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neuro pharm > Drugs for Movement Disorders > Flashcards

Drugs for Movement Disorders Flashcards

1
Q

What is the MOA of amantadine?

A

weak, noncompetetive NMDA receptor antagonist

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2
Q

What is the MOA of selegiline?

A

potent, reversible inhibitor of monoamine oxidase (MAO)

greater affinity for MAO-B

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3
Q

When is tolcapone used in the treatment of Parkinson’s

A

as an adjunct to levodopa and carbidopa

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4
Q

What is a common toxic effect of dopamine agonists?

A

impulse control issues

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5
Q

What is the MOA of ropinirole?

A

D2 and D3 DA receptor agonist

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6
Q

What are the toxicities associated with taking ropinirole

A 
dyskinesias
Impulse control disorders
increased risk of MELANOMA
orthostatic hypotension
psychotic effects
somnolence
N/V, constipation
headaches
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7
Q

What toxicities are associated with amantadine

A 
CNS depression
impulse control disorders
psychosis
suicidal ideation/depression
livedo reticularis
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8
Q

What is a reversible MAO-B inhibitor alternative to selegiline

A

safinamide

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9
Q

What is the MOA of tolcapone?

A

reversible inhibitor of COMT

leads to more sustained levels of levodopa and carbidopa

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10
Q

What is the most dangerous toxicity of tolcapone?

When should tolcapone be used

A

1) potentially fatal acute fulminant liver failure
2) only use in parkinson disease pts on L-dopa/carbidopa who are experiencing symptom fluctuations and are not responding satisfactorily to other agents

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11
Q

toxicities of tolcapone

A 
behavior changes
CNS depression
Impulse control loss
orthostatic hypotension and syncope
exacerbation of preexisting dyskinesia
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12
Q

What is a COMT inhibitor that cannot cross the blood brain barrier?

What is it used to treat?

A

Entacapone

Acts in the periphery to treat ‘off’ symptoms

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13
Q

What are the toxicities of using levodopa and carbidopa

A 
GI effects (decreased with carbidopa)
postural hypotension
Wearing-off and on-off phenomena
hypertension/cardiac arrhythmias
dyskinesias
behavioral effects
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14
Q

Why is carbidopa given with levodopa?

A

Carbidopa blocks peripheral DOPA decarboxylase

This decreases the amount metabolized by the first pass system and allows a decrease in the dosage of levodopa

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15
Q

What is the on-off phenomenon in Parkinson disease?

A

Refers to a back and forth switch between mobility and immobility in levodopa treated patients

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16
Q

What are the options for managing the on off phenomenon

A

controlled release form of levodopa
shorten the interval between levodopa doses
adding a medication

17
Q

benztropine is an anticholinergic agent that should be avoided in which patient populations?

A

The elderly

People with cognitive impairment

18
Q

What is benztropine used to treat

A

1) Primarily for tremor and dystonia in younger people

2) Reducing the amount of saliva to treat excessive drooling

19
Q

What is the most potent antiparkinson therapy?

A

levodopa

20
Q

What is treatment is used for patients wanting meds for mild symptoms

A

MAO-B inhibitor

amantadine

21
Q

What is used in a patient <65 yo with PD diminished daily function and quality of life?

What about >65?

A

1) either a DA agonist or levodopa

2) immediate-release levodopa

22
Q

What are agents that reduce serum copper levels?

A

Penicillamine (copper chelating agent)

Potassium disulfide

23
Q

What is the only drug to have any impact on survival in ALS?

A

riluzole

  • only prolongs by a few months
  • and/or time to tracheostomy
24
Q

How do you treat Huntington disease

A

treat the non-motor symptoms bc there’s no known way to slow disease progression

25
Q

Symptoms of restless leg syndrome may revolve with correction of what?

A

iron deficiency anemia

26
Q

If there is persistent sever restless leg syndrome despite non-pharm therapy, what drugs would you choose?

A

non-ergot dopamine agonist (if comorbid depression and/or obesity/metabolic syndrome)

alpha-2-delta calcium channel ligand

27
Q

How is restless leg syndrome managed in pregnancy

A

usually with nonpharm strategies, iron supplementation

if needed, clonazepa, and carbidopa-levodopa

28
Q

For intermittent but disabling RLS symptoms, what is used?

A

DA agonist or carbidopa-levodopa

may also benefit from benzodiazepines or opioids

neuro pharm (5 decks)

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