Drugs for Movement Disorders

Question 1

amantadine

Answer 1

• weak noncompetitive NMDA receptor antagonist
• has direct and indirect effects on dopaminergic neurons
• risk of CNS Depression, Impulse Control, Psychosis, livedo reticularis

Question 2

Selegeline
Rasagiline

Safinamide

Answer 2

• IRREVERSIBLE inhibitor of MAO-B
• risk of suicide, and SEROTONIN SYNDROME

-Safinamide is REVERSIBLE inhibitor of MAO-B

Question 3

ropinirole

Answer 3

• D2 agonist
• 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

Question 4

pramipexole

Answer 4

• D2 agonist similar to ropinirole

- decreased hypotension and somnolence, but increased hallucinations

Question 5

rotigotine

Answer 5

• D2 agonist similar to ropinirole

- given as transdermal patch

Question 6

apomorphine

Answer 6

• DA agonist given as sublingual film or subQ

- use to quickly treat “off” episodes

Question 7

promocriptine

Answer 7

-ergot alkaloid DA agonist

Question 8

tolcapone

Answer 8

• 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

Question 9

carbidopa + levodopa

Answer 9

• 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

Question 10

benztropine

Trihexylphenidyl

Answer 10

• Anti-cholinergic used for parkinsons and tremor/dystonia in young people
• should be avoided in the elderly and those with cognitive impairment

Question 11

botox

Answer 11

-used for excessive drooling in parkinsons

Question 12

propranolol

Answer 12

• blockade of beta receptors in muscle spindles

- used for essential tremor

Question 13

primidone

Answer 13

-barbiturate anticonvulsant used for essential tremor

Question 14

riluzole

Answer 14

• treatment of ALS

- only prolongs life for a few months

Question 15

penicillamine

Answer 15

• copper chelating agent

- used to treat wilson dz

Question 16

potassium disulfide

Answer 16

• reduces intestinal absorption of copper

- used to treat wilson dz