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Question Date: 08/02/2024

Question: An 82-year-old male with a history of Parkinson disease presents to the emergency department with headaches and mild left-sided weakness. An emergent computed tomography scan of his brain demonstrates a small, right-sided intracerebral hemorrhage in the internal capsule. His blood pressure remains above 220 systolic despite two doses of intravenous labetalol. His wife mentions he was recently started on a new medication for his Parkinson disease. Which of the following is the most likely causative agent?

Options:

• Entacapone
• Rasagiline
• Amantadine
• L-dopa

Correct Answer: Rasagiline

Explaination: Rasagiline is a monoamine oxidase B inhibitor, which is involved in the breakdown of dopamine and norepinephrine, so it has a potentially serious side effect of malignant hypertension, particularly when combined with some selective serotonin reuptake inhibitors, resulting in serotonin syndrome. Entacapone is a catecholamine methyltransferase inhibitor (catechol-O-methyl transferase) that slows the degradation of dopamine. Serious complications include orthostasis, syncope, hallucinations, and psychosis. Amantadine is an antiviral agent also used in Parkinson disease that has possible side effects of psychosis, seizures, and arrhythmias. L-dopa and ropinirole have similar side effect profiles, including orthostasis, excessive reward-seeking behavior,psychosis, dyskinesias, and arrhythmias.

Reference: ( Bradleys NiCP, 7th edn, Ch. 96, pp. 14221460)