Drugs for Movement Disorders Flashcards
1
Q
amantadine
A
- weak noncompetitive NMDA receptor antagonist
- has direct and indirect effects on dopaminergic neurons
- used mostly for parkinsons
- risk of impaired physical or mental ability, falling asleep, impulse control, psychosis, suicide, and livedo reticularis
2
Q
selegeline
A
- IRREVERSIBLE inhibitor of MAO-B
- decreases breakdown of catecholamines
- used mostly of parkinsons
- metabolized by CYP2B6, 2C9, 2A4, and 2A6
- risk of impaired physical or mental ability, falling asleep, impulse control, psychosis, suicide, and SEROTONIN SYNDROME
3
Q
rasagiline
A
- IRREVERSIBLE inhibitor of MAO-B, greater potency
- decreases breakdown of catecholamines
- used mostly of parkinsons
- metabolized by CYP2B6, 2C9, 2A4, and 2A6
- risk of impaired physical or mental ability, falling asleep, impulse control, psychosis, suicide, and SEROTONIN SYNDROME
4
Q
safinamide
A
- REVERSIBLE and HIGHLY SELECTIVE inhibitor of MAO-B
- decreases breakdown of catecholamines
- used mostly of parkinsons
- metabolized by CYP2B6, 2C9, 2A4, and 2A6
- risk of impaired physical or mental ability, falling asleep, impulse control, psychosis, suicide, and SEROTONIN SYNDROME
5
Q
ropinirole
A
- non-ergot dopamine receptor agonist
- active at D2 and D3
- precise MOA unknown but it activates D2 DA receptors in the caudate putamen which activate Gi and decrease cAMP
- treatment of parkinsons and restless leg syndrome
- can be given with levo/carbidopa to mitigate on/off effect
- not useful in those in which levodopa doesn’t work
- risk of impulse control issues, dyskinesia, melanoma, orthostatic hypotension, psychosis, somnolence, N/V
6
Q
pramipexole
A
- D2 agonist similar to ropinirole
- decreased hypotension and somnolence, but increased hallucinations
7
Q
rotigotine
A
- D2 agonist similar to ropinirole
- given as transdermal patch
8
Q
apomorphine
A
- DA agonist given as sublingual film or subQ
- use to quickly treat “off” episodes
9
Q
promocriptine
A
-ergot alkaloid DA agonist
10
Q
tolcapone
A
- selective and reversible inhibitor of catechol-o-methyl-transferase (COMT)
- prevents breakdown of levodopa (given with levo/carbidopa)
- risk of LIVER FAILURE, psychosis, CNS depression, impulse control issue, orthostatic hypotension, dyskinesia
11
Q
entacapone
A
- inhibitor of catechol-o-methyl-transferase (COMT)
- shorter half life, less toxic to liver
- does not cross BBB and prevents levodopa breakdown in periphery
- used to treat “off” symptoms
12
Q
carbidopa + levodopa
A
- levodopa is the immediate precursor to DA, crosses BBB
- carbidopa is a peripheral DOPA decarboxylase inhibitor, does not cross BBB
- MOST EFFECTIVE AGENT for treating motor symptoms of parkinsons
- risk of N/V, postural hypotension, HTN, dyskinesia, psychosis, ON/OFF EFFECTS
13
Q
benztropine
A
- cholinergic antagonist at muscarinic receptors
- blocks cholinergic nerve signals which allow GABAergic nerves to inhibit movement
- used for parkinsons and tremor/dystonia in young people
- should be avoided in the elderly and those with cognitive impairment
14
Q
trihexyphenidyl
A
-anticholinergic used for parksinons
15
Q
botox
A
-used for excessive drooling in parkinsons
