Movement disorder drugs Flashcards by Bina Malapur

what illegal drug can induce Parkinson

MPTP

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what is the oxidative stress theroy

increased lipid per oxidation
increase iron levels
reduce levels of GSH
complex I deficiency

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what are 2 main MOA for Parkinson’s drugs

Increasing dopamine signal

decrease ACh signal

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In Parkinson’s, there is loss of substantia nigra dopamine which causes what

over activity of indirect pathway

-increase glutaminergic output from the subthalamic nucleus

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what is the MOA for Levodopa

metabolic precursor of DA

converted to DA by L-aromatic amino acid (Dopa) decarboxylase

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what are the actions of Levodopa

decrease rigidity

decrease tremor

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what are side effects of Levodopa from over activity of DA at receptors

visual, auditory hallucinations

Dyskinesia

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what are other side effects of Levodopa

occasional psychotic symptoms

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Levodopa has what phenomenon

“on-off”

on: associated with relief
off: during low levels of L-dopa

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you should not give Levodopa with what

within 14 days of MAOI

Pyriodoxine ( B6): increases peripheral breakdown

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what is a contraindication of Levodopa

avoid rapid discontinuation-syndrome similar to neuroleptic malignant syndrome

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MOA of Carbidopa

aromatic L-dopa acid decarboxylate inhibitor
decreases peripheral dopa
decreases peripheral side effects of L-Dopa

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when does the doctor prescribe Carbidopa

Levodopa

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what type of drug is entacapone

COMT inhibitor

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does Entacapone cross BBB

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When is Entacapone used

conjunction with levodopa/carbidopa

patients who have end of dose wearing off

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Tolcapone MOA

inhibits peripheral and COMT

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domes Tolcapone cross BBB

yes

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what is a side effect of Tolcapone

fulminating hepatic necrosis

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what is the caution use for Tolcapone

if no clinical improvement after 3 weeks of therapy (regardless of dose) , discontinue

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Selegline is what type of drug

monoamine oxidase B inhibitor

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Selegline is metabolized how

amphetamine, potentiating effects of DA in brain

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compare Rasagiline and Selegiline

Rasagiline more potent

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what are common side effects of Selegline

headache
insomnia
dizziness
nasuea

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what are less common side effects of Selegline

hypotension pain weight loss

what should be avoided when taking Selegline

SSRI tyramine food other MAO inhibitors

Rasagiline is an adjunct therapy with wha

levadopa/carbidopa

MOA for Bromocriptine

potent D2 agonist | ergot

how should Pramipexole be dosed appropriately

lower dose for renal insufficiency patients

Pramiperxole is a dopamine agonist but what else does it treat

restless leg syndrome

MOA for Ropinirole

D2 receptor agonist

Apomorphine is used when

rescue therapy | continuous infusions to treat "off" episodes

Pergolide MOA

D1 and D2 agonist | ergot

why was Rotigone withdrawn from markter

due to crystal formulation at site of patch inducing skin rash

Dopamine agonists have side effects of what systems

GI CV dyskinesias mental

when do mental side effects occur with dopamine agonists

taken withLevodopa

what are side effects of Ergot agnoists | and Pramiprexiole and roprinirole

uncontrollable tendency to fall asleep pulmonary tendencies -discontinue medication use

What are CV symptoms seen with dopamine agonsts

postural hypotension | painless digital vasospasms

Amantadine is what type of drug

antiviral drug

MOA for Amantadine

enhances DA synthesis and release | inhibits DA reuptake

when is Amantadine used

early stages of PD or as supplement

compare the side effects of Amantadine with L-Dopa

Amentadine is less severe

talk about the half life of Amantadine

variable

how do Antimuscarinic agents work

decrease the excitatory action of cholinergic neurons in the striatum by blocking muscarinic receptors

what is the most common antimuscarnic given for Parkinsons in US

Trihexyphenidyl

when would a doctor prescribe an antimuscarnic

younger patients with initial mild tremors

MOA of Tetrabenazine

blocks dopamine reuptake into presynaptic vesicles

side effect of Tetrabenazine

mostly dose related and related to dopamine loss

what are drug interactions with Tetrabenazine

MAOI: use with or within 14 days | use with or within 20 days of reserpine

what are the atypical antipsychotic dopamine antagonist | for Huntingtons

Risperidone | Alanzapeine

what are the typical antipsychotic dopamine antagonist for Huntington's

chlorpromazine | Haloperidol

MOA for Baclofen

GABA analog | GABAb agonist

how does Baclofen work in the brain

low penetration of brain | slow clearance from brain

what happens when Baclofen interacts with other drugs

CNS depression of other drugs

Who is more prone to CNS effects of Baclofen

elderly patients

MOA of Riluzole

inhibitory effect on glutamate release | inactivation of voltage-dependent sodium channels

what is an adverse effect of Acetylcholine esterase inhibitor for Alzheimers? how do you prevent this

Insomnia | titrate dose slowly

what was the first approved agent for Alzhiemers

Tacrine

what drug is used to treat mild to moderate AD

Donepezil

what is the drug interaction with Acetylcholine esterase inhibitor

Succinylcholine : prolonged neuromusclar blockade results in increased muscle relaxation during anesthesia NSAIDS: risk of stomach ulcer

MOA for Memantine

NMDA antagonist

how is Memantine elimination reduced

by alkaline urine pH

what is the drug interaction of Memantine

carbonic anhydrase inhibitor my inhibit excretion

what should be avoided when taking Memantine for AD

drugs and diet that alter urine pH

What vitamin can help AD

Methylene Bue MOA

strong MAOI

what are interferon B-1a and b used for

Relapsing remitting multiple sclerosis

how is IFN beta 1 a administered Avonex? Rebif?

A: IM Rebif: SC

how is IFN beta 1b administered

what is Glatiramer used for

RRMS | relapsing remitting multiple sclerosis

Glatiramer is used in combination with

IFNs

what is Mitoxantrone used for

``` worsening RRMS (relapsing remitting multiple sclerosis) PMS ( progressive multiple sclerosis) ```

what is Natiluzamab used for? when is it used

RRMS | generally second line agent due to side effects

Side effect of Natiluzamab

potential for progressive multifocal leukoencephalopathy

what is Methylprednisolone used for

``` PMS acute relapse (first choice) ```

what is used as an antispasmodics for MS

Baclofen