Drugs for Movement Disorders (Wolff) Flashcards
Bradykinesia, Muscular Rigidity, Resting Tremor, and Postural Balance Impairment are all cardinal features of what disease?
PARKINSONS DISEASE
- loss of Dopaminergic neurons in Substantia Nigra with onset around age 60
Amantadine
What is its MOA, what is it used for, and how is it administered?
MOA: weak, noncompetitive NMDA receptor antagonist that reduced Parkinson Dz symptoms
- used for Parkinsons Dz as adjunctive therapy in pts getting levodopa
- administered ORALLY
Amantadine
What are 3 toxicities of use? (D/S/LR)
- CNS depression and impulse control issues
- suicidal ideations and depression
- Livedo Reticularis (purplish mottled discoloration of skin on legs)
Ropinirole
What is its MOA, what is it used to treat, and how is it administered?
MOA: D2/D3 receptor agonist that inc. DA-mediated effect in CNS
- used for Parkinsons Dz and can be administered with levodopa/carbidopa to treat “on-off” phenomenon
- *NO EFFICACY if pt. can’t use levodopa**
- administered ORALLY
Ropinirole
What are 3 toxicities of use? (IC/M/OH)
- Impulse Control and compulsive behaviors
- inc. risk of MELANOMA
- orthostatic hypotension
Selegiline
What is its MOA, what is it used for, and how is it administered?
What is its major toxicity of use?
MOA: irreversible inhibitor of Monoamine Oxidase (MAO) with greater MAO-B affinity, blocking catabolism of dopamine
- used for Parkinsons Dz when patients get “on-off” phenomenon with levodopa/carbidopa use
- *early Parkinsons Dz is off-label use**
- given ORALLY (taper dose off over 2-4 wks if given for > 3 wks
T: inc. risk of suicidal ideations in pediatrics and young-adults
Tolcapone
What is its MOA, what is it used for, and how is it administered?
What toxicity is most common with use?
MOA: selective/reversible inhibitor of COMT (levodopa degradation) that inc. plasma lvls of levodopa
- used as adjunct to levodopa/carbidopa for Parkinsons Dz with motor fluctuations NOT RESPONSIVE to other therapies
- given ORALLY
T: risk of fata; ACUTE FULMINANT LIVER FAILURE (also CNS depression and abnormal thinking)
What is Entacapone?
- COMT inhibitor that CANNOT cross BBB and is less toxic to the liver
- used to treat “off” symptoms
Carbidopa + Levodopa
What is its MOA, what is it used for, and how is it administered?
MOA: peripheral DOPA decarboxylase inhibitor and immediate precursor to dopamine
- most effective agent for motor symptoms of Parkinsons Dz (works best early in disease before neurons are lost)
- given ORALLY (tablets); fixed combo with ENTACAPONE makes sure levadopa NOT degraded in periphery
Carbidopa + Levodopa
What are its two major toxicities of use?
- GI effects (if levodopa WITHOUT carbidopa)
- dyskinesias occur in 80% of patients
What is the “on-off” phenomenon in Parkinsons Disease?
What can be added to help manage this issue?
- back and forth switching between mobility and immobility in levodopa-treated patients
- some respond to controlled-release levodopa
- can give dopamine agonist, COMT inhibitor, and MAO-B inhibitors to help blunt response
Benztropine
What is its MOA, what is it used for, and how is it administered?
What is its major toxicity?
MOA: cholinergic antagonist that block nerve signals leading to activation of GABA nerves that inhibit movement
- used for Parkinsons in young people (tremor/dystonia) and should be AVOIDED in the elderly and can treat excessive drooling/saliva
How can Botulinum Toxin A injections help with Non-Motor features of Parkinsons Dz?
- treats Sialorrhea (Excessive Drooling)
How can melatonin and clonazepam help with Non-Motor features of Parkinsons Dz?
- treats rapid eye movement sleep behavior disorder
How can quetiapine and clozapine, along with pimavanserin, help with Non-Motor features of Parkinsons Dz?
- atypical antipsychotics that can treat psychosis
How is Huntingtons Dz treated and what do Fluoxetine and Carbamazepine help with?
Tx: NO CURRENT THERAPY SLOWS DZ PROGRESSION
F - treats depression and irritability
C - depression
How is Persistent Severe and Intermittent but Disabling Restless Leg Syndrome treated?
PS: non-ergot dopamine agonist (ROPINIROLE) and a2d calcium channel ligand (GABAPENTIN)
ID: DA agonist or carbidopa/levodopa
symptoms may resolve with CORRECTION OF COEXISTING IRON-DEFICIENCY ANEMIA
What are the 3 treatments for Essential Tremor?
- Propranolol (1st line)
- block beta receptors in muscle spindles
- Primidone (barbiturate 1st line if persistent disability)
- Botulinum Toxin A (dec. ACh release = neuromuscular blocking effect)
What is the only drug that can impact survival in ALS?
Riluzole
- prolongs survival by a few months and/or time to tracheostomy
How do Penicillamine and Potassium Disulfide help treat Wilson’s Disease?
P: copper-chelating agent
PD: dec. intestinal absorption of copper that can be prescribed along with Penicillamine
also maintain a low-copper diet
Wilson’s Dz = AR disorder of copper metabolism (LOW CERULOPLASMIN = inc. copper lvls in brain/viscera)
