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Chapter 28: Drugs Used in Parkinsonism & Other Movement Disorders

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Bradykinesia has made drug treatment necessary in a 60-year-old male patient with Parkinson’s disease, and therapy is to be initiated with levodopa.

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Regarding the anticipated actions of levodopa, the patient would not be informed that

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(A) Dizziness may occur, especially when standing

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(B) He should take the drug in divided doses to avoid nausea

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(C) Livedo reticularis is a possible side effect

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(D) The drug will probably improve his symptoms for a period of time but not indefinitely

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(E) Uncontrollable muscle jerks may occur

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In prescribing levodopa, the patient should be informed about adverse effects, including gastrointestinal distress, postural hypotension, and dyskinesias. It is reasonable to advise the patient that therapeutic benefits cannot be expected to continue indefinitely. Livedo reticularis (a netlike rash) is an adverse effect of treatment with amantadine. The answer is C.

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Bradykinesia has made drug treatment necessary in a 60-year-old male patient with Parkinson’s disease, and therapy is to be initiated with levodopa.

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The prescribing physician will (or should) know that levodopa

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(A) Causes fewer CNS side effects if given together with a drug that inhibits hepatic dopa decarboxylase

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(B) Fluctuates in its effectiveness with increasing frequency as treatment continues

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(C) Prevents extrapyramidal adverse effects of antipsychotic drugs

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(D) Protects against cancer in patients with melanoma

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(E) Has toxic effects, which include pulmonary infiltrates

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Levodopa causes less peripheral toxicity but more CNS or behavioral side effects when its conversion to dopamine is inhibited outside the CNS. The drug is not effective in antagonizing the akinesia, rigidity, and tremor caused by treatment with antipsychotic agents. Levodopa is a precursor of melanin and may activate malignant melanoma. Use of levodopa is not associated with pulmonary dysfunction. The answer is B.

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Which statement about pramipexole is accurate?

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(A) Effectiveness in Parkinson’s disease requires its metabolic conversion to an active metabolite

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(B) It should not be administered to patients taking antimuscarinic drugs

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(C) Pramipexole causes less mental disturbances than levodopa

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(D) The drug selectively activates the dopamine D3 receptor subtype

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(E) Warfarin may enhance the actions of pramipexole

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