Drugs for Movement Disorders (Wolff)

Question 1

What preferentially metabolizes norepinephrine and serotonin?

What preferentially metabolizes phenylethylamine and benzylamine?

What preferentially metabolizes dopamine and tryptamine?

Answer 1

1) MAO-A
2) MAO-B
3) Equally by MAO-A and MAO-B

Question 2

What is amantadine?

Answer 2

Noncompetitive NMDA receptor antagonist

Question 3

What is the clinical application for amantadine?

Answer 3

As adjunctive therapy for dyskinesia in Parkinson’s patients receiving levodopa

Question 4

What are potential toxicities of amantadine?

Answer 4

1) CNS depression
2) Psychosis
3) Livedo reticularis (Purplish discoloration of legs)

Question 5

What is ropinirole?

Answer 5

A D2 receptor agonist

Question 6

D2 receptors are coupled to?

This causes?

Answer 6

1) Gi

2) Decrease cAMP

Question 7

What is the clinical application for ropinirole?

Answer 7

Treatment of Parkinson disease

Question 8

What are potential toxicities of ropinirole?

Answer 8

1) Dyskinesia
2) Increase risk of melanoma
3) Orthostatic hypotension

Question 9

What is selegiline?

Answer 9

A potent irreversible inhibitor of MAO

Question 10

What is the clinical application for selegiline?

Answer 10

Adjunct in the management of Parkinson disease

Question 11

What is the black box warning for selegiline?

Answer 11

Increased risk of suicidal thoughts and behaviors in pediatric and young adult patients

Question 12

What is tolcapone?

Answer 12

A selective and reversible inhibitor of COMT

Question 13

What is the clinical application of tolcapone?

Answer 13

Adjunct to levodopa and carbidopa

Question 14

What is the black box warning for tolcapone?

Answer 14

Risk of potential fatal acute fulminant liver failure

Question 15

What effect does COMT inhibiton have?

Answer 15

More sustained plasma levels of levodopa

Question 16

Entacapone is another nitrocatechol COMT inhibitor but differs from tolcapone in that?

Answer 16

It cannot cross the BBB

Question 17

What is the most effective agent for treating motor symptoms of Parkinson disease?

Answer 17

Carbidopa + levodopa

Question 18

Carbidopa + levodopa crosses the BB via?

Answer 18

L-amino acid transporter

Question 19

What does carbidopa block?

Answer 19

Peripheral DOPA decarboxylase

Question 20

Why is carbidopa given with levodopa?

Answer 20

Carbidopa prevents levodopa from being converted into dopamine prematurely in the bloodstream, allowing more of it to get to the brain

Question 21

Deep brain stimulation of what areas of the brain are effective against motor fluctuations and dyskinesia?

Answer 21

Subthalamic nucleus or globus pallidus interna

Question 22

What is the “on-off” phenomenon in Parkinson disease?

Answer 22

The back and forth switch between mobility and immobility in levodopa treated patients

Question 23

What is benztropine?

Answer 23

Cholinergic antagonist at muscarinic receptors

Question 24

What is the clinical application for benztropine?

Answer 24

Tremor and dystonia in younger Parkinson’s patients

Question 25

What populations should avoid benztropine?

Answer 25

1) Elderly | 2) Cognitive impaired patients

Question 26

What Parkinson medications should be given for mild symptoms/little interference with daily function?

Answer 26

1) MAO-B inhibitor | 2) Amantadine

Question 27

When should levodopa be given as initial therapy?

Answer 27

Older than 65 with symptoms affecting daily life

Question 28

What potential non-motor symptom of PD is treated with injection of botulinum toxin A into the salivary glands?

Answer 28

Sialorrhea

Question 29

What potential non-motor symptom of PD is treated with midodrine, domperidone, and fludrocortisone?

Answer 29

Orthostatic hypotension

Question 30

What potential non-motor symptom of PD is treated with melatonin or clonazepam?

Answer 30

REM sleep behavior disorder

Question 31

What potential non-motor symptom of PD often precedes motor symptoms and becomes more prominent and difficult to treat with Parkinson disease progression?

Answer 31

Depression

Question 32

What potential non-motor symptom of PD is treated with quetiapine and clozapine?

Answer 32

Psychosis

Question 33

Cholinesterase inhibitors such as rivastigmine or donepezil and/or NMDA-antagonist memantine are used to slow?

Answer 33

Dementia

Question 34

What receptor when activated in PD treatment, can cause psychosis, nausea, and vomiting?

Answer 34

D2 receptors

Question 35

What receptor when blocked in PD treatment, can cause dementia?

Answer 35

Ach muscarinic receptors

Question 36

What is the current therapy to treat/manage Huntington Disease?

Answer 36

There are no current therapies that slows disease progression

Question 37

Restless leg syndrome is a common condition that causes?

Answer 37

Uncontrollable urge to move the legs

Question 38

What pharmacologic therapy is used to treat restless leg syndrome?

Answer 38

1) Ropinirole | 2) Carbidopa-levodopa

Question 39

What is the only drug to have any impact on survival in ALS?

Answer 39

Riluzole

Question 40

Penicillamine and potassium disulfide are agents that have what effect? They are used with what condition?

Answer 40

1) Reduce serum copper levels | 2) Wilson disease