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NMSP Exam 1 > Drugs For Movement Disorders > Flashcards

Drugs For Movement Disorders Flashcards

1
Q

what is the underlying pathology of Parkinsons?

A

loss of dopamine-producing neurons in the substantia nigra

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2
Q

what are the 4 hallmark features of Parkinsons?

A

bradykinesia
muscular rigidity
resting tremor
impairment of postural balance

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3
Q

what is the pharmacologic goal in treating Parkinsons?

A

treat the symptoms

cannot slow disease process

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4
Q

What are the classes of drugs to treat movement disorders?

A 
Dopamine analogs 
Dopamine receptor agonists
MAOBi
COMTi
Anticholinergics
Misc
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5
Q

what is the MOA of amantadine?

A

weak, noncompetitive NMDA receptor antagonist

direct and indirect effects on dopamine neurons

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6
Q

what are the adverse reactions of amantadine?

A 
CNS depression
impulse control disorder
psychosis
SI
livedo reticularis
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7
Q

what is the MOA of ropinirole?

A

stimulation of postsynaptic D2 receptors leading to increased DA

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8
Q

what are the adverse reactions of ropinirole?

A 
dyskinesia
impulse control disorders
risk of melanoma
orthostatic hypotension
psychotic effects
somnolence
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9
Q

you want to prescribe your patient ropinirole for their Parkinsons however they cannot swallow pills, what do you prescribe instead?

A

rotigotine –> 24 hr transdermal patch

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10
Q

a parkinson’s patient comes in with an “off episode”. you want to treat it quickly with a dopamine receptor agonist, what do you give?

A

apomorphine –> sublingual film or subQ injection

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11
Q

you prescribed your patient a medication that is a dopamine receptor agonist that has a decreased risk of hypotension due to their hx of orthostatic hypotension. they are rushed to the ER for hallucinations. what med did you prescribe?

A

pramipexole

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12
Q

what is the MOA of selegiline?

A

irreversible MAOBi

increases dopamine by interfering with dopamine reuptake

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13
Q

what are the adverse reactions of selegiline?

A

SI when used with antidepressants

serotonin syndrome

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14
Q

what is the MOA of safinamide?

A

reversible MAOBi

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15
Q

you want to prescribe a irreversible MAOBi with greater potency than selegiline, what do you prescribe?

A

rasagiline

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16
Q

what is the MOA of tolcapone?

A

selective and reversible COMTi

sustained plasma levels of levodopa

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17
Q

when is it appropriate to use tolcapone?

A

in a patient taking levodopa and carbidopa with continued motor dysfunctions not responsive to other therapies

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18
Q

what are the adverse reactions of tolcapone?

A

potentially fatal acute fulminant liver failure

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19
Q

what is the MOA of carbidopa?

A

decarboxylase inhibitor that cannot cross BBB

20
Q

what is the MOA of levodopa?

A

immediate precursor to dopamine

crosses BBB unlike DA

21
Q

what are the standard combinations of meds used to treat Parkinsons?

A

levodopa + carbidopa
OR
levodopa + carbidopa + entacapone (COMTi)

22
Q

what is the “on-off” phenomenon in Parkinsons?

A

switch between mobility and immobility in levodopa-treated patients

23
Q

what is the “off” period?

A

the end-of-dose phase characterized by worsening motor function

24
Q

what are options for managing the “on-off” phenomenon?

A

controlled-release levodopa
shortening the interval between doses
adding a medication

25
Q

what is the typical treatment for patients with PD with mild symptoms/little interference with daily function?

A

MAOBi
or
amantadine

26
Q

what is the typical treatment for Parkinsons patients with more severe motor dysfunction that are ≤ 65 y/o?

A

DA agonist
or
levodopa

27
Q

what is the typical treatment for Parkinsons patients with more severe motor dysfunction that are > 65 y/o?

A

immediate-release levodopa

28
Q

what can be used to treat sialorrhea (drooling) in PD patients?

A

botox injections

29
Q

what can be used to treat orthostatic hypotension in PD patients?

A

midodrine + domperidone + fludrocortisone

30
Q

what can be used to treat sleep disorders in PD patients?

A

melatonin or clonazepam

31
Q

what can be used to treat depression in PD patients?

A

typical antidepressants with low/slow approach

32
Q

what can be used to treat psychosis in PD patients?

A

quetiapine and clozapine

new: pimavanserin

33
Q

what can be used to treat dementia in PD patients?

A

rivastigmine or donepezil and/or memantine

34
Q

what can be used to treat nausea/vomiting in PD patients?

A

domperidone

35
Q

what can be used to treat arterial HTN in PD patients?

A

ARBs

36
Q

what are standard treatments for patients with Huntingtons?

A

fluoxetine or carbamazepine for depression

avoid anticholinergic agents

37
Q

what should be used to treat restless leg syndrome in patients with comorbid depression or metabolic syndrome?

A

non-ergot dopamine agonist (ropinirole)

38
Q

what should be used to treat restless leg syndrome in patients without comorbidities?

A

alpha-2-delta calcium channel ligand (gabapentin)

39
Q

what should be used to treat disabling restless leg syndrome?

A

DA agonist or carbidopa-levodopa

may also benefit from benzos or opioids

40
Q

what can be used to treat essential tremors?

A

propranolol
primidone
botox

41
Q

what is used for the treatment of ALS?

A

riluzole

42
Q

what is the MOA of riluzole?

A

inhibits glutamate release
blocks postsynaptic NMDA receptors
blocks Na+ channels

43
Q

what can be used to treat Wilson disease?

A

penicillamine

potassium disulfide

44
Q

what is the MOA of penicillamine?

A

copper chelating agent

45
Q

what is the MOA of potassium disulfide?

A

reduces intestinal absorption of copper

NMSP Exam 1 (17 decks)

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