Drugs for Movement Disorders (Wolff) Flashcards
What preferentially metabolizes norepinephrine and serotonin?
What preferentially metabolizes phenylethylamine and benzylamine?
What preferentially metabolizes dopamine and tryptamine?
1) MAO-A
2) MAO-B
3) Equally by MAO-A and MAO-B
What is amantadine?
Noncompetitive NMDA receptor antagonist
What is the clinical application for amantadine?
As adjunctive therapy for dyskinesia in Parkinson’s patients receiving levodopa
What are potential toxicities of amantadine?
1) CNS depression
2) Psychosis
3) Livedo reticularis (Purplish discoloration of legs)
What is ropinirole?
A D2 receptor agonist
D2 receptors are coupled to?
This causes?
1) Gi
2) Decrease cAMP
What is the clinical application for ropinirole?
Treatment of Parkinson disease
What are potential toxicities of ropinirole?
1) Dyskinesia
2) Increase risk of melanoma
3) Orthostatic hypotension
What is selegiline?
A potent irreversible inhibitor of MAO
What is the clinical application for selegiline?
Adjunct in the management of Parkinson disease
What is the black box warning for selegiline?
Increased risk of suicidal thoughts and behaviors in pediatric and young adult patients
What is tolcapone?
A selective and reversible inhibitor of COMT
What is the clinical application of tolcapone?
Adjunct to levodopa and carbidopa
What is the black box warning for tolcapone?
Risk of fatal acute fulminant liver failure
What effect does COMT inhibiton have?
More sustained plasma levels of levodopa
Entacapone is another nitrocatechol COMT inhibitor but differs from tolcapone in that?
It cannot cross the BBB
What is the most effective agent for treating motor symptoms of Parkinson disease?
Carbidopa + levodopa
Carbidopa + levodopa crosses the BBB via?
L-amino acid transporter
What does carbidopa block?
Peripheral DOPA decarboxylase
Why is carbidopa given with levodopa?
Carbidopa prevents levodopa from being converted into dopamine prematurely in the bloodstream, allowing more of it to get to the brain
Deep brain stimulation of what areas of the brain are effective against motor fluctuations and dyskinesia?
Subthalamic nucleus or globus pallidus interna
What is the “on-off” phenomenon in Parkinson disease?
The back and forth switch between mobility and immobility in levodopa treated patients
What is benztropine?
Cholinergic antagonist at muscarinic receptors
What is the clinical application for benztropine?
Tremor and dystonia in younger Parkinson’s patients
What populations should avoid benztropine?
1) Elderly
2) Cognitive impaired patients
What Parkinson medications should be given for mild symptoms/little interference with daily function?
1) MAO-B inhibitor
2) Amantadine
When should levodopa be given as initial therapy?
Older than 65 with symptoms affecting daily life
What potential non-motor symptom of PD is treated with injection of botulinum toxin A into the salivary glands?
Sialorrhea
What potential non-motor symptom of PD is treated with midodrine, domperidone, and fludrocortisone?
Orthostatic hypotension
What potential non-motor symptom of PD is treated with melatonin or clonazepam?
REM sleep behavior disorder
What potential non-motor symptom of PD often precedes motor symptoms and becomes more prominent and difficult to treat with Parkinson disease progression?
Depression
What potential non-motor symptom of PD is treated with quetiapine and clozapine?
Psychosis
Cholinesterase inhibitors such as rivastigmine or donepezil and/or NMDA-antagonist memantine are used to slow?
Dementia
What receptor when activated in PD treatment, can cause psychosis, nausea, and vomiting?
D2 receptors
What receptor when blocked in PD treatment, can cause dementia?
Ach muscarinic receptors
What is the current therapy to treat/manage Huntington Disease?
There are no current therapies that slows disease progression
Restless leg syndrome is a common condition that causes?
Uncontrollable urge to move the legs
What pharmacologic therapy is used to treat restless leg syndrome?
1) Ropinirole
2) Carbidopa-levodopa
What is the only drug to have any impact on survival in ALS?
Riluzole
Penicillamine and potassium disulfide are agents that have what effect?
They are used with what condition?
1) Reduce serum copper levels
2) Wilson disease
