Drugs for Movement Disorders PDF

Drugs for Movement Disorders \#\#\# Slide 1 - Overview 1\. \*\*What is the primary goal of drug therapy for Parkinson\'s disease?\*\* \- A) Reduce dopamine levels \- B) Increase acetylcholine activity \- C) Improve dopaminergic neurotransmission \- D) Block GABA activity \*\*Answer\*\*: C) Im...

Drugs for Movement Disorders \#\#\# Slide 1 - Overview 1\. \*\*What is the primary goal of drug therapy for Parkinson\'s disease?\*\* \- A) Reduce dopamine levels \- B) Increase acetylcholine activity \- C) Improve dopaminergic neurotransmission \- D) Block GABA activity \*\*Answer\*\*: C) Improve dopaminergic neurotransmission 2\. \*\*Which of the following is a symptom of Parkinsonism?\*\* \- A) Tachycardia \- B) Bradykinesia \- C) Hypotension \- D) Hyperactivity \*\*Answer\*\*: B) Bradykinesia 3\. \*\*What is a common class of drugs used in the treatment of Parkinson\'s disease?\*\* \- A) Dopamine agonists \- B) Serotonin antagonists \- C) MAO-A inhibitors \- D) SSRIs \*\*Answer\*\*: A) Dopamine agonists \#\#\# Slide 2 - Parkinsonism 4\. \*\*What is the neuroanatomical structure most affected in Parkinson\'s disease?\*\* \- A) Hippocampus \- B) Substantia nigra \- C) Thalamus \- D) Cerebellum \*\*Answer\*\*: B) Substantia nigra 5\. \*\*Which of the following is a characteristic sign of Parkinsonism?\*\* \- A) Hyperactivity \- B) Resting tremor \- C) Tachycardia \- D) Paresthesia \*\*Answer\*\*: B) Resting tremor 6\. \*\*Parkinsonism symptoms can be induced by which class of drugs?\*\* \- A) Antipsychotics \- B) Beta blockers \- C) Benzodiazepines \- D) MAO-B inhibitors \*\*Answer\*\*: A) Antipsychotics \#\#\# Slide 3 - Etiology and Pathogenesis of Parkinsonism 7\. \*\*What is one of the proposed causes of Parkinson\'s disease?\*\* \- A) Oxidative stress \- B) Viral infection \- C) Bacterial infection \- D) Autoimmune disorder \*\*Answer\*\*: A) Oxidative stress 8\. \*\*Mutations in which gene are associated with juvenile Parkinsonism?\*\* \- A) Synuclein gene \- B) Parkin gene \- C) ApoE4 gene \- D) BRCA1 gene \*\*Answer\*\*: B) Parkin gene 9\. \*\*At what age does Parkinson's disease typically manifest?\*\* \- A) 25-35 years \- B) 35-45 years \- C) 50-60 years \- D) 70-80 years \*\*Answer\*\*: C) 50-60 years \#\#\# Slide 4 - Basal Ganglia and Motor Function 10\. \*\*Which brain structure is primarily involved in motor control affected by Parkinson\'s disease?\*\* \- A) Cerebellum \- B) Basal ganglia \- C) Hypothalamus \- D) Medulla \*\*Answer\*\*: B) Basal ganglia 11\. \*\*Which neurotransmitter is deficient in Parkinson's disease, leading to motor dysfunction?\*\* \- A) Serotonin \- B) Dopamine \- C) Acetylcholine \- D) GABA \*\*Answer\*\*: B) Dopamine 12\. \*\*What role does acetylcholine play in Parkinson's disease pathogenesis?\*\* \- A) It inhibits dopamine production \- B) It becomes overactive when dopamine levels drop \- C) It blocks NMDA receptors \- D) It enhances GABA activity \*\*Answer\*\*: B) It becomes overactive when dopamine levels drop \#\#\# Slide 5 - Basal Motor Pathway 13\. \*\*What is the primary effect of dopamine in the basal ganglia?\*\* \- A) Stimulate cholinergic neurons \- B) Inhibit cholinergic neurons \- C) Increase GABA release \- D) Decrease serotonin release \*\*Answer\*\*: B) Inhibit cholinergic neurons 14\. \*\*In Parkinsonism, what happens to the inhibitory pathway of the basal ganglia?\*\* \- A) It becomes overactive due to dopamine deficiency \- B) It becomes underactive due to acetylcholine excess \- C) It becomes overactive due to serotonin deficiency \- D) It becomes underactive due to excessive dopamine \*\*Answer\*\*: A) It becomes overactive due to dopamine deficiency 15\. \*\*What symptom arises from an imbalance between dopamine and acetylcholine in Parkinson's disease?\*\* \- A) Tremor \- B) Hyperactivity \- C) Hypertension \- D) Paresthesia \*\*Answer\*\*: A) Tremor \#\#\# Slide 6 - Parkinsonism Pathophysiology 16\. \*\*What neurotransmitter imbalance is critical in Parkinson's disease?\*\* \- A) Dopamine and serotonin \- B) Dopamine and acetylcholine \- C) GABA and norepinephrine \- D) Acetylcholine and glutamate \*\*Answer\*\*: B) Dopamine and acetylcholine 17\. \*\*What role does GABA play in the motor dysfunction seen in Parkinsonism?\*\* \- A) GABA becomes overactive due to excess acetylcholine \- B) GABA becomes underactive due to dopamine loss \- C) GABA increases dopamine production \- D) GABA stimulates serotonin release \*\*Answer\*\*: A) GABA becomes overactive due to excess acetylcholine 18\. \*\*How does dopamine deficiency affect GABAergic signaling in Parkinson's disease?\*\* \- A) Increases inhibitory control of muscles \- B) Reduces motor inhibition \- C) Enhances motor function \- D) Reduces acetylcholine signaling \*\*Answer\*\*: A) Increases inhibitory control of muscles \#\#\# Slide 7 - Parkinsonism Treatment Goals 1\. \*\*What is the primary goal of treatment in Parkinsonism?\*\* \- A) Decrease acetylcholine activity \- B) Increase dopaminergic neurotransmission \- C) Increase GABA levels \- D) Decrease serotonin activity \*\*Answer\*\*: B) Increase dopaminergic neurotransmission 2\. \*\*Which drug class is the most commonly used to increase dopamine levels in Parkinson's disease?\*\* \- A) Anticholinergics \- B) Dopamine agonists \- C) SSRIs \- D) MAO inhibitors \*\*Answer\*\*: B) Dopamine agonists 3\. \*\*Which neurotransmitter is overactive in Parkinsonism due to dopamine deficiency?\*\* \- A) GABA \- B) Acetylcholine \- C) Serotonin \- D) Norepinephrine \*\*Answer\*\*: B) Acetylcholine \#\#\# Slide 8 - Dopamine Pathway Targets 4\. \*\*Which drug prevents the peripheral conversion of levodopa to dopamine?\*\* \- A) Selegiline \- B) Carbidopa \- C) Amantadine \- D) Entacapone \*\*Answer\*\*: B) Carbidopa 5\. \*\*What is the mechanism of action of MAO-B inhibitors in Parkinson's disease?\*\* \- A) Block dopamine receptors \- B) Inhibit dopamine breakdown \- C) Increase GABA activity \- D) Stimulate serotonin release \*\*Answer\*\*: B) Inhibit dopamine breakdown 6\. \*\*Which medication inhibits the COMT enzyme to increase levodopa's availability in the brain?\*\* \- A) Entacapone \- B) Bromocriptine \- C) Carbidopa \- D) Selegiline \*\*Answer\*\*: A) Entacapone \#\#\# Slide 9 - Carbidopa/Levodopa 7\. \*\*What is the role of Carbidopa in the Carbidopa/Levodopa combination?\*\* \- A) It increases dopamine release in the brain \- B) It inhibits peripheral conversion of levodopa to dopamine \- C) It blocks the breakdown of acetylcholine \- D) It enhances the release of GABA \*\*Answer\*\*: B) It inhibits peripheral conversion of levodopa to dopamine 8\. \*\*Levodopa is most effective in relieving which Parkinson's symptom?\*\* \- A) Tremors \- B) Bradykinesia \- C) Dyskinesia \- D) Postural instability \*\*Answer\*\*: B) Bradykinesia 9\. \*\*Levodopa absorption can be delayed by which dietary component?\*\* \- A) High-fat meals \- B) High-protein meals \- C) High-carbohydrate meals \- D) Vitamin B12 \*\*Answer\*\*: B) High-protein meals \#\#\# Slide 10 - Carbidopa/Levodopa Formulations 10\. \*\*Which formulation of Carbidopa/Levodopa is used for on-demand relief of motor fluctuations?\*\* \- A) Rytary \- B) Duopa \- C) Parcopa \- D) Inbrija \*\*Answer\*\*: D) Inbrija 11\. \*\*Which Carbidopa/Levodopa formulation is available in an extended-release capsule?\*\* \- A) Rytary \- B) Sinemet CR \- C) Duopa \- D) Parcopa \*\*Answer\*\*: A) Rytary 12\. \*\*What is the most common side effect of long-term Carbidopa/Levodopa therapy?\*\* \- A) Bradykinesia \- B) Dyskinesia \- C) Hypertension \- D) Psychosis \*\*Answer\*\*: B) Dyskinesia \#\#\# Slide 11 - Dopamine Agonists 13\. \*\*What is a major advantage of dopamine agonists over levodopa in Parkinson\'s disease?\*\* \- A) Higher symptomatic benefit \- B) Lower incidence of dyskinesia \- C) Increased acetylcholine activity \- D) Longer duration of action \*\*Answer\*\*: B) Lower incidence of dyskinesia 14\. \*\*Which of the following is a dopamine agonist?\*\* \- A) Selegiline \- B) Pramipexole \- C) Carbidopa \- D) Tolcapone \*\*Answer\*\*: B) Pramipexole 15\. \*\*Dopamine agonists are particularly useful in treating which symptom of Parkinson's?\*\* \- A) Tremors \- B) On-off phenomena \- C) Hyperactivity \- D) Hypertension \*\*Answer\*\*: B) On-off phenomena \#\#\# Slide 12 - MAO-B Inhibitors 16\. \*\*MAO-B inhibitors work by:\*\* \- A) Inhibiting the breakdown of dopamine in the brain \- B) Stimulating dopamine release from neurons \- C) Blocking acetylcholine receptors \- D) Enhancing the release of serotonin \*\*Answer\*\*: A) Inhibiting the breakdown of dopamine in the brain 17\. \*\*Which of the following is a common side effect of MAO-B inhibitors?\*\* \- A) Hypertension \- B) Nausea \- C) Bradycardia \- D) Dyskinesia \*\*Answer\*\*: B) Nausea 18\. \*\*Which MAO-B inhibitor is known to have neuroprotective effects?\*\* \- A) Selegiline \- B) Rasagiline \- C) Pramipexole \- D) Tolcapone \*\*Answer\*\*: B) Rasagiline \#\#\# Slide 13 - COMT Inhibitors 19\. \*\*Which COMT inhibitor is associated with hepatotoxicity?\*\* \- A) Entacapone \- B) Tolcapone \- C) Carbidopa \- D) Selegiline \*\*Answer\*\*: B) Tolcapone 20\. \*\*COMT inhibitors are primarily used to:\*\* \- A) Reduce motor fluctuations \- B) Increase serotonin levels \- C) Block GABA release \- D) Reduce dopamine breakdown in the brain \*\*Answer\*\*: A) Reduce motor fluctuations 21\. \*\*What is a harmless but common side effect of COMT inhibitors?\*\* \- A) Yellowing of the skin \- B) Red-brown discoloration of urine \- C) Hair loss \- D) Increased salivation \*\*Answer\*\*: B) Red-brown discoloration of urine \#\#\# Slide 13 - Carbidopa/Levodopa Side Effects 1\. \*\*Which side effect is commonly associated with long-term use of Carbidopa/Levodopa?\*\* \- A) Bradycardia \- B) Dyskinesia \- C) Hyperactivity \- D) Hypotension \*\*Answer\*\*: B) Dyskinesia 2\. \*\*Which strategy is used to reduce dyskinesia in patients taking Carbidopa/Levodopa?\*\* \- A) Increasing the dose \- B) Adding a dopamine agonist \- C) Stopping the medication immediately \- D) Adding a beta-blocker \*\*Answer\*\*: B) Adding a dopamine agonist 3\. \*\*Carbidopa/Levodopa is contraindicated in patients with which condition?\*\* \- A) Open-angle glaucoma \- B) Closed-angle glaucoma \- C) Hypertension \- D) Depression \*\*Answer\*\*: B) Closed-angle glaucoma \#\#\# Slide 14 - Motor Complications of Levodopa 4\. \*\*What phenomenon is characterized by a sudden loss of Levodopa effectiveness, unrelated to dose timing?\*\* \- A) On-off phenomenon \- B) Wearing-off phenomenon \- C) Tachyphylaxis \- D) Tolerance \*\*Answer\*\*: A) On-off phenomenon 5\. \*\*Which approach may reduce the \"wearing-off\" effect of Levodopa?\*\* \- A) Switching to immediate-release formulation \- B) Increasing the dose frequency \- C) Decreasing the dose frequency \- D) Stopping Levodopa altogether \*\*Answer\*\*: B) Increasing the dose frequency 6\. \*\*What is a potential complication of a \"drug holiday\" with Levodopa?\*\* \- A) Severe immobility \- B) Increased effectiveness \- C) Weight gain \- D) Bradycardia \*\*Answer\*\*: A) Severe immobility \#\#\# Slide 15 - Dopamine Agonists 7\. \*\*Which dopamine agonist can be administered as a transdermal patch for Parkinson's disease?\*\* \- A) Pramipexole \- B) Ropinirole \- C) Rotigotine \- D) Bromocriptine \*\*Answer\*\*: C) Rotigotine 8\. \*\*What is a common side effect of dopamine agonists, particularly Pramipexole and Ropinirole?\*\* \- A) Sedation \- B) Hypertension \- C) Impulse control disorders \- D) Weight gain \*\*Answer\*\*: C) Impulse control disorders 9\. \*\*Dopamine agonists are preferred in early Parkinson's disease due to which of the following?\*\* \- A) They are neuroprotective \- B) They are associated with a lower incidence of motor fluctuations \- C) They work faster than Levodopa \- D) They cause fewer side effects \*\*Answer\*\*: B) They are associated with a lower incidence of motor fluctuations \#\#\# Slide 16 - Dopamine Agonist Side Effects 10\. \*\*Which of the following side effects is common with dopamine agonists like Ropinirole and Pramipexole?\*\* \- A) Nausea and vomiting \- B) Severe hallucinations \- C) Profound bradycardia \- D) Extreme hyperactivity \*\*Answer\*\*: A) Nausea and vomiting 11\. \*\*Which behavior might be seen in patients on dopamine agonists?\*\* \- A) Excessive gambling \- B) Sedation \- C) Weight loss \- D) Decreased libido \*\*Answer\*\*: A) Excessive gambling 12\. \*\*Why should dopamine agonists be used with caution in patients with recent myocardial infarction?\*\* \- A) Increased risk of bradycardia \- B) Risk of arrhythmias \- C) Hypertension \- D) Profound hypotension \*\*Answer\*\*: B) Risk of arrhythmias \#\#\# Slide 17 - MAO-B Inhibitors 13\. \*\*What is the primary mechanism of action of MAO-B inhibitors in Parkinson's disease?\*\* \- A) Enhancing acetylcholine release \- B) Preventing dopamine degradation \- C) Inhibiting glutamate \- D) Increasing serotonin production \*\*Answer\*\*: B) Preventing dopamine degradation 14\. \*\*Which MAO-B inhibitor is associated with fewer cardiovascular side effects?\*\* \- A) Selegiline \- B) Rasagiline \- C) Tolcapone \- D) Entacapone \*\*Answer\*\*: B) Rasagiline 15\. \*\*At high doses, which enzyme does Selegiline begin to inhibit, increasing the risk of hypertension?\*\* \- A) MAO-A \- B) COMT \- C) Acetylcholinesterase \- D) GABA \*\*Answer\*\*: A) MAO-A \#\#\# Slide 18 - COMT Inhibitors 16\. \*\*What is the main benefit of adding COMT inhibitors to a Parkinson\'s treatment regimen?\*\* \- A) Reducing Levodopa side effects \- B) Prolonging the effects of Levodopa \- C) Enhancing dopamine synthesis \- D) Blocking glutamate release \*\*Answer\*\*: B) Prolonging the effects of Levodopa 17\. \*\*Which COMT inhibitor is associated with a higher risk of hepatotoxicity?\*\* \- A) Entacapone \- B) Tolcapone \- C) Rasagiline \- D) Amantadine \*\*Answer\*\*: B) Tolcapone 18\. \*\*What harmless side effect might patients experience when taking Entacapone?\*\* \- A) Reddish-brown urine \- B) Blue-tinted skin \- C) Yellowing of the eyes \- D) Increased saliva production \*\*Answer\*\*: A) Reddish-brown urine Slide 19 - Dopamine Agonists (Pramipexole, Ropinirole) What is the primary mechanism of action for pramipexole? A\) D2 and D3 receptor agonist B\) Dopamine reuptake inhibitor C\) MAO-B inhibitor D\) COMT inhibitor\ Answer: A) D2 and D3 receptor agonist Which dopamine agonist is more selective for D2 receptors? A\) Pramipexole B\) Ropinirole C\) Bromocriptine D\) Pergolide\ Answer: B) Ropinirole What is a possible side effect of dopamine agonists like pramipexole and ropinirole? A\) Hyperactivity B\) Sleep attacks C\) Tachycardia D\) Increased blood pressure\ Answer: B) Sleep attacks Slide 20 - Dopamine Agonists (Rotigotine) What is the route of administration for rotigotine? A\) Oral B\) Transdermal patch C\) Intravenous D\) Subcutaneous injection\ Answer: B) Transdermal patch Which of the following is NOT a side effect of rotigotine? A\) Postural hypotension B\) Hallucinations C\) Diarrhea D\) Peripheral edema\ Answer: C) Diarrhea What is a unique feature of rotigotine compared to other dopamine agonists? A\) Provides continuous dopaminergic stimulation B\) Requires renal dose adjustment C\) Administered via inhalation D\) Primarily affects serotonin receptors\ Answer: A) Provides continuous dopaminergic stimulation Slide 21 - MAO-B Inhibitors Which enzyme is inhibited by MAO-B inhibitors like selegiline and rasagiline? A\) COMT B\) Dopamine decarboxylase C\) Monoamine oxidase-B D\) GABA transaminase\ Answer: C) Monoamine oxidase-B What is a side effect commonly associated with selegiline? A\) Hypertension B\) Nausea C\) Peripheral neuropathy D\) Muscle weakness\ Answer: B) Nausea At high doses, selegiline may lose selectivity and inhibit which enzyme? A\) COMT B\) Monoamine oxidase-A C\) Dopamine decarboxylase D\) Acetylcholinesterase\ Answer: B) Monoamine oxidase-A Slide 22 - Rasagiline and Safinamide Which MAO-B inhibitor is known for having neuroprotective properties? A\) Selegiline B\) Rasagiline C\) Safinamide D\) Entacapone\ Answer: B) Rasagiline Safinamide is a reversible inhibitor of which enzyme? A\) COMT B\) Monoamine oxidase-B C\) Monoamine oxidase-A D\) Dopamine decarboxylase\ Answer: B) Monoamine oxidase-B Which drug is more potent: rasagiline or selegiline? A\) Selegiline B\) Rasagiline C\) Both are equally potent D\) Neither is potent\ Answer: B) Rasagiline Slide 23 - MAO-B Inhibitors Which enzyme do MAO-B inhibitors specifically target? A\) Serotonin B\) Dopamine C\) Epinephrine D\) Acetylcholine\ Answer: B) Dopamine Which of the following MAO-B inhibitors is considered more potent and has neuroprotective effects? A\) Selegiline B\) Rasagiline C\) Tolcapone D\) Entacapone\ Answer: B) Rasagiline What is a common side effect of MAO-B inhibitors used for Parkinson's disease? A\) Hypertension B\) Hallucinations C\) Myocardial infarction D\) Renal failure\ Answer: B) Hallucinations Slide 24 - COMT Inhibitors What is the role of COMT inhibitors in Parkinson\'s treatment? A\) Increase dopamine synthesis B\) Prevent peripheral breakdown of levodopa C\) Stimulate dopamine receptors D\) Reduce acetylcholine release\ Answer: B) Prevent peripheral breakdown of levodopa Which COMT inhibitor is associated with hepatotoxicity, limiting its use? A\) Entacapone B\) Tolcapone C\) Selegiline D\) Rasagiline\ Answer: B) Tolcapone What is a potential harmless side effect of COMT inhibitors like Entacapone? A\) Red-colored urine B\) Headache C\) Nausea D\) Bradycardia\ Answer: A) Red-colored urine Slide 25 - Adenosine Antagonists What is the mechanism of action for the drug Istradefylline? A\) Blocks NMDA receptors B\) Antagonizes adenosine A2A receptors in the basal ganglia C\) Inhibits dopamine reuptake D\) Stimulates serotonin release\ Answer: B) Antagonizes adenosine A2A receptors in the basal ganglia Istradefylline is primarily used as an adjunct treatment for which Parkinson's symptom? A\) Bradykinesia B\) Tremor C\) \"Off\" episodes D\) Dyskinesia\ Answer: C) \"Off\" episodes Which enzyme metabolizes Istradefylline, necessitating caution with cytochrome P450 inducers? A\) CYP3A4 B\) CYP2C19 C\) CYP1A2 D\) CYP2D6\ Answer: A) CYP3A4 Slide 26 -- COMT Inhibitors Which enzyme does COMT inhibitors block to increase the bioavailability of levodopa? A\) DOPA decarboxylase B\) Catechol-O-methyltransferase C\) Monoamine oxidase B D\) Tyrosine hydroxylase\ Answer: B) Catechol-O-methyltransferase Which of the following is a common side effect of COMT inhibitors? A\) Hyperglycemia B\) Diarrhea C\) Bradycardia D\) Insomnia\ Answer: B) Diarrhea Why is tolcapone less commonly used than entacapone? A\) Higher risk of hepatotoxicity B\) Less effective C\) Causes hallucinations D\) Poor absorption\ Answer: A) Higher risk of hepatotoxicity Slide 27 -- Adenosine Antagonist Istradefylline (Nourianz®) is primarily used to treat which aspect of Parkinson\'s disease? A\) Bradykinesia B\) Tremor C\) "Off" episodes D\) Dyskinesia\ Answer: C) "Off" episodes Which receptor does istradefylline antagonize to exert its effects? A\) Dopamine D2 B\) Adenosine A2A C\) Acetylcholine M1 D\) NMDA\ Answer: B) Adenosine A2A What is a common side effect of istradefylline? A\) Dyskinesia B\) Bradycardia C\) Sedation D\) Hallucinations\ Answer: A) Dyskinesia Slide 28 -- Amantadine Amantadine is effective in treating which symptom of Parkinson\'s disease? A\) Rigidity B\) Dyskinesia C\) Bradykinesia D\) Postural instability\ Answer: B) Dyskinesia What is the primary mechanism of action of amantadine? A\) NMDA receptor blockade B\) Dopamine receptor agonist C\) COMT inhibition D\) Monoamine oxidase B inhibition\ Answer: A) NMDA receptor blockade Which side effect is commonly associated with amantadine? A\) Livedo reticularis B\) Hypoglycemia C\) Dry mouth D\) Hyperhidrosis\ Answer: A) Livedo reticularis Slide 29 -- Antimuscarinics Which symptom of Parkinson\'s disease are antimuscarinics most effective in treating? A\) Tremor B\) Bradykinesia C\) Dyskinesia D\) Rigidity\ Answer: A) Tremor Which of the following is a known side effect of antimuscarinics like benztropine? A\) Memory impairment B\) Hyperglycemia C\) Weight gain D\) Bradycardia\ Answer: A) Memory impairment What is the mechanism of action of benztropine in Parkinson's disease? A\) Inhibits dopamine reuptake B\) Inhibits acetylcholine activity C\) Blocks NMDA receptors D\) Inhibits serotonin reuptake\ Answer: B) Inhibits acetylcholine activity Slide 30 -- Considerations What is a key consideration when initiating levodopa treatment in elderly patients with Parkinson's? A\) Start with dopamine agonists B\) Combine with antipsychotics C\) Avoid carbidopa/levodopa due to motor complications D\) Start with a COMT inhibitor\ Answer: A) Start with dopamine agonists Which of the following drugs may worsen Parkinson's symptoms by blocking dopamine receptors? A\) Metoclopramide B\) Clonidine C\) Propranolol D\) Diazepam\ Answer: A) Metoclopramide Which approach can help manage motor complications in long-term levodopa therapy? A\) Increasing the dose of levodopa B\) Switching to antimuscarinics C\) Adding a COMT inhibitor D\) Adding beta-blockers\ Answer: C) Adding a COMT inhibitor Slide 31 -- Essential Tremor Which treatment is first-line for essential tremor? A\) Anticholinergics B\) Beta blockers C\) Levodopa D\) MAO-B inhibitors\ Answer: B) Beta blockers Which type of tremor is typically seen in essential tremor? A\) Resting tremor B\) Intention tremor C\) Postural tremor D\) Rubral tremor\ Answer: B) Intention tremor Which medication may worsen essential tremor? A\) Lithium B\) Topiramate C\) Metoprolol D\) Propranolol\ Answer: A) Lithium Slide 32 -- Beta Blockers for Essential Tremor Which beta blocker is most commonly used for essential tremor? A\) Atenolol B\) Propranolol C\) Metoprolol D\) Bisoprolol\ Answer: B) Propranolol Which of the following beta blockers can cross the blood-brain barrier, making it more effective for essential tremor? A\) Propranolol B\) Atenolol C\) Bisoprolol D\) Metoprolol\ Answer: A) Propranolol What is a potential side effect of beta blockers when treating essential tremor? A\) Bradycardia B\) Insomnia C\) Hyperglycemia D\) Constipation\ Answer: A) Bradycardia \#\#\# Slide 26 - COMT Inhibitors 1\. \*\*What is the primary function of COMT inhibitors in Parkinson's treatment?\*\* \- A) Inhibit the breakdown of acetylcholine \- B) Inhibit the breakdown of dopamine \- C) Inhibit the breakdown of L-Dopa \- D) Inhibit the breakdown of serotonin \*\*Answer\*\*: C) Inhibit the breakdown of L-Dopa 2\. \*\*Which of the following is a side effect commonly associated with tolcapone?\*\* \- A) Hepatotoxicity \- B) Cardiovascular toxicity \- C) Nephrotoxicity \- D) Insomnia \*\*Answer\*\*: A) Hepatotoxicity 3\. \*\*What is the effect of COMT inhibitors on motor function in Parkinson's patients?\*\* \- A) They provide immediate relief of symptoms \- B) They help reduce fluctuations in motor function \- C) They eliminate dyskinesias \- D) They only work in advanced stages of Parkinson's \*\*Answer\*\*: B) They help reduce fluctuations in motor function \#\#\# Slide 27 - COMT Inhibitors (continued) 4\. \*\*Which medication combination includes entacapone for simplifying the drug regimen in Parkinson's patients?\*\* \- A) Sinemet® \- B) Stalevo® \- C) Rytary® \- D) Parcopa® \*\*Answer\*\*: B) Stalevo® 5\. \*\*What is the significance of the reddish-brown urine side effect when taking COMT inhibitors?\*\* \- A) It indicates liver toxicity \- B) It is a harmless side effect \- C) It indicates renal failure \- D) It is a sign of drug overdose \*\*Answer\*\*: B) It is a harmless side effect 6\. \*\*COMT inhibitors are most commonly used in combination with which other class of drugs?\*\* \- A) Anticholinergics \- B) MAO-B inhibitors \- C) Levodopa/carbidopa \- D) Beta-blockers \*\*Answer\*\*: C) Levodopa/carbidopa \#\#\# Slide 28 - Adenosine Antagonists 7\. \*\*Which of the following drugs is an adenosine A2A receptor antagonist used to treat Parkinson's disease?\*\* \- A) Istradefylline \- B) Pramipexole \- C) Ropinirole \- D) Amantadine \*\*Answer\*\*: A) Istradefylline 8\. \*\*What is a common side effect associated with adenosine A2A receptor antagonists?\*\* \- A) Dyskinesias \- B) Weight gain \- C) Sedation \- D) Hypotension \*\*Answer\*\*: A) Dyskinesias 9\. \*\*Which of the following best describes the mechanism of action of adenosine A2A receptor antagonists in Parkinson's disease?\*\* \- A) Increase dopamine synthesis \- B) Block adenosine receptors to improve motor function \- C) Inhibit acetylcholine \- D) Block serotonin receptors \*\*Answer\*\*: B) Block adenosine receptors to improve motor function \#\#\# Slide 29 - Amantadine 10\. \*\*Which of the following is an indication for the use of amantadine in Parkinson's disease?\*\* \- A) Early-stage monotherapy \- B) Adjunctive therapy for dyskinesias \- C) Treatment of hallucinations \- D) Treatment of constipation \*\*Answer\*\*: B) Adjunctive therapy for dyskinesias 11\. \*\*Which side effect is unique to amantadine treatment?\*\* \- A) Livedo reticularis \- B) Hepatotoxicity \- C) Rhabdomyolysis \- D) Hyperkalemia \*\*Answer\*\*: A) Livedo reticularis 12\. \*\*Amantadine was initially developed for the treatment of which condition?\*\* \- A) Influenza \- B) Multiple sclerosis \- C) Alzheimer\'s disease \- D) Diabetes \*\*Answer\*\*: A) Influenza \#\#\# Slide 30 - Antimuscarinics 13\. \*\*Which symptom of Parkinson's disease do antimuscarinics primarily target?\*\* \- A) Bradykinesia \- B) Tremor \- C) Postural instability \- D) Akinesia \*\*Answer\*\*: B) Tremor 14\. \*\*Which of the following is a common side effect of antimuscarinics?\*\* \- A) Memory impairment \- B) Hypertension \- C) Bradycardia \- D) Tachypnea \*\*Answer\*\*: A) Memory impairment 15\. \*\*Antimuscarinic drugs like benztropine are less effective than dopaminergic drugs in treating which symptom of Parkinson's disease?\*\* \- A) Tremor \- B) Rigidity \- C) Bradykinesia \- D) Dyskinesia \*\*Answer\*\*: C) Bradykinesia \#\#\# Slide 31 - Dopamine Agonists 16\. \*\*Which dopamine agonist is used as a rescue treatment for "freezing" episodes in Parkinson's disease?\*\* \- A) Apomorphine \- B) Pramipexole \- C) Ropinirole \- D) Rotigotine \*\*Answer\*\*: A) Apomorphine 17\. \*\*Dopamine agonists like pramipexole have which potential side effect?\*\* \- A) Impulse control disorders \- B) Weight gain \- C) Hyperkalemia \- D) Respiratory depression \*\*Answer\*\*: A) Impulse control disorders 18\. \*\*Which dopamine receptor subtype is primarily targeted by ropinirole?\*\* \- A) D1 \- B) D2 \- C) D3 \- D) D4 \*\*Answer\*\*: B) D2 \#\#\# Slide 32 - MAO-B Inhibitors 19\. \*\*Which of the following drugs is an MAO-B inhibitor used in Parkinson's treatment?\*\* \- A) Rasagiline \- B) Bromocriptine \- C) Apomorphine \- D) Entacapone \*\*Answer\*\*: A) Rasagiline 20\. \*\*What is the primary function of MAO-B inhibitors in the treatment of Parkinson's disease?\*\* \- A) Increase dopamine synthesis \- B) Inhibit dopamine breakdown \- C) Block dopamine receptors \- D) Enhance dopamine reuptake \*\*Answer\*\*: B) Inhibit dopamine breakdown 21\. \*\*MAO-B inhibitors like selegiline are contraindicated in combination with which of the following drugs?\*\* \- A) SSRIs \- B) Beta-blockers \- C) Anticholinergics \- D) Calcium channel blockers \*\*Answer\*\*: A) SSRIs \#\#\# Slide 33 - Treatment Strategies 22\. \*\*What is a common strategy to address the \"wearing-off\" effect of levodopa in Parkinson's patients?\*\* \- A) Reduce the dose of levodopa \- B) Add a COMT inhibitor \- C) Discontinue all dopamine agonists \- D) Switch to anticholinergic drugs \*\*Answer\*\*: B) Add a COMT inhibitor 23\. \*\*Which drug class is typically added to levodopa therapy to reduce motor complications in Parkinson's disease?\*\* \- A) Anticholinergics \- B) MAO-B inhibitors \- C) Calcium channel blockers \- D) Beta-blockers \*\*Answer\*\*: B) MAO-B inhibitors 24\. \*\*Which symptom is least likely to improve with dopaminergic therapy in Parkinson's disease?\*\* \- A) Bradykinesia \- B) Tremor \- C) Rigidity \- D) Cognitive impairment \*\*Answer\*\*: D) Cognitive impairment Here are PANCE-style questions for \*\*Slides 34 through 36\*\* from the \"Drugs for Movement Disorders\" PowerPoint: \#\#\# Slide 34 - Amantadine and Antimuscarinics 1\. \*\*Which of the following is a common side effect of amantadine in Parkinson\'s disease treatment?\*\* \- A) Bradycardia \- B) Ankle edema \- C) Increased salivation \- D) Constipation \*\*Answer\*\*: B) Ankle edema 2\. \*\*What is the mechanism of action of amantadine in Parkinson's disease?\*\* \- A) Dopamine receptor agonist \- B) NMDA receptor antagonist \- C) MAO-B inhibitor \- D) COMT inhibitor \*\*Answer\*\*: B) NMDA receptor antagonist 3\. \*\*Which antimuscarinic drug is commonly used in the treatment of Parkinson's tremor?\*\* \- A) Benztropine \- B) Pramipexole \- C) Selegiline \- D) Levodopa \*\*Answer\*\*: A) Benztropine \#\#\# Slide 35 - Essential Tremor 4\. \*\*Which movement disorder is characterized by fine motor movement of the fingers/hands during intentional movement?\*\* \- A) Parkinson's disease \- B) Essential tremor \- C) Huntington's disease \- D) Multiple sclerosis \*\*Answer\*\*: B) Essential tremor 5\. \*\*What is the first-line treatment for essential tremor?\*\* \- A) Levodopa \- B) Beta-blockers \- C) Dopamine agonists \- D) Anticholinergics \*\*Answer\*\*: B) Beta-blockers 6\. \*\*Which of the following is an aggravating factor for essential tremor?\*\* \- A) Caffeine \- B) Dopamine deficiency \- C) Excessive exercise \- D) Calcium supplements \*\*Answer\*\*: A) Caffeine \#\#\# Slide 36 - Additional Treatments for Essential Tremor 7\. \*\*Which medication can be used for essential tremor when beta-blockers are not effective?\*\* \- A) Topiramate \- B) Bromocriptine \- C) Memantine \- D) Donepezil \*\*Answer\*\*: A) Topiramate 8\. \*\*Which medication used for essential tremor is associated with sedation as a side effect?\*\* \- A) Topiramate \- B) Primidone \- C) Propranolol \- D) Amantadine \*\*Answer\*\*: B) Primidone 9\. \*\*Which type of tremor is more commonly treated with beta-blockers such as propranolol?\*\* \- A) Resting tremor \- B) Intention tremor \- C) Kinetic tremor \- D) Postural tremor \*\*Answer\*\*: D) Postural tremor Let me know if you need any further assistance!