Drugs For Movement Disorders Flashcards by Christian Wakim

what is the underlying pathology of Parkinsons?

loss of dopamine-producing neurons in the substantia nigra

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what are the 4 hallmark features of Parkinsons?

bradykinesia
muscular rigidity
resting tremor
impairment of postural balance

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what is the pharmacologic goal in treating Parkinsons?

treat the symptoms

cannot slow disease process

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What are the classes of drugs to treat movement disorders?

Dopamine analogs 
Dopamine receptor agonists
MAOBi
COMTi
Anticholinergics
Misc

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what is the MOA of amantadine?

weak, noncompetitive NMDA receptor antagonist

direct and indirect effects on dopamine neurons

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what are the adverse reactions of amantadine?

CNS depression
impulse control disorder
psychosis
SI
livedo reticularis

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what is the MOA of ropinirole?

stimulation of postsynaptic D2 receptors leading to increased DA

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what are the adverse reactions of ropinirole?

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

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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

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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

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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

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what is the MOA of selegiline?

irreversible MAOBi

increases dopamine by interfering with dopamine reuptake

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what are the adverse reactions of selegiline?

SI when used with antidepressants

serotonin syndrome

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what is the MOA of safinamide?

reversible MAOBi

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

rasagiline

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what is the MOA of tolcapone?

selective and reversible COMTi

sustained plasma levels of levodopa

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when is it appropriate to use tolcapone?

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

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what are the adverse reactions of tolcapone?

potentially fatal acute fulminant liver failure

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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