Drugs for Movement Disorders (Wolff) Flashcards
What are the 2 drugs used for Wilson’s Disease?
Basically low copper diets and agents that reduce serum copper levels
- Penicillamine: Copper chelating agent
- Potassium disulfide: Reduces intestinal absorption of copper
What is the Levodopa combination?
Levodopa + carbidopa
OR
Levodopa + carbidopa + entacapone
Tx for Essential Tremor Algorithm
- Mild tremor, no disability –> No rx therapy
- Intermittent disability –> First line agent: Propranolol (unknown MOA, blockade of beta receptors in muscle spindles) –> second line agent: Benzodiazepine
- Persistent disability due to tremor –> First line agents: Propranolol, Primidone (a barbiturate anticonvulsant), or both –> poor response –> second line agents: Gabapentin –> poor response plus predominant limb tremor or head or voice tremor: Botulinum toxin injections (binds to high affinity presynaptic recognition sites on cholinergic nerve terminals –> decreases ACh release, causing a neuromuscular blocking effect)
Tx of Restless Leg Syndrome Algorithm
- Check iron stores, if serum ferritin < 75 ng/mL –>
- Replete iron –>
- Moderate to severe symptoms 2 or more days per week?
- -> No, then intermittent therapy of Carbidopa-levodopa PRN - –> Yes: Daily rx recommended –> Comorbidities (obesity, depression, gait, respiratory failure, substance abuse)?
- -> yes, then give Dopamine agonist (ex. prampipexole, ropinirole, or rotigotine)
- -> no, then give Alpha 2 delta calcium channel ligand (ex. gabapentin, enacarbil, pregabalin, or gabapentin)
What are the treatments for Restless Leg Syndrome?
- Correct iron deficiency anemia
- Non-ergot dopamine agonist (e.g. ropinirole) if comorbid depression, obesity/metabolic syndrome
- Alpha-2-delta calcium channel ligand (e.g. gabapentin) - no co-morbidities. Hx of impulsive control DO
- For intermittent but disabling sx, use DA agonist or carbidopa-levodopa, benxodiazepines or opioids
if pregnant - nonpharmacologic strategies, iron supplement, clonazepam or carbidopa-levodopa
What are the treatments for Huntington Disease?
No current therapy slows dz progression.
Treat non-motor symptoms
- fluoxetine for depression and irritability
– carbamazepine for depression
– avoid agents with substantial anticholinergic effects since can exacerbate chorea
Where are the Dopaminergic neurons in the brain?
Substantia nigra
Where are the Dopaminergic neurons in the brain?
Substantia nigra
What is the main function of Dopamine in normal movement?
movement happens when the “brake” is released
What is the function of Ach in normal movement?
It stimulates the release of GABA which slows movement
Name of drug with “unknown” exact MOA
amantadine
Name of drug that is a weak, noncompetitive NMDA receptor antagonist
amantadine
What is the main effect of amantadine?
reduces Parkinson disease symptoms
What drug is used for Amyotrophic Lateral Sclerosis (ALS)?
Riluzole
- prolongs survival by a few months
Tx for Essential Tremor Algorithm
- Mild tremor, no disability –> No rx therapy
- Intermittent disability –> First line agent: Propranolol (unknown MOA, blockade of beta receptors in muscle spindles) –> second line agent: Benzodiazepine
- Persistent disability due to tremor –> First line agents: Propranolol, Primidone (a barbiturate anticonvulsant), or both –> poor response –> second line agents: Gabapentin –> poor response plus predominant limb tremor or head or voice tremor: Botulinum toxin injections (binds to high affinity presynaptic recognition sites on cholinergic nerve terminals –> decreases ACh release, causing a neuromuscular blocking effect)
What are the 3 clinical applications of amantadine?
- treatment of drug-induced extra-pyramidal symptoms
- adjunctive therapy for dyskinesias in patients receiving Levodopa
- used as monotherapy for pts with mild motor symptoms
What drug has the following toxicities:
- CNS depression
- impulse control disorders
- psychosis
- suicidal ideation/depression
- causes livedo reticularis (purple discoloration of legs)
amantadine
Tx of Restless Leg Syndrome Algorithm
- Check iron stores, if serum ferritin < 75 ng/mL –>
- Replete iron –>
- Moderate to severe symptoms 2 or more days per week?
- -> No, then intermittent therapy of Carbidopa-levodopa PRN - –> Yes: Daily rx recommended –> Comorbidities (obesity, depression, gait, respiratory failure, substance abuse)?
- -> yes, then give Dopamine agonist (ex. prampipexole, ropinirole, or rotigotine)
- -> no, then give Alpha 2 delta calcium channel ligand (ex. gabapentin, enacarbil, pregabalin, or gabapentin)
What are the treatments for Restless Leg Syndrome?
- Correct iron deficiency anemia
- Non-ergot dopamine agonist (e.g. ropinirole) if comorbid depression, obesity/metabolic syndrome
- Alpha-2-delta calcium channel ligand (e.g. gabapentin) - no co-morbidities. Hx of impulsive control DO
- For intermittent but disabling sx, use DA agonist or carbidopa-levodopa, benxodiazepines or opioids
if pregnant - nonpharmacologic strategies, iron supplement, clonazepam or carbidopa-levodopa
What drug has the following toxicity [black box]:
antidepressants increased risk of suicidal thoughts and behaviors in pediatric and young adult patients in short-term studies
selegiline
What are the 2 main clinical applications of selegiline?
- adjunct in the management of PD when levodopa/carbidopa use during the on-off phenomenon
- early PD
What drug has the following toxicity [black box]:
antidepressants increased risk of suicidal thoughts and behaviors in pediatric and young adult patients in short-term studies
selegiline
What are the treatments for Huntington Disease?
No current therapy slows dz progression.
Treat non-motor symptoms
- fluoxetine for depression and irritability
– carbamazepine for depression
– avoid agents with substantial anticholinergic effects since can exacerbate chorea
Name of drug that is another MAO-B selective irreversible inhibitor, has greater potency, and has similar efficacy and adverse effects to the OG drug
rasagiline
