and view all the answers

Which of the following substances should not be used with a MAO-B inhibitor?

<p>Dopamine</p> Signup and view all the answers

Which enzyme is responsible for metabolizing rasagiline?

<p>CYP1A2</p> Signup and view all the answers

True or false: MAO-B inhibitors should not be taken with foods high in tyramine.

<p>True</p> Signup and view all the answers

True or false: MAO-B inhibitors should not be used with products containing dopamine, tyrosine, phenylalanine, tryptophan or caffeine.

<p>True</p> Signup and view all the answers

True or false: Rasagiline is a substrate of CYP1A2.

<p>True</p> Signup and view all the answers

Match the following food items with their compatibility with MAO-B inhibitor drugs:

<p>Aged cheese = Should not be consumed Sausages = Should not be consumed Soy sauce = Should not be consumed Fresh meat = Can be consumed</p> Signup and view all the answers

Match the following substances with their compatibility with MAO-B inhibitor drugs:

<p>Dopamine = Should not be used Tyrosine = Should not be used Caffeine = Should not be used Vitamin C = Can be used</p> Signup and view all the answers

Match the following drugs with their interaction with Rasagiline:

<p>Ciprofloxacin = Limit dose to 0.5mg daily Paracetamol = No specific interaction Aspirin = No specific interaction Ibuprofen = No specific interaction</p> Signup and view all the answers

Which of the following drugs should NOT be used with a MAO-B inhibitor?

<p>Selective serotonin reuptake inhibitors (SSRIs)</p> Signup and view all the answers

Which enzyme is responsible for metabolizing rasagiline?

<p>CYP1A2</p> Signup and view all the answers

Study Notes

Selective MAO-B Inhibitors

  • Safinamide is used as adjunctive treatment to carbidopa/levodopa and has an indication for monotherapy.
  • Rasagiline is available in an orally disintegrating tablet (ODT) formulation and is indicated for depression.
  • Safinamide blocks the breakdown of dopamine, increasing dopaminergic activity.
  • Selegiline can be taken at bedtime if dosed twice daily.

Dosing and Administration

  • The recommended starting dose of Safinamide for adjunctive treatment to carbidopa/levodopa in patients experiencing 'off' episodes is unknown.
  • Rasagiline is not available in an orally disintegrating tablet (ODT) formulation.
  • Safinamide is not indicated for monotherapy.

Contraindications and Warnings

  • Selective MAO-B inhibitors should not be used with products containing tyramine, dopamine, tyrosine, phenylalanine, tryptophan, or caffeine.
  • Selective MAO-B inhibitors decrease dopaminergic activity is False.
  • Selective MAO-B inhibitors should be monitored for serotonin syndrome and hypertensive crisis.

Centrally-Acting Anticholinergics

  • Benztropine (Cogentin) and Trihexyphenidyl are centrally-acting anticholinergics used for tremor in Parkinson's disease.
  • Benztropine (Cogentin) is recommended to be started at a dose of 1 mg at bedtime.
  • Trihexyphenidyl is available in an orally disintegrating tablet (ODT) formulation.

Side Effects and Notes

  • Benztropine (Cogentin) and Trihexyphenidyl have a high incidence of anticholinergic side effects.
  • Benztropine (Cogentin) and Trihexyphenidyl should be avoided in elderly patients due to anticholinergic side effects.
  • Common side effects of Benztropine (Cogentin) and Trihexyphenidyl include dry mouth, blurry vision, and constipation.

Food and Substances Interactions

  • Foods high in tyramine, dopamine, tyrosine, phenylalanine, tryptophan, and caffeine should be avoided while taking a MAO-B inhibitor.
  • Rasagiline is a substrate of CYP1A2.

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