PART III Antiparkinsonian agents
01. Which neurons are involved in parkinsonism?
a) Cholinergic neurons
b) GABAergic neurons
c) Dopaminergic neurons
d) All of the above
02. The pathophysiologic basis for antiparkinsonism therapy is:
a) A selective loss of dopaminergic neurons
b) The loss of some cholinergic neurons
c) The loss of the GABAergic cells
d) The loss of glutamatergic neurons
03. Which of the following neurotransmitters is involved in Parkinson′s disease?
a) Acetylcholine
b) Glutamate
c) Dopamine
d) All of the above
04. The concentration of dopamine in the basal ganglia of the brain is reduced in parkinsonism.
a) True
b) False
05. Principal aim for treatment of Parkinsonian disorders is:
a) To restore the normal balance of cholinergic and dopaminergic influences on the basal ganglia with antimuscarinic drugs
b) To restore dopaminergic activity with levodopa and dopamine agonists
c) To decrease glutamatergic activity with glutamate antagonists
d) All of the above
06. Indicate the drug that induces parkinsonian syndromes:
a) Chlorpromazine
b) Diazepam
c) Triazolam
d) Carbamazepine
07. Which of the following drugs is used in the treatment of Parkinsonian disorders?
a) Phenytoin
b) Selegiline
c) Haloperidol
d) Fluoxetine
08. Select the agent, which is preferred in the treatment of the drug-induced form of parkinsonism:
a) Levodopa
b) Bromocriptine
c) Benztropine
d) Dopamine
09. Which of the following agents is the precursor of dopamine?
a) Bromocriptine
b) Levodopa
c) Selegiline
d) Amantadine
10. The main reason for giving levodopa, the precursor of dopamine, instead of dopamine is:
a) Dopamine does not cross the blood-brain barrier
b) Dopamine may induce acute psychotic reactions
c) Dopamine is intensively metabolized in humans
d) All of the above
11. Indicate a peripheral dopa decarboxylase inhibitor:
a) Tolcapone
b) Clozapine
c) Carbidopa
d) Selegiline
12. The mechanism of carbidopa′s action is:
a) Stimulating the synthesis, release, or reuptake of dopamine
b) Inhibition of dopa decarboxilase
c) Stimulating dopamine receptors
d) Selective inhibition of catecol-O-methyltransferase
13. Carbidopa is unable to penetrate the blood-brain barrier, it acts to reduce the peripheral conversion of levodopa to dopamine.
a) True
b) False
14. When carbidopa and levodopa are given concomitantly:
a) Levodopa blood levels are increased, and drug half-life is lengthened
b) The dose of levodopa can be significantly reduced (by 75%), also reducing toxic side effects
c) A shorter latency period precedes the occurrence of beneficial effects
d) All of the above
15. Which of the following preparations combines carbidopa and levodopa in a fixed proportion?
a) Selegiline
b) Sinemet
c) Tolkapone
d) Biperiden
16. Which of the following statements is correct for levodopa?
a) Tolerance to both beneficial and adverse effects develops gradually
b) Levodopa is most effective in the first 2-5 years of treatment
c) After 5 years of therapy, patients have dose-related dyskinesias, inadequate response or toxicity
d) All of the above
17. Gastrointestinal irritation, cardiovascular effects, including tachycardia, arrhythmias, and orthostatic hypotension, mental disturbances, and withdrawal are possible adverse effects of:
a) Amantadine
b) Benztropine
c) Levodopa
d) Selegiline
18. Which of the following agents is the most helpful in counteracting the behavioral complications of levodopa?
a) Tolkapone
b) Clozapine
c) Carbidopa
d) Pergolide
19. Which of the following vitamins reduces the beneficial effects of levodopa by enhancing its extracerebral metabolism?
a) Pyridoxine
b) Thiamine
c) Tocopherol
d) Riboflavin
20. Which of the following drugs antagonizes the effects of levodopa because it leads to a junctional blockade of dopamine action?
a) Reserpine
b) Haloperidol
c) Chlorpromazine
d) All of the above
21. Levodopa should not be given to patients taking:
a) Bromocriptine
b) Monoamine oxydase A inhibitors
c) Carbidopa
d) Nonselective beta-adrenergic antagonists
22. Indicate D2 receptor agonist with antiparkinsonian activity:
a) Sinemet
b) Levodopa
c) Bromocriptine
d) Selegiline
23. Which of the following antiparkinsonian drugs has also been used to treat hyperprolactinemia?
a) Benztropine
b) Bromocriptine
c) Amantadine
d) Levodopa
24. Indicate a selective inhibitor of monoamine oxidase B:
a) Levodopa
b) Amantadine
c) Tolcapone
d) Selegiline
25. Which of the following statements is correct?
a) MAO-A metabolizes dopamine; MAO-B metabolizes serotonin
b) MAO-A metabolizes norepinephrine and dopamine; MAO-B metabolizes serotonin
c) MAO-A metabolizes norepinephrine and serotonin; MAO-B metabolizes dopamine
d) MAO-A metabolizes dopamine; MAO-B metabolizes norepinephrine and serotonin
26. Treatment with selegilin postpones the need for levodopa for 3-9 months and may retard the progression of Parkinson′s disease.
a) True
b) False
27. The main reason for avoiding the combined administration of levodopa and an inhibitor of both forms of monoamine oxidase is:
a) Respiratory depression
b) Hypertensive emergency
c) Acute psychotic reactions
d) Cardiovascular collapse and CNS depression
28. Indicate selective catechol-O-methyltransferase inhibitor, which prolongs the action of levodopa by diminishing its peripheral metabolism:
a) Carbidopa
b) Clozapine
c) Tolcapone
d) Rasagiline
29. Which of the following antiparkinsonian drugs is an antiviral agent used in the prophylaxis of influenza A2?
a) Selegiline
b) Sinemet
c) Pergolide
d) Amantadine
30. The mechanism of amantadine action is:
a) Stimulating the glutamatergic neurotransmission
b) Blocking the excitatory cholinergic system
c) Inhibition of dopa decarboxilase
d) Selective inhibition of catechol-O-methyltransferase
31. Which of the following antiparkinsonism drugs is an anticholinergic agent?
a) Amantadine
b) Selegilin
c) Trihexyphenidyl
d) Bromocriptine
32. Mental confusion and hallucinations, peripheral atropine-like toxicity (e.g. Cycloplegia, tachycardia, urinary retention, and constipation) are possible adverse effects of:
a) Sinemet
b) Benztropine
c) Tolkapone
d) Bromocriptine
33. Indicate the antiparkinsonism drug which should be avoided in patients with glaucoma:
a) Selegilin
b) Levodopa
c) Bromocriptine
d) Trihexyphenidyl
