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Old 08-04-2012
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Drug GERD treatment side effects in a Parkinson

A 67-year-old woman with Parkinson disease responds well to treatment with a combination of levodopa and carbidopa. The woman develops gastroesophageal reflux disease (GERD) and is prescribed an appropriate drug for its management. She is instructed to continue taking levodopa and carbidopa. After she starts taking the drug for GERD, she complains that her symptoms of Parkinson disease have gotten worse. The drug most likely prescribed to treat GERD in this patient was:

a) atropine
b) bethanechol
c) cisapride
d) famotidine
e) metoclopramide
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Old 08-04-2012
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E...............
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metoclopromide i gues..
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e) metoclopramide
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E the answer: D2 receptor antagonist
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Old 08-04-2012
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Default correct answer

The answer is e) metoclopramide

The manifestations of Parkinson disease are believed to arise from the loss of pigmented neurons in the substantia nigra that synthesize dopamine. This loss causes a decrease in dopamine’s inhibitory input to the striatum and also creates a relative increase in acetylcholine’s excitatory input to the striatum. In patients with GERD, metoclopramide has beneficial prokinetic and antiemetic activities. Metoclopramide releases acetylcholine from the myenteric plexus of the enteric nervous system and thereby increases the tone of the lower esophageal sphincter. It also blocks dopamine receptors and thereby prevents vomiting. By blocking dopamine receptors in the nigrostriatal dopaminergic pathway, metoclopramide would exacerbate the imbalance of dopamine and acetylcholine input to the striatum and thereby worsen the manifestations of Parkinson disease.
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