Drugs for Movement Disorder _ kruse

Question 1

What receptor does Levodopa bind to?

Answer 1

D2

Question 2

What is the first line therapy for PD symptoms?

Answer 2

Levodopa

Question 3

What can be prescribed to reduce peripheral metabolism of levodopa and thus increase half life and better transmission to CNS?

Answer 3

Carbidopa

Question 4

What CV AE are associated with levodopa?

Answer 4

• postural hypotension
• Hypertension with large dose or with nonselective monoamine oxidase inhibitors or sympathomimetic
• increase cardiac arrhythmias, rare but can happen

Question 5

What behavioral effects are seen with levodopa use?

Answer 5

• depression, anxiety, agitation, insomnia, somnolence, confusion, delusions, hallucinations, nightmares, euphoria, other changes in mood or personality

Question 6

Explain the on-off phenomenon as seen with use of levodopa.

Answer 6

Occur due to timing of dose or due to unrealted reason. In on-off, periods of marked akinesia alterante over the course of a few hours with on-periods of improved mobility but often marked dyskinesia.

Question 7

PD patients taking levodopa, can develop on-off phenomenon. What drug can be given to those with severe case of off-periods?

Answer 7

Apomorphine

Question 8

What are the contraindications with levodopa?

Answer 8

• pts taking monoamine oxidase A inhibitor –> hypertensive crisis
• Psychotic pts
• pts with angle-closure glucoma
• hx of melanoma

Question 9

Bromocriptine, pramipexole and ropinirole are all 1 receptor agonist. Indicate what receptor each of them work in

Answer 9

They’re all dopamine receptor agonist used to treat PD symptoms.
Bromocirptine = D2 agonist (also for tx of endocrine disorder)
Pramipexole = D3 (also approved for RLS
Ropinirole = D2 (also approved for RLS)

Question 10

Bromocriptine is contraindicated in pts with _

Answer 10

peripheral vacular disease

Question 11

What are the two common MAO inhibitors?

Answer 11

Selegiline and Rasagiline . both inhibit MAO -B

Question 12

what is the MOA for MAO inhibitors?

Answer 12

slows breakdown of dopamine and prolongs antiparkinsonism effects of levodopa; reduce on-off periods

Question 13

What drugs are commonly used as COMPT inhibitors?

Answer 13

Tolcapone and entacepone

Question 14

What is the MOA of COMT inhibitors?

Answer 14

Metabolze levodopa to 3 0-methyldopa, which competes with levodopa for transport across intestinal mucosa and BBB –> prolongs levodopa

Question 15

Which COMT inhibitor is associated with liver failure and death?

Answer 15

Tolcapone

Question 16

What is the MOA of apomorphine?

Answer 16

Dopamine agonist that appears to act by stimulating postsynaptic D2 receptor in caudate-putamen. Can in injected subq for quick off period relief.

Question 17

which drug is presumed to work by enhancing the action of endogenous dopamine and is associated with livedo reticularis, and should be cautioned in pts with seizures and HF

Answer 17

amantidine

Question 18

Anticholinergic drugs used to treat PD symptoms, helps with which symptoms mainly?

Answer 18

Mainly tremor and rigidity, but have little effect on bradykinesia

Question 19

What are the common anti-cholinergic drugs used for PD tremor and rigidity?

Answer 19

Benztropine, biperiden, orphenadrine, procyclidine, trihexyphenidyl

Question 20

Reserpine and tetrabenzaine have been known to impair _

Answer 20

dopamineric neurotransmission of alleivate chorea as seen in HD.

Question 21

What is the MOA for reeserpine and tetrabenzaine?

Answer 21

Reserpine (irreversible) and tetrabeznaine (reversible) are agents that block vesciular monoamine transporter and deplete cerebral dopamine stores

Question 22

Botulinin toxin A, a-drenergic agents like clonidine, guanfacine) and neuroleptic antipscyhotics like pimozide all have been known to help relieve symptoms of what movement disorder?

Answer 22

Tics

Question 23

What drug is the only drug that which can prolong life by a few months and is often used in patients with ALS?

Answer 23

Riluzole

Question 24

Penicillamine, potassium disulfide, and trientine have been used to treat what disease?

Answer 24

Wilson’s disease