Parkinson's Disease Multiple Sclerosis Migraines Epilepsy Potpourri
Decrease in dopamine and increase in acetylcholine
What are the neurotransmitters that are effected in Parkinson's Disease and how are they effected?
interferon beta 1a (Avonex®, Rebif®), interferon beta 1b (Betaseron®, Extavia®), glatiramer (Copaxone)
Name 1 agent for MS that is administered as a SC/IM self-injection
Medication overuse headaches
S.B. is a 25 year old male with history of migraine with aura, high blood pressure, hyperlipidemia, and hyperthyroidism. He is very active is involved with boxing, horse back riding, and fencing. He has been experiencing 15 headaches per month and is routinely using triptans and Excedrin on average around 5 times throughout the week. He noticed that his headaches have gotten worse. What could be the cause of his worsening headaches?
Increased suicide risk
As a class, antiepileptics all have warnings for which of the following:
a. Teratogenicity in women of childbearing age
b. Steven Johnson’s Syndrome
c. Increased suicide risk
d. Depression
Increase gabapentin
L.R. is being seen for follow up for his neuropathy and hypertension. His blood pressure readings at home have been running in the 170s/90s. He has been on gabapentin 300mg TID for 6 weeks with no benefit. What would be the next step to take.
a. Increase gabapentin dose
b. Start pregabalin
c. Start venlafaxine
d. Start nortriptyline
Depression, anxiety, cognitive changes, psychosis, hallucinations, fatigue, autonomic dysfunction (orthostasis, swallowing concerns, constipation, urinary incontinence, increased secretions), dementia
Name 2 non-motor symptoms of Parkinson's Disease
50% - oral
Approximately what percent efficacy is dimethyl fumarate?
No due to contraindications with history of stroke.
V.B. presents to clinic for hypertension follow up. Her blood pressure is currently running at 150/90. Her lisinopril dose has been increased to 40mg once daily. She is also on apixaban 5mg BID for atrial fibrillation, which she has been reminded to take on a consistent basis due to history of stroke 3 months ago after being non-adherent. She reports she was recently diagnosed with migraines and acetaminophen does not work. The patient heard that sumatriptan was helpful for her friend's migraine. Is this appropriate? Why or why not?
Copper IUD (Paraguard)
D.B. is a 21 year old female who is being started on lamotrigine and would like to also be initiated on birth control. What contraceptive would you recommend?
Which neurotransmitter is responsible for alertness and arousal and is often the target of stimulants?
dopamine agonist
What drug class is ropinirole?
Natalizumab (Tysabri)
What medication for MS is highest risk for progressive multifocal leukoencephalopathy (PML)? Hint: Think REMS medication/BBW
L.F. is a 58 year old male who has a history of hypertension, chronic constipation, and depression. He has trialed propranolol and amitriptyline for migraine prophylaxis but could not tolerate the side effects. What would be the next option to trial for prophylaxis?
a. Nortriptyline
b. Topiramate
c. Erenumab
d. Ubrogepant
Which medication works on the GABA pathway?
- DA: ropinirole, pramipexole, rotigotine
- Gabapentinoids: Gabapentin, gabapentin enacarbil, pregabalin
Q.C. was recently diagnosed with restless leg syndrome. Pt has normal renal and liver function. What are two potential treatment options that may be considered with different mechanisms of action?
prevents peripheral conversion of L-DOPA to dopamine
What is the purpose of carbidopa in carbidopa/levodopa?
SF is a 38 YO female with PMH of MS, migraines, and remote history of methamphetamine abuse. She is reporting significant fatigue related to her MS, what agent is the most appropriate to initiate?
A.B. is a 28 year old male who is experiencing recurring migraine symptoms that last for long periods of time. He has tried OTC medications like Excedrin, NSAIDs, and acetaminophen. Sumatriptan has been helpful, but he continues to have migraines that recur after 6 hours. What would be the next best option for abortive therapy?
a. Naratriptan
b. Rizatriptan
c. Dihydroergotamine
d. Ubrogepant
A patient will require starting higher doses of lamotrigine if concomitant therapy Is initiated with:
a. Levetiracetam
b. Valproate
c. Topiramate
d. Carbamazepine
K.G. is a 79 YO male with PMH of Alzheimer's Disease, hypertension, depression, CAD, and seasonal allergies. His medication list includes donepezil, losartan, amlodipine, aspirin, and diclofenac. He has been taking diphenhydramine and fluticasone over-the-counter for his allergy symptoms and his psychiatrist just started sertraline for his depression. His wife reports that his memory seems to have declined drastically over the past several weeks. Which of his medications is most likely contributing to his decline?
metoclopramide, chlorpromazine, and haloperidol (B, C, and D)
Which of the following medications can worsen PD symptoms (select all that apply)?
A. ondansetron
B. metoclopramide
C. chlorpromazine
D. haloperidol
Serious infections, Autoimmune effects, Malignancy, Infusion reactions, Stroke
Name 1 of the BBW associated with alemtuzumab.
L.D. is a 70 year old female with PMH of hypertension, asthma, migraines and epilepsy currently on lisinopril, verapamil, lamotrigine, sumatriptan and albuterol. Vitals in clinic today showed BP 135/76, HR 55, RR 16, Temp 98.8. She states that she keeps running out of her sumatriptan early as her insurance will only pay for 9 tablets per month and usually has to take it approximately 15 times per month. What is the best agent to initiate at this time?
a. Propranolol
b. Amitriptyline
c. Venlafaxine
d. Divalproex
T.H. is a 45 year old Asian male being treated focal onset seizure with levetiracetam that remains uncontrolled. Which of the following would be the next antiepileptic option?
a. Lamotrigine
b. Carbamazepine
c. Phenytoin
d. Oxcarbazepine
riluzole (Rilutek)
Which agent for ALS can prolong survival?


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