Review of Pharmacology - 9E (2015)

Review of Pharmacology
29. Ans. (d) Mycophenolate mofetil (Ref: Harrison 18th/3406-3408)
FDA approved therapies for multiple sclerosis include:
• Interferon beta-1a
• Interferon beta-1b
• Glatiramer
• Natalizumab
• Fingolimod
• Mitoxantrone
• Methylprednisolone
30. Ans. (b) Rotigotine (Ref: Katzung 11/e p475)
• Rotigotine is a non-ergot dopamine agonist indicated for the treatment of Parkinson’s disease (PD) and restless legs
syndrome (RLS). It is formulated as a once-daily transdermal patch which provides a slow and constant supply of
the drug over the course of 24 hours. However, it was withdrawn in 2008 because of crystal formation on the patches,
affecting the bioavailability and efficacy of this drug.
31. Ans. (c) Tricyclic antidepressants (Ref: Katzung 11/e p524; CMDT-2010/987)
• Rivastigmine is used in Alzheimer’s disease. It inhibits acetylcholinesterase and increases the level of ACh.
• Tricyclic antidepressants have strong anticholinergic actions. Therefore, these can reduce the efficacy of rivastigmine.
• Depression is commonly seen in patients with Alzheimer’s disease. The anti-depressants that are used should have
minimum anticholinergic activity, therefore SSRI or MAO-inhibitors are preferred.
32. Ans. (a) It is more potent than penicillamine (Ref: Katzung 11/e p482; Parkinson’s disease & movement disorders by Joseph
Jankovic/264, Harrison 17/e p2451)
Central Nervous System
• Penicillamine is the most potent chelating agent useful in Wilson’s disease.
• Trientine is not as potent as penicillamine and was used in patients unable to tolerate penicillamine. However,
now a days, trientine is preferred because of severe adverse effects of penicillamine.
• Trientine cause fewer adverse effects other than mild anemia due to iron deficiency in few patients.
• Concomitant administration with iron reduces absorption of both. Thus minimum gap of two hours should
be given between the administration of trientine and iron salts.
33. Ans. (c) Entacapone (Ref: Katzung 10/e p448-449; KDT 6/e p421)
Levo-dopaetabolized in the body by two enzymes; MAO and COMT. Thus MAO inhibitors like selegiline and COMT
inhibitors like entacapone and tolcapone can increase the bioavailability of dopa.
34. Ans. (d) Domperidone blocks levodopa induced emesis and its therapeutic potential (Ref: KDT 6/e p418)
• Domperidone decreases the vomitting due to levo-dopa without interferring with its therapeutic action. Because
domperidone can not cross BBB, it does not inhibit the D 2
receptors in the brain but as CTZ is present outside BBB, it
can inhibit the emetogenic potential of levo-dopa.
• L-dopa is a prodrug that acts by conversion to dopamine in the brain.
• Phenothiazines and other D 2
blockers that can cross BBB will interfere with therapeutic actions of levo-dopa.
• Pyridoxine decreases the efficiency of l-dopa therapy as discussed earlier.
35. Ans. (d) Decreased efficiency will result (Ref: KDT 6/e p418)
36. Ans. (a) Parkinson’s disease (Ref: KDT 6/e p419)
Ropinirole is a non-ergot dopamine agonist useful for Parkinsonism. It is also used these days for restless leg syndrome.
37. Ans. (c) Amantadine is more effective than levo-dopa (Ref: KDT 6/e p415)
Levo-dopa is very effective in the treatment of Parkinsonism. It initially resolves hypokinesia and rigidity but later on
tremors are also reduced. It is more effective than amantadine. Amantadine is an antiviral drug that can be used in Parkinsonism.
Central anticholinergic drugs are the agents of choice for the treatment of drug induced Parkinsonism.
38. Ans. (a) Levodopa; (c) Bromocriptine; (e) Benserazide (Ref: KDT 6/e p415)
• Levodopa, bromocryitine and benserazide are used in Parkinsonism.
• Mazindol is a potent anorectic agent. It has an additional peripheral effect of increasing metabolic rate.
• Acyclovir is an antiviral agent, not used in parkinsonism.
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