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NMSP Exam 1 > Drugs For Movement Disorders > Flashcards

Drugs For Movement Disorders Flashcards

1
Q

What are the 10 early signs of Parkinson’s disease?

A

Tremor, small handwriting, loss of smell, trouble sleeping, trouble moving or walking, constipation, a soft or low voice, masked face, dizziness or fainting, stooping or hunching over

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2
Q

What are the non-pharm treatments for Parkinson’s?

A

Rehab (physical and exercise therapies) or occupational therapy

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3
Q

Why is carbidopa given with levodopa?

A

Levodopa on its own gets reabsorbed into the gut and peripheral tissues so only 1-3% gets to the brain, but with carbidopa a higher amount reaches the brain

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4
Q

Deep brain stimulation of the subthalamic nucleus or globus pallidus interna is effective against what?

A

Motor fluctuations and dyskinesia

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5
Q

Intra-jejunal levodopa-carbidopa enteric gel administered through percutaneous gastrostomy may be considered for what?

A

The reduction of off-time or to reduce dyskinesia (can reduce off time when compared to standard oval levodopa)

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6
Q

What is the on off phenomenon in PD?

A

Refers to a back and forth switch between mobility and immobility in levodopa treated pts; occurs as an end of dose or wearing off worsening of motor function

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7
Q

What are the options for managing the on off phenomenon?

A

Some may respond to controlled release form of levodopa but may cause other sx to get worse; shorten the interval between levodopa doses, or adding a medication such as DA agonist, COMT inhibitor or MAO-B inhibitor

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8
Q

How is autonomic dysfunction treated in PD?

A

Limited ability to treat or manage; significant adverse effects on quality of life

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9
Q

How is sialorrhea treated in PD pts?

A

Treated with botulinum toxin A injections into the salivary glands

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10
Q

How is orthostatic hypotension treated in PD pts?

A

Drug therapy includes the addition of alpha adrenergic agonist midodrine, peripheral D2 antagonist domperidone, and mineralocorticoid fludrocortisone

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11
Q

How are REM sleep behavior disorders treated in PD pts?

A

Melatonin or clonazepam

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12
Q

How is depression treated in PD pts?

A

Treated like other causes of depression with start low/go slow approach

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13
Q

How is psychosis treated in PD pts?

A

Atypical antipsychotics quetiapine and clozapine are standard treatment; pimavanserin (selective 5HT2a) inverse agonist has also become an option

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14
Q

What can be used to slow the cognitive decline of PD dementia?

A

Cholinesterase inhibitors such as rivastigmine or donepezil and/or NMDA antagonist mematine

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15
Q

CNS D2 receptors activated in PD can cause what?

A

Psychosis, nausea and vomiting

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16
Q

Why are CNS ACh muscarinic receptors not blocked in order to treat PD?

A

Dementia is treated by increasing ACh levels in the brain; reason these drugs are restricted to young PD patients without cognitive problems

17
Q

What is Huntington disease?

A

AD inherited disorder caused by mutation in chromosome 4 characterized by progressive chorea and dementia that usually begin in adulthood

18
Q

Development of chorea in HD is most likely due to what?

A

An imbalance of dopamine, ACh and GABA in the basal ganglia —> overactivity of dopaminergic nigrostriatal pathways

19
Q

What is restless leg syndrome?

A

Common condition that causes an uncontrollable urge to move the legs usually because of an uncomfortable sensation; cause is unknown but suspected cause is dopamine imbalance

20
Q

When dos RLS usually occur?

A

Typically happens in the evening or nighttime when sitting or laying down, sx temporarily relieved by moving (disrupts sleep and quality of life), often occurs during pregnancy

21
Q

What is essential tremor?

A

Shaking occurs with simple tasks such as tying shoes, writing or shaving; aggravated by stress, fatigue, caffeine and temp extremes

22
Q

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

A

Riluzole

23
Q

What is the MOA and adverse effects of riluzole?

A

Unknown in ALS but inhibits glutamate release, blocks presynaptic NMDA and kainite type glu receptors, inhibits voltage dependent Na channels; AE include nausea and weakness

24
Q

What is Wilson disease?

A

Recessively inherited disorder of Cu metabolism; characterized by reduced ceruloplasmin, marked increases of Cu in the brain and viscera, and signs of hepatic and neurologic dysfunction

25
Q

What is the treatment for Wilson disease?

A

Low Cu diet and agents that reduce serum Cu levels

26
Q

Which agents can be used to reduce serum Cu levels in those with Wilson disease?

A

Penicillamine and potassium disulfide

27
Q

What is the MOA and adverse effects for penicillamine?

A

Copper chelating agent; N/V, nephritic syndrome, myasthenia, optic neuropathy, and various blood disorders

28
Q

What is the MOA for potassium disulfide?

A

Reduces intestinal absorption of Cu and can be prescribed in addition to penicillamine

29
Q

What are some drug induced movement disorders?

A

Akathisia, tardive dyskinesia, dystonia, Parkinsonism

30
Q

What is akathisia?

A

Subjective feeling of restlessness and need to move, objective sx of pacing, walking in place, foot shaking/toe taping, rocking while seated, distress if restrained or unable to move, sx may improve during sleep or in supine position

31
Q

What is tardive dyskinesia?

A

Abnormal involuntary choreoathetoid movements affecting the orofacial region and tongue (lip smacking, chewing movements, tongue protrusion), not painful but can be embarrassing and interfere with chewing, speech and swallowing

32
Q

What is dystonia?

A

Sustained involuntary muscular contractions/spasms —> abnormal postures and twisting/repetitive movements, affected body parts include back, neck, extremities, jaw and larynx, difficulty with ambulating, breathing, head turning, speech and swallowing

33
Q

What is Parkinsonism?

A

Tremor, rigidity, bilateral slowness of movement affecting trunk and extremities, difficulty rising from seated position, gait imbalance, masked facies, micrographia, slow shuffling gait, stooped posture

34
Q

What causes acute and tardive akathisia?

A

Antiemetics, antiepileptics, psychotropics, reserpine, SSRIs, tricyclic antidepressants

35
Q

What causes acute and tardive dyskinesia?

A

Antiemetics, antiepileptics, antipsychotics, high dose of atypical antipsychotics

36
Q

What causes acute and tardive dystonia?

A

Antiemetics, antipsychotics, high dose atypical antipsychotics

37
Q

What causes Parkinsonism?

A

Antiemetics, reserpine, antipsychotics, high dose atypical antipsychotics

NMSP Exam 1 (8 decks)

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