Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

NMSP Exam 1 > Drugs for Movement Disorders > Flashcards

Drugs for Movement Disorders Flashcards

1
Q

How can rehabilitation be used as a non-pharmacological treatment of PD?

A
  • Focus on gait re-education
  • Improvement of balance and flexibility
  • Enhancement of aerobic capacity and strength
  • Improvement of movement initiation
  • Augmentation of functional independence
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What can occupational therapy include in treatment of PD?

A
  • Speech and language therapy for those experiencing problems with communicating, swallowing, or saliva
  • Strategies to improve the safety and efficacy of swallowing to minimize the risk of aspiration, such as expiratory muscle stress
  • Strategies to improve speech and communication, such as attention to effort therapies
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What does MAO-A metabolize?

A
  • Norepinephrine and serotonin
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What does MAO-B metabolize?

A
  • Phenylethylamine and benzylamine
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What metabolizes dopamine and tryptamine?

A
  • Equally by MOA-A and MOA-B
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What is the MOA of amantadine?

A
  • Exact mechanism is unknown

- Direct and indirect effects on dopamine neurons

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What are the clinical applications of amantadine?

A
  • Drug-induced extrapyramidal symptoms
  • Adjunctive therapy for dyskinesias
  • Monotherapy for patients with mild motor symptoms
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What are some toxicities of amantadine?

A
  • CNS depression
  • Impulse control disorders
  • Psychosis
  • Suicidal ideation and depression
  • May cause livedo reticularis –> purplish mottled discoloration of the skin, usually on the legs
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What is the MOA of selegiline?

A
  • Potent, irreversible inhibitor of MAO
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What are the clinical applications of selegiline?

A
  • Adjunct in the management of PD when levodopa/carbidopa use has on-off phenomenon
  • Off label use is PD
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What are some toxicities seen with selegiline?

A
  • Antidepressants increased risk of suicidal thoughts and behaviors in pediatric and young adult patients in short term studies
  • May cause exacerbation of HTN
  • May cause CNS depression
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What is the MOA of ropinirole?

A
  • Non-ergot, has high relative in vitro specificity and full intrinsic activity at D2 and D3 DA receptors
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What are the clinical applications of ropinirole?

A
  • Treatment of PD
  • Can be administered in addition to levodopa/carbidopa and/or to treat levodopa on-off phenomenon
  • No efficacy in those who levodopa doesn’t work
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What are some toxicities with ropinirole?

A
  • Dyskinesias
  • Impulse control disorders/compulsive behaviors
  • Increased risk of melanomas
  • Orthostatic hypotension
  • Psychotic effects
  • Somnolence
  • N/V, constipation
  • Headaches
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What is the MOA of tolcapone?

A
  • Selective and reversible inhibitor of COMT –> a major pathway for levodopa degradation when decarboxylase is blocked by carbidopa
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What are the clinical applications of tolcapone?

A

Adjunct to levodopa and carbidopa for the treatment of idiopathic PD in patients with motor fluctuations

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What is a big risk of tolcapone?

A
  • Risk of potentially fatal acute fulminant liver failure, only use in PD patients on L-dopa/carbidopa who are experiencing symptom fluctuations and are NOT responding satisfactory to other agents
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What are some toxicities of tolcapone?

A
  • Abnormal thinking/behavioral changes
  • CNS depression
  • Loss of impulse control
  • Orthostatic hypotension
  • Exacerbation of preexisting dyskinesia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What is the MOA of carbidopa and levodopa?

A
  • Immediate precursor to dopamine
  • Crosses BBB
  • Carbidopa is a peripheral DOPA decarboxylase inhibitor
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What are the clinical applications of carbidopa and levodopa?

A
  • Parkinsonian syndrome

- Restless leg syndrome

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What are the toxicities of carbidopa and levodopa?

A
  • GI effects –> anorexia, N/V
  • Postural hypotension
  • Hypertension and/or cardiac arrhythmias
  • Dyskinesias
  • Behavioral effects
  • Wearing off and on-off phenomena
22
Q

Why is carbidopa given with levodopa?

A
  • A smaller dose of levodopa can be given but still have the same amount reach the brain
  • Carbidopa blocks peripheral DOPA decarboxylase
23
Q

What are some device aided therapies for movement disorders?

A
  • Deep brain stimulation of the subthalamic nucleus or globus pallidus interna
  • Intrajejunal levodopa-carbidopa enteric gel administered through percutaneous gastrostomy
24
Q

What is the on-off phenomenon in PD?

A
  • Back and forth switch between mobility and immobility in levodopa treated patients
  • Typically occurs as an end-of-dose or “wearing off” worsening of motor function
25
Q

What can help reduce the on-off phenomenon in PD?

A
  • Controlled release form of levodopa
  • Shorten the interval between levodopa doses
  • Adding a medication –> dopamine agonist, COMT inhibitors, or MAO-B
26
Q

What is the MOA of benztropine?

A
  • Cholinergic antagonist at muscarinic receptors

- Also blocks histamine receptors

27
Q

What are the clinical applications of benztropine?

A
  • Monotherapy or combo for PD
  • Predominantly for tremor and dystonia in younger people
  • Should be avoided in elderly and those with cognitive impairment
  • Can be helpful in reducing the amount of saliva to treat excessive drooling
28
Q

What are some toxicities of benztropine?

A
  • Anti-cholinergic effects
29
Q

What are the four main drugs class choices for monotherapy of symptomatic PD?

A
  • MAO-B inhibitors
  • Amantadine
  • Dopamine agonists
  • Levodopa
30
Q

What is given to patients with mild symptoms and want little interference with daily function?

A
  • MAO-B inhibitor –> given once daily

- Amantadine

31
Q

What is given to patients older than 65 with diminished daily function and quality of life?

A
  • DA agonist or levodopa
32
Q

What is given to patients younger than 65 with diminished daily function and quality of life?

A
  • Immediate release levodopa –> more effective for improving motor function and quality of life
33
Q

What can be used to treat sialorrhea in PD?

A
  • Botulinum toxin A injections
34
Q

What can be used to treat orthostatic hypotension in PD

A
  • Midodrine
  • Domperidone
  • Fludrocortisone
35
Q

What can be used to treat REM sleep behavior disorder in PD?

A
  • Melatonin or clonazepam
36
Q

What can be used to treat depression in PD?

A
  • Start low and go slow
37
Q

What can be used to treat psychosis in PD?

A
  • Quetiapine and clozapine –> standard treatment

- Maybe rimavanserin

38
Q

What can be used to treat dementia in PD?

A
  • Rivastigmine or donepezil

- Memantine

39
Q

What is the biggest focus when treating Huntington disease?

A
  • Treat non-motor symptoms like depression, irritability, paranoia, anxiety, or psychosis
40
Q

What are some non-pharmacologic treatments for restless leg syndrome?

A
  • Exercise
  • Leg massage
  • Applied heat
  • Avoidance of aggravating drugs and sleep deprivation
41
Q

What could help symptoms of restless leg syndrome?

A
  • Correction of coexisting iron deficiency anemia
42
Q

What can be given if there is persistent severe restless leg syndrome despite non-pharmacologic therapy?

A
  • Non-ergot dopamine agonists (ropinirole) –> if comorbid depression or obesity/metabolic syndrome
  • Alpha-2-delta calcium channel ligand if there are no comorbidities or comorbid pain, anxiety, or insomnia
43
Q

What can be given for restless leg syndrome in pregnancy?

A
  • Often managed with nonpharmacologic strategies, iron supplementation
  • Pharmacologic therapies to consider if needed include clonazepam and carbidopa-levodopa
44
Q

What should first be looked at when treating restless leg syndrome?

A
  • Iron stores –> replete iron if <75 ng/mL
45
Q

What is used when treating an intermittent disability due to tremor?

A
  • Propranolol is first line
46
Q

What is used when treating a persistent disability due to tremor?

A
  • Propranolol and primidone are first line
  • Gabapentin is second line
  • Botulinum toxin is used in drug refractory tremor
47
Q

What is the only drug that seems to have an impact on the survival of ALS?

A
  • Riluzole
48
Q

What are some treatment options for Wilson disease?

A
  • Low copper diet

- Agents that reduce copper levels –> penicillamine and potassium disulfide

49
Q

What is the MOA of penicillamine?

A
  • Copper chelating agent that is readily excreted by the kidney
50
Q

What does potassium disulfide do?

A
  • Reduces intestinal absorption of copper

NMSP Exam 1 (12 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions