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NMSP > Drugs for movement disorders > Flashcards

Drugs for movement disorders Flashcards

1
Q

What neurons are affected in Parkinson’s

A

dopaminergic neurons in the substantia nigra

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2
Q

Bradykinesia, muscular rigidity, resting tremor, and impairment of postural balance leading to gait disturbances are cardinal features of what?

A

Parkinsons

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3
Q

What are the functions of the Dopamine pathways?

A
  • Reward
  • pleasure, euphoria
  • motor function
  • compulsion
  • perseveration
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4
Q

What are the functions of the serotonin pathways?

A
  • mood
  • memory processing
  • sleep
  • cognition
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5
Q

Which MAO metabolizes NE, serotonin, dopamine, and tryptamine?

A

MAO-A (dopamine and tryptamine equal MAO A and B)

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6
Q

Which MAO metabolizes phenylethylamine, benzylamine, dopamine, and tryptamine?

A

MAO-B

dopamine and tryptamine equal MAO A and B

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7
Q

How does amantadine work?

A

exact mechanism unknown–> direct and indirect effects on dopamine neurons

weak, non-competitive NMDA receptor antagonists

  • has direct and indirect effects on dopamine neurons
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8
Q

What drug in indicated in tx of drug induced extrapyramidal symptoms and Parkinson’s as adjunctive for dyskinesias in pts taking levodopa?

A

Amantidine

-weak, noncompetitive NMDA receptor antagonist

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9
Q 
What NMDA receptor antagonist can cause...
-CNS depression
-impulse control disorders
-psychosis 
-suidcide ideation
levedo reticulares
A

Amantidine

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10
Q

What is ropinirole MOA?

A

Post synaptic D2 agonist ( some action on D3)

  • increases DA- mediated effects in CNS to treat movement disorders
  • Tx of Parkinson’s
  • can be given with levodopa/carbidopa
  • won’t work if L dopa doesn’t work
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11
Q

What drug’s toxicities include…

  • dyskinesias
  • impulse control disorders/compulsice behaviors
  • increased risk for melanoma
  • orthostatic hypotension (from D2 stimulation)
  • psychotic events
  • somnolence (fall asleep while driving)
  • n/v, constipation
  • headaches
A

Ropinirole

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12
Q

Which D2 agonist has decreased risk of hypotension and somnolence but increased risk of hallucinations compared to ropinirole?

A

Pramipexole

  • sounds kinda mystical right? like hallucinations?
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13
Q

What D2 agonist is available in transdermal patch?

A

Rotigotine

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14
Q

what DA agonist is available in sublingual film or subQ injection?

A

Apomorphine

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15
Q

What early DA agonist is an ergot alkaloid derivative?

A

Bromocriptine

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16
Q

What is the MOA of selegiline?

A

Irrevesible inhibitor of MAO with affinity for MAO- B compared to A(A is found in intestinal tract)

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17
Q

What drug has BBW of antidepressants increased risk of suicidal thoughts and behaviors in pediatric and young adult patients?

A

Selegiline

  • IRREVERSIBLE inhibitor of monoamine oxidase
  • greater affinity for MAO-B
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18
Q

Could selegiline cause hyper or hypotension?

A

Hyper as opposed to D2 agonist causing hypo

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19
Q

What is a MAO-B selective irreversible inhibitory that has greater potency, but similar efficacy and adverse effects as selegiline?

A

Rasagiline

RAAAAAAA — sounds more powerful right?

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20
Q

What is a REVERSIBLE MAO-B inhibitor?

A

Safinaminde

21
Q

What is the MOA of tolcapone?

A

Selective and reversible inhibitor of catechol-o-methyl-transferase (pathway for degradation of levodopa)

22
Q

When is tolcapone used?

A

Adjuct to levodopa and carbidopa in tx of Parkinson’s, helps prevent degradation

  • tolcapone is a selective and reversible inhibitor of catechol-o-methly transferase (COMT)
  • COMT is a major pathway for levodopa degradation
23
Q

What drug requires patients to acknowledge/sign warning about liver failure?

A

Tolcapone– This is a LAST RESORT DRUG

  • can cause liver failure
  • only use if not responding to other agents
24
Q

Why would someone want to use entacapone?

A

is a nitrocatechol COMT inhibitor with a short half life.

  • can’t cross BBB
  • acts in periphery to block Levodopa degradation
  • is less toxic to liver than Tolcapone
25
Q

What type of drug is Carbidopa?

A

peripheral DOPA decarboxylase inhibitor, can’t cross BBB

26
Q

Can levodopa cross BBB?

A

yes

27
Q

What is given with levodopa?

A

cabidopa to prevent levodopa degradation

28
Q

What COMT inhibitor is given with carbidopa and levodopa?

A

Entacapone

29
Q

What is MOA of benztropine?

A

Cholinergic antagonist at muscarinic receptors (like atropine but less activity)

30
Q

What Parkinson drug can cause dry mouth, blurred vision, cognitive changes, drowsiness, constipation, urinary retention, tachycardia, anorexia, Severe delirium and hallucinations at toxic doses

A

Benztropine

-cholinergic antagonist at muscarinic receptors like atropine but less activity

31
Q

What are the 4 main classes of drugs for Parkinson’s tx?

A
  1. MAO-B inhibitors
  2. Amantidine
  3. Levodopa
  4. Dopaminergic agonists

MALD was BALD and had Parkinsons

32
Q

What is the most potent antiparkinson therapy?

A

levodopa

33
Q

How is sialorrhea treated in Parkinson’s patients?

A

Botulinum toxin A into the salivary glands

34
Q

What should be given to patients on antiparkinsons meds that have a risk of orthostatic HTN?

A

alpha adrenergic agonist MIDODRINE

-peripheral D2 antagonist DOMPERIDONE

mineral corticoid FLUCORTISONE

35
Q

Melatonin and clonazepam can be used to treat what?

A

those with rapid eye movement sleep behavior disorder

36
Q

What drugs are used to treat cognitive decline of PD?

A

Cholinesterase inhibitors: Rivastigmine or donepezil
NMDA-antagonist: Memantine

* the only drugs in the dementia lecture*

37
Q

What are first line agents for treating essential tremor?

A

Propranolol and primidone (barbiturate anticonvulsant)

38
Q

What drug can prolong ALS survival for a few months/ prolong time to tracheostomy?

A

Riluzole

39
Q

What does penicillamine treat? How?

A

Wilson’s disease

- copper chelating agent

40
Q

What does potassium disulfide treat? How?

A

reduces intestinal absorption of copper, can be

prescribed in addition to penicilamines

41
Q

How would mild sx of Parkinson’s be treated? (little interference with daily function)

A
  1. MAO B inhibitor

2. Amantadine–> useful if tremor is predominant

42
Q

If PD diminishes daily quality of life, what drug is indicated in pt less than 65?

A

-DA agonist

or

-levodopa

43
Q

If PD diminishes daily quality of life, what drug is indicated in pt greater than 65?

A

initiate with immediate release levodopa

44
Q

What often proceeds motor symptoms in PD?

A

Depression

45
Q

What are standard atypical anti psychosis agents?

A

quetiapine

clozapine

46
Q

What are adverse effects to D2 receptor activation in PD?

A

psychosis

N/V

47
Q

What is adverse effect to using Ach muscarinic receptors antagonists?

A

dementia– use restricted to young PD patients

48
Q

How is restless leg syndrome treated?

A

-non-ergot dopamine agonist–> like ropinirole

alpha 2 delta calcium channel ligand

NMSP (14 decks)

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