Drugs for Movement Disorders - Kruse

Question 1

T1/2: Bromocriptine

Answer 1

15 h

Question 2

Peak [plasma]: bromocriptine

Answer 2

1-3 h

Question 3

metabolism: bromocriptine

Answer 3

CYP3A4 - extensive first pass

Question 4

benefit of dopamine antagonist

Answer 4

lower incidence of response fluctuations and dyskinesia in comparison to LT L-dopa tx

Question 5

MOA: Pramipexole

Answer 5

D3 receptor agonist

Question 6

Tx; Pramipexole

Answer 6

RLS

Question 7

peak [plasma]: pramixole

Answer 7

2h

Question 8

T1/2: pramipexole

Answer 8

8h

Question 9

ROE: pramipexole

Answer 9

90% in urine

Question 10

MOA: ropinirole

Answer 10

D2 receptor agonist

Question 11

tx: ropinirole

Answer 11

RLS

Question 12

Met: ropinirole

Answer 12

primarily CYP1A2

Question 13

T1/2: ropinirole

Answer 13

6h

Question 14

peak [plasma]: ropinirole

Answer 14

1-2h

Question 15

Dopamine receptor agonists

Answer 15

• bromocriptine
• pramipexole
• ropinirole

Question 16

AEs: Dopamine Agonists

Answer 16

• GI: anorexia, nausea, vomiting
• postural hypotenstion
• peripheral edema + cardiac arrhythmias = stop using
• more severe mental dist than w/ L-dopa

Question 17

CIs: Dopamine agonists

Answer 17

• psychosis
• recent MI
• active peptic ulcers
• periperal vascular dz (bromocriptine)

Question 18

MOA: Selegiline

Answer 18

selective, irreversible MAO-Bi

Question 19

MOA: Rasagiline

Answer 19

irreversible MAO-Bi, > potent than selegiline

Question 20

CIs: Selegiline

Answer 20

• merperidine
• tricyclic antidepressants
• SRIs

Question 21

AEs: Rasagline

Answer 21

hypertensive crisis when used with L-dopa

Question 22

AEs: Tolcapone

Answer 22

death from acute hepatic failure d/t increase in liver enzymes

Question 23

MOA: COMTi

Answer 23

competes with L-dopa for transport across membranes - prolongs L-Dopa activity by inhibiting peripheral metabolism

Question 24

AE: Amatadine

Answer 24

livedo reticularis: purplish mottled disocloration of skin, usually legs

Question 25

CIs: Amatadine

Answer 25

use with caution in pts with hx of seizures and heart failure

Question 26

Anticholinergics used for PD tx

Answer 26

• benztropine
• biperiden
• orphenadrine
• procyclidine
• trihexphenidyl

Question 27

Tx: anticholinergics for PD

Answer 27

may improve tremor and rigidity, little effect on bradykinesia

Question 28

beta-blockers used for tremor

Answer 28

metoprolol and propranolol (beta 1)

Question 29

AEDs to tx tremor

Answer 29

pirimidone and topirimate

Question 30

Pyschoactive drug used to tx tremor

Answer 30

benzodiazepines

Question 31

IM injection used to tx tremor

Answer 31

botox

Question 32

drugs used to manage choria in HD pts

Answer 32

• reserpine
• tetrabenazine
• olanzapine
• perphenazine
• haloperidol

Question 33

neuroletic antipsychotics used for tics

Answer 33

• tetrabenzaine
• haloperidol
• pimozide

Question 34

alpha-andrenergic tx for tics

Answer 34

• clonidine

- guanfacine

Question 35

only FDA approved tx for RLS

Answer 35

• prampexole

- ropinirole

Question 36

MOA: Riluzole

Answer 36

• inhibits glutamate release
• blocks postsynaptic NMDA and kainite-type glutamate receptors
• inhibits VGNaCs

Question 37

Tx: riluzole

Answer 37

ALS

Question 38

Tx: penicillamine

Answer 38

wilson’s dz

Question 39

MOA: Penicillamine

Answer 39

Cu chelating agent

Question 40

AEs: Penicillamine

Answer 40

• nausea
• vomiting
• nephritic syndrome
• myasthenia
• optic neuropathy
• various blood disorders

Question 41

tx: potassium disulfide

Answer 41

wilsons dz

Question 42

MOA: potassium disulfide

Answer 42

reduces intestinal absorption of copper

Question 43

MOA: Bromocriptine

Answer 43

D2 agonist (ergot alkaloid)