🧠 Parkinson’s Disease Drugs: Mnemonics, Mechanisms, and Step 1 Clarity

Parkinson’s disease is a neurodegenerative disorder with hallmark features like bradykinesia, tremor, and rigidity. But on the USMLE, you’re far more likely to see a question asking which drug is used and why. This blog gives you a fast, structured review of Parkinson’s meds—grouped by mechanism, indications, and easy mnemonics.

🧠 The Pathway Behind the Problem

• Parkinson’s = ↓ dopamine in substantia nigra (pars compacta)

• Goal of treatment = boost dopamine signaling or rebalance cholinergic tone

💊 Core Drug Classes

Mnemonic: BALSA
Key drugs for Parkinson’s

Letter	Drug/Class	Purpose
B	Bromocriptine (Pramipexole, Ropinirole)	Dopamine agonists
A	Amantadine	↑ dopamine release + ↓ reuptake
L	Levodopa + Carbidopa	Dopamine precursor + peripheral decarboxylase inhibitor
S	Selegiline / Rasagiline	MAO-B inhibitors (prevent dopamine breakdown)
A	Antimuscarinics (Benztropine, Trihexyphenidyl)	↓ cholinergic tone (esp. for tremor/rigidity)

🔍 Class-by-Class Breakdown

🧬 1. Dopamine Precursors: Levodopa + Carbidopa

• MOA: Levodopa crosses BBB and converts to dopamine. Carbidopa inhibits peripheral conversion.

• Side effects: Nausea, hypotension, hallucinations, “on-off” phenomena

🚀 2. Dopamine Agonists: Pramipexole, Ropinirole

• MOA: Directly stimulate dopamine receptors

• Use: Early-stage Parkinson’s or as add-ons

• Pearl: Non-ergot agents preferred for fewer side effects

💡 3. MAO-B Inhibitors: Selegiline

• MOA: Prevent dopamine breakdown

• Pearl: Do not combine with SSRIs (risk of serotonin syndrome)

🛡 4. Amantadine

• MOA: ↑ dopamine release, ↓ reuptake; also antiviral

• Side effect: Livedo reticularis (mottled skin rash)

⚖ 5. Antimuscarinics: Benztropine

• MOA: Balance excess cholinergic tone in basal ganglia

• Use: Best for tremor-predominant Parkinson’s

• Warning: Avoid in elderly due to anticholinergic burden

📌 Before You Go…

Don’t forget—when dopamine’s down, BALSA picks you up.

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