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NMSP 1 > Drugs for Mvmt Disorders > Flashcards

Drugs for Mvmt Disorders Flashcards

1
Q

What drug is unable to cross the BBB and is thus used in combo w/ levodopa to ensure that more levodopa makes it into the brain?

A

Carbidopa

-decarboxylase inhibitor in the periphery

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2
Q

How does botulinum toxin A work in Parkinson’s Dz patients?

A

–binds w/ high affinity to presynaptic cholinergic neurons to decrease Ach release, thus causing a neuromuscular-blocking effect

ex: injected into salivary glands to prevent sialorrhea

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3
Q

What are some potential toxicities of MAO-B inhibitors such as selegiline and rasagiline?

A
  • exacerbate HTN

- when paired w/ antidepressants, increased risk of suicidal thoughts in pediatrics and young adults

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4
Q

True or False: palliative care and end-of-life decisions should be discussed early in the disease process of patients w/ Parkinson’s

A

True; conversations while the patient is still ambulatory are more productive than conversations that are made bedside in the hospital under crisis

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5
Q

True or False: the motor symptoms of Huntington Disease can be treated

A

False; only treatments for the non-motor symptoms (depression, irritability) exist.

ex: fluoxetine for depression and irritability
ex: carbamazepine for depression

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6
Q

What kinds of drugs should be avoided in patients w/ Huntington Disease?

A

-anticholinergics b/c they can exacerbate chorea

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7
Q

What drug can be used to treat tremor, dystonia, and sialorrhea in younger patients w/ Parkinson’s Dz?

A
  • benztropine (antimuscarinic, cholinergic antagonist)

- contraindicated in elderly and cognitively impaired

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8
Q

What are symptoms seen in Parkinson’s patients when they walk?

A
  • decreased arm swing

- shuffling, festinating gait

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9
Q

What is a major toxicity in the use of tolcapone (a catechol-O-methyltransferase inhibitor)?

A
  • risk of potentially fatal acute fulminant liver failure

- tolcapone is used a last resort

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10
Q

What is the inheritance pattern of Wilson Dz?

A

autosomal recessive

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11
Q

What builds up in the serum on patients w/ Wilson Disease?

A

copper

avoid eating calf liver, spinach, cashews, molasses

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12
Q

What two body systems are affected by Wilson Disease?

A

hepatic

neuro

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13
Q

What is the mechanism of action of ropinirole?

A

dopamine agonist (non-ergot)

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14
Q

What are the side effects of ropinirole (a dopamine antagonist)?

A
  • dyskinesia
  • impulse control disorder (gambling, hypersexuality)
  • increased melanoma risk
  • orthostatic hypotension
  • somnolence
  • N/V, constipation
  • HA
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15
Q

What is the hallmark symptom of Parkinson’s Disease?

A

“pill-rolling” resting tremor

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16
Q

Besides benztropine, what is another antimuscarinic, cholinergic antagonist used to treat Parkinson’s Disease?

A

trihexyphenidyl

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17
Q

What is a complication of long-term levodopa use in treating restless leg syndrome?

A

augmentation of the symptoms

ex: symptom spread, shorter duration of drug action

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18
Q

True or False: autonomic dysfunction is a common complication of Parkinson Disease?

A

True; includes cardiovascular, GIGU, and thermoregulatory problems

-however, there is a limited ability to treat/manage the autonomic dysfunction

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19
Q

What is a complication when MAO-B inhibitors (such as selegiline or rasagiline) are used simultaneously with serotonergic agents?

A

serotonin syndrome (potentially life-threatening)

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20
Q

What is the mechanism of action of penicillamine?

A
  • copper chelation that makes a stable complex that is readily excreted by the kidney
  • used to treat Wilson Dz
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21
Q

What class of enzymes metabolizes catecholamine-like NTR’s, and thus can be inhibited pharmacologically in the treatment of Parkinson’s Disease?

A

monoamine oxidases

MAO’s

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22
Q

What is a clinical application of amantidine, other than just as adjunctive therapy for dyskinesias in Parkinson patients?

A
  • -treats drug-induced extrapyramidal symptoms
    (ex: dystonia, rigidity, bradykinesia, tremor)

-useful to tx of tremor when other symptoms are mild

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23
Q

What are the side effects of amantidine?

A
  • CNS depression (decreased alertness)
  • impulse control disorders
  • psychosis (hallucinations, paranoia, delusions)
  • suicidal ideation
  • livedo reticularis
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24
Q

What class of drugs contains members that are noteworthy of causing drug-induced movement disorders?

A

anti-emetics

ex: metoclopramide

25
Q

What are two components of non-pharmacological treatment in Parkinson’s Disease?

A
  • rehabilitation

- occupational therapy

26
Q

What is a class of enzyme that metabolizes dopamine and is inhibited by tolcapone and entacapone?

A

catechol-O-methyltransferase

27
Q

What treatment is considered in select Parkinson patients to treat motor complications when other optimized medical treatments have failed?

A

Deep Brain Stimulation

  • subthalamic nucleus
  • globus pallidus interna
28
Q

What electrolyte imbalance can mimic Parkinson’s dementia?

A

hypoNa+

confusion, disorientation, drowsiness

29
Q

What is the typical age of onset for Parkinson’s Disease?

A

60 yrs

30
Q

What two drugs can be used to treat a Parkinson’s tremor that is causing a disability?

A
  • propranolol (beta blocker)

- primidone (barbiturate)

31
Q

What is a class of enzymes that metabolizes dopamine and is inhibited by selegiline and rasagiline?

A

MAO-B

monoamine oxidase B

32
Q

What are the characteristics of entacapone?

A
  • COMT inhibitor (catechol-O-methyltransferase)
  • cannot cross BBB (restricted to periphery)
  • blocks levodopa degradation
  • used to treat “off” symptoms
33
Q

In regards to the MAO-B inhibitors, how does the binding of selegiline and rasagiline differ from the binding of safinamide?

A
  • safinamide binds reversibly

- selegiline and rasagiline bind irreversibly

34
Q

What is the most potent anti-Parkinson therapy that patients are fearful of starting?

A

levodopa

35
Q

In Parkinson’s Disease, what is one way to administer levodopa-carbidopa that can reduce off-times when compared w/ standard oral levodopa?

A

-intrajejunal enteric gel (levodopa-carbidopa) through percutaneous gastrostomy

  • -substantially reduces “off-time”
  • -reduces dyskinesia
36
Q

What type of cancer at Parkinson’s patients more at risk of developing?

A

melanoma

-risk exacerbated by Tx w/ ropinirole (DA agonist)

37
Q

What is Parkinson’s Disease?

A

-neurodegenerative disorder that predominantly affects dopaminergic neurons in the substantia nigra

-70-80% loss of dopaminergic neurons in Parkinson’s
(some loss during aging is normal, but not this much!)

38
Q

What drugs can be used to treat psychosis in Parkinson patients?

A
  • atypical antipsychotics (ex: quetiapine, clozapine)

- also pimavanserin, serotonin 5-HT2a inverse agonist

39
Q

What is the mechanism of action of amantidine?

A
  • unknown
  • direct and indirect effects of DA neurons
  • weak NMDA receptor antagonist
40
Q

Of the MAO-B inhibitors, which is the most highly selective for the receptor?

A

safinamide (which binds reversibly)

41
Q

What NTR stimulates GABAergic neurons?

A

Ach

42
Q

What is the mechanism of action of gabapentin and one movement disorder it can be used to treat?

A
  • -alpha-2-delta calcium channel ligand

- -restless leg syndrome

43
Q

What class of drugs should be used to treat arterial HTN in Parkinson’s patients (who tend to have orthostatic hypotension)?

A

angiotension receptor blockers (ARB’s)

–ex: (valsartan, losartan)

44
Q

What is dystonia?

A
  • sustained involuntary muscular contractions/spasms

- abnormal postures

45
Q

What is akathisia?

A
  • subjective: feeling of restlessness
  • objective: pacing, foot shaking, toe tapping, rocking
  • get distressed if restrained
  • symptoms may improve when asleep or supine
46
Q

In what region of the brain does dopaminergic stimulation generate reward, pleasure, euphoria, motivation, perseverance, etc?

A

frontal cortex

47
Q

True or False: treatments for Parkinson’s alter the progression of the disease

A

False

48
Q

What dopamine agonist (same category as ripinirole) has decreased risk of hypotension, but increased risk of hallucinations?

A

pramipexole

49
Q

True or False: restless leg syndrome may resolve when a co-existing iron-deficiency anemia is corrected

A

True

50
Q

True or False: tyramine in conjunction w/ MAO-B inhibitors can cause a HTN crisis

A

False

51
Q

What is the only drug that has any impact on survival (or time to tracheostomy) in ALS (amyotrophic lateral sclerosis) patients?

A

riluzole
(inhibits glutamate release, blocks post-synaptic NMDA receptors, and inhibits voltage-dependent Na+ channels)

-side effects: nausea, weakness

52
Q

True or False: parkinsonism can be induced by typical antipsychotics

A

True

53
Q

What is a major risk factor for drug-induced dyskinesias?

A

age

54
Q

What dopamine agonist (same class as ropinirole) can be administered in the form of a 24hr transdermal patch?

A

rotigotine

55
Q

How can apomorphine be used to treat Parkinson patients?

A
  • dopamine agonist
  • sublingual or subQ
  • quickly treats “off” episodes
56
Q

How can potassium disulfide be used to treat Wilson Disease?

A

-reduces intestinal absorption of copper

can be prescribed in addition to penicillamine

57
Q

What type of neuron are lost in Huntington Disease?

A

GABA-ergic

58
Q

What is an ergot-derivative dopamine agonist that was used early on in the treatment of Parkinson’s Disease, but is now declining in use?

A

bromocriptine

NMSP 1 (9 decks)

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