416 Exam 4 PD, MS, Epilepsy Flashcards
MOA carbidopa/levodopa (PD)
Dopamine replacement
Carbidopa/Levodopa AE
Dyskinesia N/V Insomnia Hallucinations Confusion Hypotension
Carbidopa/Levodopa
Sinemet (25/100) Sinemet CR (50/200)
Dopamine agonists (PD)
Bromocriptine (rare) Pramipexole Ropinirole Rotigotine Apomorphine
Dopamine agonists AE
Hallucinations Fatigue/somnolence Edema Nausea Hypotension Pleuropulmonary fibrosis Impulsivity
MOA of MAOI (PD)
Inhibition of DA metabolism- specific for MAO-B receptors
Irreversible MAO-I agents (PD)
Selegiline
Rasagiline (monotherapy)
Reversible MAO-I agents (PD)
Safinamide
MOA of COMT-I (PD)
Inhibition of DA and levodopa metabolism
COMT-I agents (PD)
Entacapone (peripherally only)
Tolcapone (BBB)
MOA anticholinergics (PD)
Decreases excessive cholinergic activity
Anticholinergic agents for PD
Trihexyphenidyl
Benztropine (Cogentin)
Diphenhydramine
MOA of Amantadine for PD
Mild increase in DA concentrations
Amantadine SE
Anticholinergic Nightmares Insomnia Confusion Levido reticularis (discoloration) Withdrawal encephalopathy
Amantadine (Symmetrel) immediate release approved for
PD motor symptoms but NOT dyskinesia
Amantadine (Gocovri) extended release approved for
Levodopa-induced dyskinesia but NOT motor symptoms
Trt depression in PD
Pramipexole (D3 receptors)
SSRIs, SNRIs, TCAs
Trt psychosis in PD
Quetiapine
Primavanserin
Trt dementia in PD
Rivastigmine (approved)
Trt restless leg syndrome in PD
Ropinirole
Pramipexole
Levodopa
Trt REM behavior disorder in PD
Clonazepam (Klonopin)
Injectable agents for MS
IFN B-1a (Betaseron, Extavia)
IFN B-1b (Avonex, Rebif, Plegridy)
Glatiramer acetate (Copaxone)
Daclizumab (Zinbryta)
Oral agents for MS
Fingolimod (Gilenya)
Teriflunomide (Aubagio)
Dimethyl Fumarate (Tecfidera)
Infusion agents for MS
Natalizumab (Tysabri)
Alemtuxumab (Lemtrada)
Mitoxantrone (Novantrone)
Ocrelizumab (Ocrevus)
IFN approved for
RRMS CIS (except Plegridy)
IFN SE
- flu like symptoms
- injection site pain
- leukopenia
- hepatic injury
- worsening of CHF
- hyperthyroidism/thyrotoxicosis
- depression
Glatiramer acetate approved for
RRMS
CIS
MOA of Glatiramer acetate (MS)
Glatiramer cells secrete anti-inflammatory IL-10 cytokines in CNS
Glatiramer acetate SE
Flushing, chest pain, palpitations, anxiety, dyspnea, throat constriction, urticaria
Lipoatrophy (permanent)
Natalizuman approved for
RRMS
MOA of Natalizumab (MS)
Block alpha-4 integrin preventing linkage to VCAM-1 ultimately preventing the lymphocyte from stopping to be recruited across the BBB
Natalizumab AE
Progressive multifocal leukoencephalopathy (PML)
>2yrs of Natalizumab exposure
Fingolimod approved for
RRMS
MOA of Fingolimod (MS)
Binds to S1P1 receptors on lymphocytes blocking their capacity to egret from lymph nodes and reducing number of lymphocytes in peripheral blood
Fingolimod SE
Bradyarrythmia AV block -risk of injection -macular edema -hepatic injury -PML
Terifluonomide approved for
RRMS