Drugs For Movement Disorders Flashcards
what is the underlying pathology of Parkinsons?
loss of dopamine-producing neurons in the substantia nigra
what are the 4 hallmark features of Parkinsons?
bradykinesia
muscular rigidity
resting tremor
impairment of postural balance
what is the pharmacologic goal in treating Parkinsons?
treat the symptoms
cannot slow disease process
What are the classes of drugs to treat movement disorders?
Dopamine analogs Dopamine receptor agonists MAOBi COMTi Anticholinergics Misc
what is the MOA of amantadine?
weak, noncompetitive NMDA receptor antagonist
direct and indirect effects on dopamine neurons
what are the adverse reactions of amantadine?
CNS depression impulse control disorder psychosis SI livedo reticularis
what is the MOA of ropinirole?
stimulation of postsynaptic D2 receptors leading to increased DA
what are the adverse reactions of ropinirole?
dyskinesia impulse control disorders risk of melanoma orthostatic hypotension psychotic effects somnolence
you want to prescribe your patient ropinirole for their Parkinsons however they cannot swallow pills, what do you prescribe instead?
rotigotine –> 24 hr transdermal patch
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?
apomorphine –> sublingual film or subQ injection
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?
pramipexole
what is the MOA of selegiline?
irreversible MAOBi
increases dopamine by interfering with dopamine reuptake
what are the adverse reactions of selegiline?
SI when used with antidepressants
serotonin syndrome
what is the MOA of safinamide?
reversible MAOBi
you want to prescribe a irreversible MAOBi with greater potency than selegiline, what do you prescribe?
rasagiline
what is the MOA of tolcapone?
selective and reversible COMTi
sustained plasma levels of levodopa
when is it appropriate to use tolcapone?
in a patient taking levodopa and carbidopa with continued motor dysfunctions not responsive to other therapies
what are the adverse reactions of tolcapone?
potentially fatal acute fulminant liver failure
what is the MOA of carbidopa?
decarboxylase inhibitor that cannot cross BBB
what is the MOA of levodopa?
immediate precursor to dopamine
crosses BBB unlike DA
what are the standard combinations of meds used to treat Parkinsons?
levodopa + carbidopa
OR
levodopa + carbidopa + entacapone (COMTi)
what is the “on-off” phenomenon in Parkinsons?
switch between mobility and immobility in levodopa-treated patients
what is the “off” period?
the end-of-dose phase characterized by worsening motor function
what are options for managing the “on-off” phenomenon?
controlled-release levodopa
shortening the interval between doses
adding a medication
what is the typical treatment for patients with PD with mild symptoms/little interference with daily function?
MAOBi
or
amantadine
what is the typical treatment for Parkinsons patients with more severe motor dysfunction that are ≤ 65 y/o?
DA agonist
or
levodopa
what is the typical treatment for Parkinsons patients with more severe motor dysfunction that are > 65 y/o?
immediate-release levodopa
what can be used to treat sialorrhea (drooling) in PD patients?
botox injections
what can be used to treat orthostatic hypotension in PD patients?
midodrine + domperidone + fludrocortisone
what can be used to treat sleep disorders in PD patients?
melatonin or clonazepam
what can be used to treat depression in PD patients?
typical antidepressants with low/slow approach
what can be used to treat psychosis in PD patients?
quetiapine and clozapine
new: pimavanserin
what can be used to treat dementia in PD patients?
rivastigmine or donepezil and/or memantine
what can be used to treat nausea/vomiting in PD patients?
domperidone
what can be used to treat arterial HTN in PD patients?
ARBs
what are standard treatments for patients with Huntingtons?
fluoxetine or carbamazepine for depression
avoid anticholinergic agents
what should be used to treat restless leg syndrome in patients with comorbid depression or metabolic syndrome?
non-ergot dopamine agonist (ropinirole)
what should be used to treat restless leg syndrome in patients without comorbidities?
alpha-2-delta calcium channel ligand (gabapentin)
what should be used to treat disabling restless leg syndrome?
DA agonist or carbidopa-levodopa
may also benefit from benzos or opioids
what can be used to treat essential tremors?
propranolol
primidone
botox
what is used for the treatment of ALS?
riluzole
what is the MOA of riluzole?
inhibits glutamate release
blocks postsynaptic NMDA receptors
blocks Na+ channels
what can be used to treat Wilson disease?
penicillamine
potassium disulfide
what is the MOA of penicillamine?
copper chelating agent
what is the MOA of potassium disulfide?
reduces intestinal absorption of copper
