Drugs For Movement Disorders Flashcards
What are the 10 early signs of Parkinson’s disease?
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
What are the non-pharm treatments for Parkinson’s?
Rehab (physical and exercise therapies) or occupational therapy
Why is carbidopa given with levodopa?
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
Deep brain stimulation of the subthalamic nucleus or globus pallidus interna is effective against what?
Motor fluctuations and dyskinesia
Intra-jejunal levodopa-carbidopa enteric gel administered through percutaneous gastrostomy may be considered for what?
The reduction of off-time or to reduce dyskinesia (can reduce off time when compared to standard oval levodopa)
What is the on off phenomenon in PD?
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
What are the options for managing the on off phenomenon?
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
How is autonomic dysfunction treated in PD?
Limited ability to treat or manage; significant adverse effects on quality of life
How is sialorrhea treated in PD pts?
Treated with botulinum toxin A injections into the salivary glands
How is orthostatic hypotension treated in PD pts?
Drug therapy includes the addition of alpha adrenergic agonist midodrine, peripheral D2 antagonist domperidone, and mineralocorticoid fludrocortisone
How are REM sleep behavior disorders treated in PD pts?
Melatonin or clonazepam
How is depression treated in PD pts?
Treated like other causes of depression with start low/go slow approach
How is psychosis treated in PD pts?
Atypical antipsychotics quetiapine and clozapine are standard treatment; pimavanserin (selective 5HT2a) inverse agonist has also become an option
What can be used to slow the cognitive decline of PD dementia?
Cholinesterase inhibitors such as rivastigmine or donepezil and/or NMDA antagonist mematine
CNS D2 receptors activated in PD can cause what?
Psychosis, nausea and vomiting
Why are CNS ACh muscarinic receptors not blocked in order to treat PD?
Dementia is treated by increasing ACh levels in the brain; reason these drugs are restricted to young PD patients without cognitive problems
What is Huntington disease?
AD inherited disorder caused by mutation in chromosome 4 characterized by progressive chorea and dementia that usually begin in adulthood
Development of chorea in HD is most likely due to what?
An imbalance of dopamine, ACh and GABA in the basal ganglia —> overactivity of dopaminergic nigrostriatal pathways
What is restless leg syndrome?
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
When dos RLS usually occur?
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
What is essential tremor?
Shaking occurs with simple tasks such as tying shoes, writing or shaving; aggravated by stress, fatigue, caffeine and temp extremes
What is the only drug to have an impact on survival of ALS?
Riluzole
What is the MOA and adverse effects of riluzole?
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
What is Wilson disease?
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
What is the treatment for Wilson disease?
Low Cu diet and agents that reduce serum Cu levels
Which agents can be used to reduce serum Cu levels in those with Wilson disease?
Penicillamine and potassium disulfide
What is the MOA and adverse effects for penicillamine?
Copper chelating agent; N/V, nephritic syndrome, myasthenia, optic neuropathy, and various blood disorders
What is the MOA for potassium disulfide?
Reduces intestinal absorption of Cu and can be prescribed in addition to penicillamine
What are some drug induced movement disorders?
Akathisia, tardive dyskinesia, dystonia, Parkinsonism
What is akathisia?
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
What is tardive dyskinesia?
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
What is dystonia?
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
What is Parkinsonism?
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
What causes acute and tardive akathisia?
Antiemetics, antiepileptics, psychotropics, reserpine, SSRIs, tricyclic antidepressants
What causes acute and tardive dyskinesia?
Antiemetics, antiepileptics, antipsychotics, high dose of atypical antipsychotics
What causes acute and tardive dystonia?
Antiemetics, antipsychotics, high dose atypical antipsychotics
What causes Parkinsonism?
Antiemetics, reserpine, antipsychotics, high dose atypical antipsychotics
