Drugs For Movement Disorders - 8/23 Kruse

Question 1

What Sx do mAChR antagonists improve in PD?

Answer 1

Tremor

Rigidity

Question 2

What are the Dopamine agonists and their receptors?

Answer 2

A Real Blood Pressure
A - Apomorphine D2
R - Ropinrole D2
B - Bromocriptine D2
P - Pramipexole D3

Question 3

What are the dopamine receptor agonists?

Answer 3

Bromocriptine
Pramipexole
Ropinirole

BRP 232

Question 4

What 3 drugs that are kind of similar can also treat Wilson’s?

Answer 4

Trientine
Zinc acetate
Zinc sulfate (inc fecal excretion)

Question 5

What are the only FDA approved drugs for tx of RLS?

Answer 5

Pramipexole

Ropinirole

Question 6

What dug reduces intestinal absorption of copper and can also be used to treat Wilson’s?

Answer 6

Potassium disulfide

Question 7

What adverse side effects does L-dopa have on the CV system?

Answer 7

Postural hypotension
HTN when taken w/MAO inhibtor or sympathomimetics
INC in cardiac arrhythmia (rare)

Question 8

What Beta-1 antagonists are useful in treating tremors?

Answer 8

Metoprolol

Propranolol

Question 9

What COMT inhibitor may cause an increase in liver enzymes and lead to acute hepatic failure?

Answer 9

Tolcapone

Question 10

What neurologic antipsychotic is used to treat tics?

Answer 10

Pimozide

Question 11

What may provide patients suffering from on-off phenomenon with temp benefit?

Answer 11

Apomorphine

Question 12

What are the COMT inhibitors?

Which one works in the CNS and PNS?

Answer 12

Tolcapone
Entacapone

Tolcapone

Question 13

When is selegiline contraindicated?

Answer 13

When taken w/meperidine, tricyclics, SSRIs

Question 14

Which dopamine agonist is a D2 and has extensive first-pass metabolism (CYP1A2)?

Answer 14

Ropinirole

Question 15

What drug may cause livedo reticularis?

Answer 15

Amantadine

Question 16

What are the adverse CV effects of dopamine agonists?

Answer 16

Postural hypotension, peripheral edema, cardiac arrhythmia

Question 17

Adverse effects of Penicillamine?

Answer 17

Nausea, vomiting, nephritic syndrome, myasthenia, optic shit

Question 18

Which dopamine agonist is a D2 and has extensive first-pass metabolism (CYP3A4)?

Answer 18

Bromocriptine

Question 19

What antiviral agent whose MOA is unknown and is used to treat PD?

Use caution when?

Answer 19

Amantadine

Pts w/hx of seizure or heart failure

Question 20

What does ACh do to GABA?

Answer 20

Excites it

Question 21

L-dopa is contradicted in what Pts?

Answer 21

Psychotic
Angle-closure glaucoma
Melanoma Pts
Active peptic ulcer

Question 22

What chelating agent forms a stable complex to be excreted in the urine and is used to treat Wilson’s disease

Answer 22

Penicillamine

Question 23

What is Apomorphine and how does it act?

Used for what?

Adverse side effect of nausea can be pre-treated how?

Answer 23

D2 dopamine agonist

Injected sq for off-period Akinesia

Trimethobenzamide

Question 24

Where is GABA made?

Answer 24

Corpus Striatum (Caudate and Putamen)

Question 25

What do dopaminergic neurons come from? What do they do to GABA?

Answer 25

SNpc Inhibit

Question 26

What dopamine agonist is contraindicated in Pts with peripheral vascular disease?

Answer 26

Bromocriptine

Question 27

MOA of L-dopa? How does it enter the CNS and does it cross the BB barrier?

Answer 27

D2 receptor (some D1 and D3) Via LAT, YES

Question 28

Rasagiline MOA? Used for what? Contraindication?

Answer 28

Irreversible inhibitor of MAO-B Neuroprotective for PD When used with L-dopa leads to HTN crisis

Question 29

What drugs are used to treat HD? Which one is irreversible?

Answer 29

Reserpine and tetrabenazine Reserpine

Question 30

Which dopamine agonist is a D3 and 90% of it is excreted in the urine unchanged?

Answer 30

Pramipexole

Question 31

What are the contraindications of dopamine agonists?

Answer 31

Psychosis MI Peptic ulcer

Question 32

What adverse side effects does L-dopa have on movement?

Answer 32

Dyskinesia (80%)

Question 33

What are the mAChR antagonists used to treat PD?

Answer 33

Please Try BOB ``` Procyclidine Trihexyphenidyl Benztropine Orphenadrine Biperiden ```

Question 34

Patients taking L-dopa combined with what other drug may experience HTN crisis?

Answer 34

MAO A inhibitors

Question 35

What adverse side effects does L-dopa have on the GI system? What about when administered w/de carboxylase inhibitor?

Answer 35

Anorexia, nausea, vomiting in 80% Same but only 20% of Pts

Question 36

MAO-B preferentially metabolizes what?

Answer 36

Phenylethylamine | Benzoyl amine

Question 37

What are the non-GI or CV adverse effects of dopamine agonists?

Answer 37

Dyskinesia Mental disturbance Random - headache, sleepiness

Question 38

What alpha adrenergics are used to treat tics?

Answer 38

Clonidine | Guanfacine

Question 39

What preferentially metabolizes NE and serotonin?

Answer 39

MAO-A

Question 40

What is metabolized equally by MAO-A and MAO-B?

Answer 40

Dopamine | Tryptamine

Question 41

L-dopa administered with carbidopa reduceds the daily requirement of L-dopa by how much?

Answer 41

75%

Question 42

What dopamine agonist is used to treat restless leg syndrome?

Answer 42

Pramipexole | Ropinirole

Question 43

What is a selective MAO-B inhibitor? MOA?

Answer 43

Selegiline Slows breakdown of dopamine and prolongs the anti parkinsonian effects of L-dopa

Question 44

How do drugs that treat HD work?

Answer 44

Impair dopaminergic neurotransmission (alleviate chorea)

Question 45

What are the side effects of COMT inhibitors?

Answer 45

Orange pee Diarrhea Ab pain Fucked up slee

Question 46

What are the adverse GI effects of dopamine agonists?

Answer 46

Anorexia, nausea, vomiting, constipation, dyspepsia, reflux

Question 47

How much L-dopa gets absorbed into the brain alone? With carbidopa?

Answer 47

1-3% 10%

Question 48

What drug only effective in treating depression?

Answer 48

Carbamazepine

Question 49

What is the only drug to have an impact on survival in ALS Pts? MOA? Adverse side effects?

Answer 49

Riluzole Inhibits Glutamate and blocks NMDA and kainite receptors Nausea and weakness

Question 50

What adverse side effects does L-dopa have on behavior? What else?

Answer 50

All kinds of crazy shit, depression, anxiety, insomnia, etc On-off phenomenon

Question 51

What drug is used to treat depression and irritability in HD?

Answer 51

Fluoxetine