Movement disorder drugs Flashcards
what illegal drug can induce Parkinson
MPTP
what is the oxidative stress theroy
increased lipid per oxidation
increase iron levels
reduce levels of GSH
complex I deficiency
what are 2 main MOA for Parkinson’s drugs
Increasing dopamine signal
decrease ACh signal
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
what is the MOA for Levodopa
metabolic precursor of DA
converted to DA by L-aromatic amino acid (Dopa) decarboxylase
what are the actions of Levodopa
decrease rigidity
decrease tremor
what are side effects of Levodopa from over activity of DA at receptors
visual, auditory hallucinations
Dyskinesia
what are other side effects of Levodopa
occasional psychotic symptoms
Levodopa has what phenomenon
“on-off”
on: associated with relief
off: during low levels of L-dopa
you should not give Levodopa with what
within 14 days of MAOI
Pyriodoxine ( B6): increases peripheral breakdown
what is a contraindication of Levodopa
avoid rapid discontinuation-syndrome similar to neuroleptic malignant syndrome
MOA of Carbidopa
aromatic L-dopa acid decarboxylate inhibitor
decreases peripheral dopa
decreases peripheral side effects of L-Dopa
when does the doctor prescribe Carbidopa
Levodopa
what type of drug is entacapone
COMT inhibitor
does Entacapone cross BBB
no
When is Entacapone used
conjunction with levodopa/carbidopa
patients who have end of dose wearing off
Tolcapone MOA
inhibits peripheral and COMT
domes Tolcapone cross BBB
yes
what is a side effect of Tolcapone
fulminating hepatic necrosis
what is the caution use for Tolcapone
if no clinical improvement after 3 weeks of therapy (regardless of dose) , discontinue
Selegline is what type of drug
monoamine oxidase B inhibitor
Selegline is metabolized how
amphetamine, potentiating effects of DA in brain
compare Rasagiline and Selegiline
Rasagiline more potent
what are common side effects of Selegline
headache
insomnia
dizziness
nasuea
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
E
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
SC
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
