Pharm - CNS Degenerative Diseases
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Central nervous system disorders are a group of neurological disorders that affect the structure or function of the brain or spinal cord. Degenerative brain diseases have an enormous impact on our aging society. Take this pharmacology test on the CNS degenerative diseases and test your knowledge on the prescribed drugs for a patient.
- 1.Which of the following statements correctly pair the drugs used in parkinsonism with their appropriate mechanism of action? (Check all that apply)
- A.
Levodopa - inhibits dopamine metabolism in the brain
- B.
Benztropine - blocks central Nn cholinergic receptors
- C.
Selegiline - selectively inhibits MAO B
- D.
Amantadine - selectively inhibits catechol-O-methyl-transferase
- E.
Bromocriptine - activates central dopaminergic receptors
- F.
Entacapone - blocks central muscarinic receptors
- 2.Damage of basal ganglia can produce either hyperkinetic or hypokinetic disorders. Which of the following statements best describes the effects of cholinergic and dopaminergic agonists on these conditions?
- A.
Cholinergic agonists exacerbate hyperkinetic disorders and alleviate hypokinetic disorders
- B.
Cholinergic agonists alleviate both hyperkinetic and hypokinetic disorders
- C.
Dopaminergic agonists alleviate both hyperkinetic and hypokinetic disorders
- D.
Dopaminergic agonists exacerbate hyperkinetic disorders and alleviate hypokinetic disorders
- E.
Dopaminergic agonists alleviate hyperkinetic disorders and exacerbate hypokinetic disorders
- 3.
The following table shows the relative intensities of blockade of CNS receptors of five new drugs, each of which may have potential therapeutic value. Which of the drugs is most likely to be useful in treating Parkinson’s disease?- A.
Drug 1
- B.
Drug 2
- C.
Drug 3
- D.
Drug 4
- E.
Drug 5
- 4.Which of the following statements best explains the mechanism of action of levodopa in the treatment of Parkinson’s disease?
- A.
Increased sensitivity of dopaminergic receptors in the striatum
- B.
Increased sensitivity of dopamine receptors in the substantia nigra
- C.
Increased availability of dopamine in the striatum
- D.
Inhibition of DOPA decarboxylase in the striatum
- E.
Inhibition of dopamine reuptake in the substantia nigra
- 5.Carbidopa is currently used in combination with levodopa in the treatment of Parkinson’s disease because it inhibits which of the following actions?
- A.
Dopamine metabolism in the striatum
- B.
Active transport of levodopa outside the brain
- C.
Conversion of dopamine into norepinephrine in the striatum
- D.
Peripheral biotransformation of levodopa
- E.
Dopamine reuptake in the striatum
- 6.Co-administration of which of the following drugs with levodopa / carbidopa will increase the availability of levodopa in the brain?
- A.
Amantadine
- B.
Entacapone
- C.
Methyldopa
- D.
Benztropine
- E.
Bromocriptine
- F.
Haloperidol
- 7.Which of the following drugs is a selective monoamine oxidase B inhibitor used to reduce dopamine metabolism in Parkinson's disease?
- A.
Levodopa
- B.
Benztropine
- C.
Selegiline
- D.
Phenelzine
- E.
Bromocriptine
- F.
Entacapone
- 8.A 72-year-old man, who has been suffering from Parkinson’s disease for 4 years, complained of a purplish-red mottling of the skin which began on the thighs and spread to lower legs. The eruption appeared two weeks after a new drug was added to his therapeutic regimen. A diagnosis of livedo reticularis was made. Which of the following drugs could have caused this skin eruption?
- A.
Levodopa
- B.
Carbidopa
- C.
Selegiline
- D.
Amantadine
- E.
Bromocriptine
- F.
Benztropine
- 9.A 72-year-old man, suffering from Parkinson disease for 5 years, complains of a resting tremor, which at present is one of the most debilitating symptoms of his disease. He has gained improvement in rigidity, bradykinesia and posture as well as improvement in the ‘on-off’ effects with levodopa/carbidopa combination and benztropine, but he has experienced little if any improvement in tremor. Which of the following would be an appropriate therapeutic conduct for the reduction of the tremor in this patient?
- A.
To decrease the dose of carbidopa
- B.
To substitute levodopa/carbidopa with bromocriptine
- C.
To withdraw benztropine
- D.
To add propranolol to the present drug regimen
- E.
To start brief periods of ‘drug holidays‘ during therapy
- 10.A 75-year-old diabetic man, suffering from Parkinson’s disease, complained of worsening of his tremor and rigidity in arms and legs. His Parkinson’s disease has been responding well to a treatment of levodopa/carbidopa and amantadine, and his diabetes has been controlled by chlorpropamide and metformin. Recently metoclopramide was prescribed to manage diabetic gastroparesis. Which of the following drugs could have triggered the worsening of the symptoms reported by the patient?
- A.
Chlorpropamide
- B.
Amantadine
- C.
Carbidopa
- D.
Metformin
- E.
Metoclopramide
- 11.A 66-year-old man with Parkinson’s disease has been taking levodopa/carbidopa but lately the therapy was sometimes ineffective in controlling his symptoms. His neurologist prescribed another drug, to take concurrently with levodopa/carbidopa, that should enhance and prolong the effects of levodopa. Which of the following drugs was most likely prescribed?
- A.
Propranolol
- B.
Selegiline
- C.
Benztropine
- D.
Haloperidol
- E.
Imipramine
- F.
Diazepam
- 12.A 62-year-old woman with Parkinson’s disease complained of blurred vision, dry mouth, palpitations and constipation. She has been receiving a levodopa/carbidopa combination for 8 months but recently her neurologist added another drug to the therapeutic regimen. Which of the following drugs most likely caused the patient’s symptoms?
- A.
Benztropine
- B.
Selegiline
- C.
Bromocriptine
- D.
Amantadine
- E.
Pergolide
- F.
Entacapone
- 13.A 77-year-old woman has been showing an increasing memory impairment and recognition deficits over the past 2 years. Recently she became disoriented and confused at night. Physical examination revealed an awake and oriented to place person with no focal neurological deficits. Her physician prescribed a drug which might help to slow the progression of her symptoms. Which of the following drugs was most likely prescribed?
- A.
Fluoxetine
- B.
Chlorpromazine
- C.
Donepezil
- D.
Amitriptyline
- E.
Trazodone
- 14.A 65-year-old man presented to the hospital complaining of difficulty in writing, because of unsteadiness in his right hand, and tightness in his harms and legs. These symptoms started about one week ago. Physical examination showed a well-nourished, anxious male with a notable lack of normal changes in facial expression and with a soft, monotone voice. Tremor was present in his hands and a festinating gait was noted. A preliminary diagnosis was made and an appropriate treatment was prescribed. Which of the following drug was most likely prescribed?
- A.
Carbidopa
- B.
Entacapone
- C.
Benztropine
- D.
Pramipexole
- E.
Clonazepam
- F.
Propranolol
- 15.A 65-year-old man with Parkinson’s disease complained of periods of few minutes of complete immobility followed by a sudden switch to involuntary movements such as twitching, nodding, and jerking. The patient’s current medications included levodopacarbidopa. In order to reduce these rapid fluctuations the neurologist reduced the daily dose of levodopa-carbidopa and added another drug. Which of the following drugs was most likely prescribed?
- A.
Amantadine
- B.
Benztropine
- C.
Haloperidol
- D.
Bromocriptine
- E.
Fluoxetine
- 16.A 64-year-old woman with Parkinson’s disease complained that her tremor gradually worsened over the past two weeks. She has been receiving a levodopa-carbidopa combination for one years. The neurologist decided to add benztropine to the therapeutic regimen. Which of the following statement best explains why benztropine can alleviate the tremor of the patient?
- A.
The drug inhibits levodopa metabolism in the striatum
- B.
The drug inhibits the abnormally high cholinergic tone in the striatum
- C.
The drug activates dopaminergic receptors in the striatum
- D.
The drug blocks beta-2 receptors which mediate the tremor in the skeletal muscle
- E.
The drug activate a specific transport system that allows levodopa to enter the brain
- 17.A 72-year-old man, recently diagnosed with Alzheimer’s disease, has been prescribed a drug which might help to slow the progression of her symptoms. Which of the following sets of adverse effects is most likely to occur from this treatment?
- A.
Hypertension, palpitations
- B.
Nausea, vomiting and diarrhea
- C.
Dry mouth, anhydrosis
- D.
Drowsiness, lethargy
- E.
Mydriasis, cycloplegia
- 18.A 57-year-old woman recently diagnosed with Parkinson’s disease has been receiving a levodopa- carbidopa combination for three weeks. Which of the following adverse effects is most likely to occur from this treatment?
- A.
Blurred vision
- B.
Diarrhea
- C.
Postural hypotension
- D.
Bradycardia
- E.
Bradykinesia
- 19.A 51-year-old woman presented to her doctor complaining of a unilateral rhythmic tremor, and slowing down of all movements. Her medical history was significant for two schizophrenic episodes in her late forties which had been treated with phenothiazines. On examination she showed cog wheel rigidity. A presumptive diagnosis of parkinsonism was made. Which one of the following drugs would be relatively contraindicated at the start of her therapy?
- A.
Amantadine
- B.
Benztropine
- C.
Bromocriptine
- D.
Entacapone
- E.
Entacapone
- 20.A 67-year-old man with Parkinson’s disease complained that recently he felt increasingly confused at times, often had vivid dreams and on occasion experienced visual hallucinations. He has been receiving a levodopa-carbidopa combination for 1 years and his disease was well controlled. Which of the following actions could be implemented to reduce the occurrence of these adverse effect?
- A.
To substitute levodopa with selegiline
- B.
To substitute levodopa with bromocriptine
- C.
To add benztropine to the present regimen
- D.
To add amantadine to the present regimen
- E.
To add clozapine to the present regimen
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