1. Pharmacology Tutoring for Parkinson’s Disease By Alaina Darby adarby1@uthsc.edu By Alaina Darby adarby1@uthsc.edu

2. Which of the following is a goal of Parkinson’s disease treatment? a.Alleviate symptoms b.Prevent Parkinson’s disease c.Cure Parkinson’s disease d.Slow down the disease process

3. Which of the following is not a cardinal symptom of Parkinson’s disease? a.Postural imbalance b.Muscle rigidity c.Dyskinesia d.Resting tremor

4. In which of the following areas in the brain is the primary area of dopamine neuron degeneration in Parkinson’s disease? a.Ventral tegmental area b.Substantia nigra c.Temporal d.Nucleus accumbens

5. Which of the following pathways in the brain degenerates in Parkinson’s disease? a.Nigrostriatal b.Nigrolimbic c.Nigrocortial d.Nigroinfundibular

6. How much dopamine is lost when symptoms first start to appear? a.40% b.50% c.60% d.70%

7. What percentage of dopamine cells are lost when symptoms first appear? a.40% b.50% c.60% d.70%

8. Which of the following is true of the pathophysiology of Parkinson’s disease? a.Dopamine disrupts the basal ganglia motor control circuit b.Dopamine receptor activation in the basal ganglia results in normal function c.Dopamine receptor antagonism results in restored motor control signal d.Activation of one type of dopamine receptor is sufficient for normal function

9. Which of the following is properly paired? a.D 1 : G q b.D 2 : increased cAMP c.D 3 : G s d.D 4 : decreased transmitter release

10. Which of the following true regarding the requirements to facilitate movement? a.D 1 -R is inhibited and D 2 -R is activated b.D 1 -R is activated and D 2 -R is inhibited c.D 1 -R and D 2 -R are both activated d.D 1 -R and D 2 -R are both inhibited

11. Why might anticholinergics be used to treat Parkinson’s disease symptoms? a.Imbalance between neurotransmitters causes increased excitation through the D 1 -R pathway b.Imbalance between neurotransmitters causes decreased excitation through the D 1 -R pathway c.Imbalance between neurotransmitters causes increased excitation through the D 2 -R pathway d.Imbalance between neurotransmitters causes decreased excitation through the D 2 -R pathway

12. Which of the following it not a mechanism used to treat Parkinson’s disease? a.Dopamine receptor antagonist b.Dopamine replacement c.Inhibition of dopamine degradation d.Restore neurotransmitter system balance

13. Which of the following drugs would be considered frontline to treat Parkinson’s disease? a.Selegiline b.Biperiden c.Ropinirole d.Entacapone

14. Which of the following is true of dopamine replacement and synthesis? a.Tyrosine hydroxylase is more powerful than dopamine decarboxylase b.L-dopa to dopamine conversion can occur in serotonin receptors c.Dopamine is absorbed in the stomach via aromatic amino acid transporters d.Food does not have a significant effect on dopamine replacement therapy

15. Which of the following is true of L-dopa? a.L-dopa only exerts therapeutic effects after entering the CNS b.The periphery does not have dopamine decarboxylase c.Carbidopa may enter the CNS to exert its effects d.Carbidopa increases side effects associated with L- dopa treatment

16. Winston has anemia and is taking iron for that condition. Which of the following would not be a concern for him if he is also taking L-dopa for his Parkinson’s? a.Aromatic acid transporter competition b.Complexation with L-dopa c.Free radical formation d.Administration within two hours of one another

17. Which of the following occurs with L-dopa administration? a.Plasma half-life that outlasts its effectiveness b.Full control of motor symptoms despite neuron degeneration c.Retention of effectiveness with long-term use d.Inhibition of dyskinesias with increased dosing frequency

18. Which of the following does not describe a side effect associated with long-term L-dopa treatment? a.Loss of buffering capacity b.Akinesia c.Motor state fluctuation d.Wearing off effect

19. Which of the following cannot be a treatment for severe dyskinesia? a.Cholinergic agonists b.Stimulation of basal ganglia areas c.Discontinuation of L-dopa d.Amantadine

20. Which of the following would be considered an initial treatment for Parkinson’s disease? a.L-dopa b.Trihexyphenidyl c.Selegiline d.Pramipexole

21. Which of the following is not a result of L-dopa therapy? a.Addiction b.Hallucinations c.Anxiety d.Nausea/vomiting

22. Parkinson’s disease usually manifests in older individuals. Why might this especially be a problem in L-dopa treatment? a.Orthostatic hypotension causing injuries b.Nausea/vomiting causing dehydration c.Sedation that can mask depression d.Confusion that can mask Alzheimer’s

23. Which of the following is not a reason to choose ropinirole over L-dopa? a.Longer duration of action b.Increased efficacy c.Less likely to induce dyskinesia d.Do not have wearing-off effect

24. Which of the following inhibits extracellular dopamine degradation? a.Amantadine b.Entacapone c.Selegiline d.Benztropine

25. Which of the following is thought to decrease free radicals? a.Amantadine b.Entacapone c.Selegiline d.Benztropine

26. Which of the following is not an advantage of MAO-B inhibitors? a.Use as a monotherapy b.Established neuroprotective effects c.Reduced motor effects as adjunct therapy d.Once-daily dosing

27. Which of the following effects of anicholinergic agents might be useful in treating Parkinson’s patients? a.Decreased tear production b.Decreased GI secretions c.Decreased saliva production d.Sedation

28. Which of the following is not an anticholinergic that is used to treat Parkinson’s disease? a.Biperiden b.Procylidine c.Trihexyphenidyl d.Dicyclomine

29. Which of the following is a glutamate receptor blocker? a.Amantadine b.Entacapone c.Selegiline d.Benztropine