MCQ Quiz: Drugs Used in Parkinson’s Disease

Parkinson’s Disease is a progressive neurodegenerative disorder defined by the loss of dopamine-producing neurons in the brain. The pharmacotherapy for this condition is a classic example of rational drug design, aimed at restoring dopaminergic tone to manage the cardinal motor symptoms of tremor, rigidity, and bradykinesia. This quiz will test your knowledge on the cornerstone therapies like levodopa/carbidopa, as well as adjuvant medications including dopamine agonists, MAO-B inhibitors, and COMT inhibitors.

1. The primary pathophysiology of Parkinson’s Disease is the progressive loss of which type of neurons in the substantia nigra

• a. Serotonergic
• b. Cholinergic
• c. Dopaminergic
• d. GABAergic

Answer: c. Dopaminergic

2. What is the most effective and “gold standard” medication for the symptomatic treatment of motor symptoms in Parkinson’s Disease?

• a. Amantadine
• b. Benztropine
• c. Levodopa
• d. Selegiline

Answer: c. Levodopa

3. Why is levodopa used to treat Parkinson’s Disease instead of dopamine itself?

• a. Dopamine has too many side effects.
• b. Levodopa is more potent at the dopamine receptor.
• c. Dopamine cannot cross the blood-brain barrier, whereas levodopa can.
• d. Levodopa has a longer half-life.

Answer: c. Dopamine cannot cross the blood-brain barrier, whereas levodopa can.

4. Carbidopa is almost always co-administered with levodopa. What is the primary mechanism of action of carbidopa?

• a. It is a dopamine agonist.
• b. It inhibits the enzyme DOPA decarboxylase in the periphery.
• c. It inhibits the enzyme monoamine oxidase B (MAO-B).
• d. It helps levodopa cross the blood-brain barrier.

Answer: b. It inhibits the enzyme DOPA decarboxylase in the periphery.

5. The main benefit of adding carbidopa to levodopa is:

• a. It increases the dose of levodopa needed.
• b. It allows more levodopa to reach the brain and reduces peripheral side effects like nausea.
• c. It treats the non-motor symptoms of Parkinson’s.
• d. It cures the disease.

Answer: b. It allows more levodopa to reach the brain and reduces peripheral side effects like nausea.

6. A patient on long-term levodopa therapy experiences uncontrollable, dance-like, writhing movements. This is known as:

• a. “Wearing-off”
• b. A “freezing” episode
• c. Dyskinesia
• d. Bradykinesia

Answer: c. Dyskinesia

7. Dopamine agonists like pramipexole and ropinirole work by:

• a. Increasing the release of dopamine from neurons.
• b. Preventing the breakdown of dopamine.
• c. Directly stimulating postsynaptic dopamine receptors.
• d. Blocking the reuptake of dopamine.

Answer: c. Directly stimulating postsynaptic dopamine receptors.

8. A significant and unique side effect that patients should be counseled on when starting a dopamine agonist is the risk of:

• a. A dry, hacking cough.
• b. Impulse control disorders (e.g., compulsive gambling, shopping).
• c. Severe hypertension.
• d. Lactic acidosis.

Answer: b. Impulse control disorders (e.g., compulsive gambling, shopping).

9. Selegiline and rasagiline are medications that provide symptomatic benefit in Parkinson’s Disease by:

• a. Acting as dopamine agonists.
• b. Inhibiting the COMT enzyme.
• c. Selectively inhibiting the MAO-B enzyme.
• d. Blocking acetylcholine receptors.

Answer: c. Selectively inhibiting the MAO-B enzyme.

10. What is the “wearing-off” phenomenon associated with levodopa therapy?

• a. The development of dyskinesias.
• b. The return of Parkinson’s symptoms before the next dose is due.
• c. An allergic reaction to the medication.
• d. A sudden inability to move.

Answer: b. The return of Parkinson’s symptoms before the next dose is due.

11. Entacapone is a medication that is added to levodopa/carbidopa to help with “wearing-off.” What is its mechanism of action?

• a. It is a dopamine agonist.
• b. It is an MAO-B inhibitor.
• c. It is a peripheral inhibitor of Catechol-O-methyltransferase (COMT).
• d. It is an anticholinergic.

Answer: c. It is a peripheral inhibitor of Catechol-O-methyltransferase (COMT).

12. By inhibiting the peripheral breakdown of levodopa, entacapone effectively:

• a. Increases the amount of levodopa available to cross the blood-brain barrier.
• b. Decreases the amount of levodopa available.
• c. Cures Parkinson’s disease.
• d. Treats dyskinesias.

Answer: a. Increases the amount of levodopa available to cross the blood-brain barrier.

13. A key counseling point for a patient taking entacapone is that it may:

• a. Cause a severe rash.
• b. Cause their urine to turn a brownish-orange color.
• c. Cause significant weight loss.
• d. Be taken on an empty stomach only.

Answer: b. Cause their urine to turn a brownish-orange color.

14. Which class of medication is most effective for treating the tremor associated with early-stage Parkinson’s disease, especially in younger patients?

• a. COMT inhibitors
• b. Dopamine agonists
• c. Anticholinergics (e.g., benztropine)
• d. Amantadine

Answer: c. Anticholinergics (e.g., benztropine)

15. The use of anticholinergic medications for Parkinson’s is often limited in elderly patients due to the risk of:

• a. Hypertension
• b. Diarrhea
• c. Confusion, dry mouth, and urinary retention.
• d. Weight gain.

Answer: c. Confusion, dry mouth, and urinary retention.

16. Amantadine is an antiviral medication also used in Parkinson’s disease. It is thought to provide benefit by:

• a. Increasing dopamine release and blocking its reuptake.
• b. Inhibiting COMT.
• c. Inhibiting MAO-B.
• d. Directly stimulating dopamine receptors.

Answer: a. Increasing dopamine release and blocking its reuptake.

17. A peculiar, mottled, purplish skin discoloration known as livedo reticularis is a side effect of which medication?

• a. Levodopa
• b. Pramipexole
• c. Entacapone
• d. Amantadine

Answer: d. Amantadine

18. Patients taking an MAO-B inhibitor like rasagiline should be counseled to avoid concomitant use of which drugs due to the risk of serotonin syndrome?

• a. Acetaminophen
• b. SSRIs, SNRIs, and certain opioids like tramadol.
• c. Statins
• d. ACE inhibitors

Answer: b. SSRIs, SNRIs, and certain opioids like tramadol.

19. What is the primary reason for initiating therapy with a dopamine agonist or MAO-B inhibitor in a younger patient with early disease, rather than starting with levodopa?

• a. These agents are more effective than levodopa.
• b. To delay the need for levodopa and postpone the development of motor complications like dyskinesias.
• c. They have fewer side effects.
• d. They are less expensive.

Answer: b. To delay the need for levodopa and postpone the development of motor complications like dyskinesias.

20. A pharmacist’s role in managing Parkinson’s pharmacotherapy includes:

• a. Counseling on the complex timing of doses, especially relative to meals.
• b. Monitoring for and helping to manage side effects.
• c. Assessing adherence.
• d. All of the above.

Answer: d. All of the above.

21. A patient taking levodopa/carbidopa should be counseled to take their dose with a low-protein snack if they experience nausea, but to avoid taking it with a high-protein meal because:

• a. Protein can increase the side effects of levodopa.
• b. Levodopa competes with dietary amino acids for absorption from the gut and transport across the blood-brain barrier.
• c. The combination is toxic to the liver.
• d. Protein inactivates the carbidopa.

Answer: b. Levodopa competes with dietary amino acids for absorption from the gut and transport across the blood-brain barrier.

22. Which of the following is considered a non-motor symptom of Parkinson’s disease?

• a. Tremor
• b. Depression
• c. Rigidity
• d. Bradykinesia

Answer: b. Depression

23. Apomorphine is a potent dopamine agonist administered via subcutaneous injection for what purpose?

• a. As a first-line therapy for early Parkinson’s.
• b. For the acute, intermittent treatment of “off” episodes in advanced disease.
• c. To treat dyskinesias.
• d. To manage psychosis.

Answer: b. For the acute, intermittent treatment of “off” episodes in advanced disease.

24. A patient being started on apomorphine must be pre-treated with an antiemetic to prevent severe:

• a. Hypertension
• b. Nausea and vomiting
• c. Dyskinesias
• d. Constipation

Answer: b. Nausea and vomiting

25. Which class of medication would be the WORST choice for treating psychosis in a patient with Parkinson’s disease, as it would block dopamine receptors and worsen motor symptoms?

• a. A selective serotonin reuptake inhibitor (SSRI)
• b. A typical antipsychotic like haloperidol.
• c. A low-potency atypical antipsychotic like quetiapine.
• d. A benzodiazepine.

Answer: b. A typical antipsychotic like haloperidol.

26. The “on-off” phenomenon in advanced Parkinson’s disease is characterized by:

• a. Fluctuations in sleep and wakefulness.
• b. Unpredictable shifts between good mobility and severe parkinsonian symptoms.
• c. A side effect of dopamine agonists.
• d. A type of dyskinesia.

Answer: b. Unpredictable shifts between good mobility and severe parkinsonian symptoms.

27. Istradefylline is a newer, non-dopaminergic medication for Parkinson’s disease that works by:

• a. Inhibiting MAO-B.
• b. Antagonizing adenosine A2A receptors.
• c. Stimulating dopamine receptors.
• d. Blocking acetylcholine.

Answer: b. Antagonizing adenosine A2A receptors.

28. A patient on levodopa experiences “wearing-off” at the end of their dosing interval. Which of the following is a strategy to manage this?

• a. Increase the dose of levodopa.
• b. Increase the frequency of levodopa doses.
• c. Add a COMT inhibitor or an MAO-B inhibitor.
• d. All of the above are potential strategies.

Answer: d. All of the above are potential strategies.

29. The ultimate goal of pharmacotherapy in Parkinson’s disease is to:

• a. Cure the disease.
• b. Improve quality of life by managing motor and non-motor symptoms.
• c. Regenerate dopaminergic neurons.
• d. Stop the progression of the disease.

Answer: b. Improve quality of life by managing motor and non-motor symptoms.

30. Tolcapone is a COMT inhibitor that is rarely used due to a black box warning for:

• a. Severe hepatotoxicity.
• b. Cardiotoxicity.
• c. Agranulocytosis.
• d. Severe rash.

Answer: a. Severe hepatotoxicity.

31. Which of the following is NOT a cardinal sign of Parkinson’s disease?

• a. Resting tremor
• b. Bradykinesia
• c. Rigidity
• d. Spasticity

Answer: d. Spasticity

32. A patient experiences “freezing of gait,” a common symptom in advanced Parkinson’s. This is an example of a(n):

• a. Dyskinesia
• b. “On” period
• c. Motor fluctuation
• d. Non-motor symptom

Answer: c. Motor fluctuation

33. The use of a rotigotine patch, a dopamine agonist, offers what potential advantage?

• a. It is dosed once weekly.
• b. It provides continuous, steady delivery of the drug, which may reduce motor fluctuations.
• c. It has no side effects.
• d. It is not a dopamine agonist.

Answer: b. It provides continuous, steady delivery of the drug, which may reduce motor fluctuations.

34. The pharmacotherapy for Parkinson’s disease becomes more complex over time due to:

• a. The progressive nature of the disease and the development of motor complications from long-term levodopa use.
• b. The medications becoming less effective.
• c. Patients becoming non-adherent.
• d. The medications becoming more expensive.

Answer: a. The progressive nature of the disease and the development of motor complications from long-term levodopa use.

35. A key counseling point for any patient starting a new medication for Parkinson’s disease is:

• a. The medication will cure the disease.
• b. The dose is often started low and titrated up slowly to improve tolerability.
• c. The medication will work immediately at full effect.
• d. The medication has no drug interactions.

Answer: b. The dose is often started low and titrated up slowly to improve tolerability.

36. Levodopa/carbidopa is available in a controlled-release (CR) formulation. Its primary advantage is:

• a. A faster onset of action.
• b. It may help reduce “wearing-off” by providing a longer duration of action.
• c. It is better absorbed than the immediate-release form.
• d. It causes fewer dyskinesias.

Answer: b. It may help reduce “wearing-off” by providing a longer duration of action.

37. A pharmacist should ensure that a patient prescribed a COMT inhibitor is also taking what other medication?

• a. A dopamine agonist
• b. An MAO-B inhibitor
• c. Levodopa
• d. Amantadine

Answer: c. Levodopa

38. The management of non-motor symptoms like depression or constipation is an important part of comprehensive Parkinson’s care.

• a. True
• b. False

Answer: a. True

39. Deep Brain Stimulation (DBS) is a surgical procedure that can help manage:

• a. The progression of Parkinson’s disease.
• b. Intractable motor fluctuations and dyskinesias in advanced disease.
• c. The non-motor symptoms only.
• d. The initial diagnosis of the disease.

Answer: b. Intractable motor fluctuations and dyskinesias in advanced disease.

40. A pharmacist’s role includes counseling on the safe and effective use of complex devices like an apomorphine pen.

• a. True
• b. False

Answer: a. True

41. The “-capone” suffix is characteristic of which drug class?

• a. MAO-B inhibitors
• b. Dopamine agonists
• c. Anticholinergics
• d. COMT inhibitors

Answer: d. COMT inhibitors

42. Which of the following is NOT a primary goal of pharmacotherapy for Parkinson’s disease?

• a. To improve motor function.
• b. To improve quality of life.
• c. To stop the neurodegenerative process.
• d. To manage non-motor symptoms.

Answer: c. To stop the neurodegenerative process.

43. A patient is prescribed Rytary, which is an extended-release capsule formulation of:

• a. Pramipexole
• b. Ropinirole
• c. Levodopa/carbidopa
• d. Selegiline

Answer: c. Levodopa/carbidopa

44. The medication management of Parkinson’s disease is highly individualized.

• a. True
• b. False

Answer: a. True

45. Which of the following is a common side effect of anticholinergic medications?

• a. Diarrhea
• b. Dry mouth and blurred vision
• c. Increased salivation
• d. A productive cough

Answer: b. Dry mouth and blurred vision

46. Safinamide is a newer MAO-B inhibitor that also has what other proposed mechanism?

• a. Dopamine agonism
• b. COMT inhibition
• c. Inhibition of glutamate release
• d. Acetylcholine blockade

Answer: c. Inhibition of glutamate release

47. A pharmacist counseling a patient about dyskinesias would describe them as:

• a. Periods of immobility.
• b. Involuntary, dance-like movements.
• c. A feeling of internal restlessness.
• d. A resting tremor.

Answer: b. Involuntary, dance-like movements.

48. It is important to avoid abrupt discontinuation of any medication for Parkinson’s disease.

• a. True
• b. False

Answer: a. True

49. The overall management of Parkinson’s disease requires a multidisciplinary team approach, including pharmacists, physicians, physical therapists, and others.

• a. True
• b. False

Answer: a. True

50. The ultimate goal of learning about the drugs used in Parkinson’s disease is to:

• a. Be able to safely and effectively manage complex medication regimens to improve a patient’s function and quality of life.
• b. Memorize all the available brand names.
• c. Pass the neurology exam.
• d. Be able to diagnose Parkinson’s disease.

Answer: a. Be able to safely and effectively manage complex medication regimens to improve a patient’s function and quality of life.