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D&T2 Exam 1 > Movement disorder drugs > Flashcards

Movement disorder drugs Flashcards

1
Q

what illegal drug can induce Parkinson

A

MPTP

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2
Q

what is the oxidative stress theroy

A

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

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3
Q

what are 2 main MOA for Parkinson’s drugs

A

Increasing dopamine signal

decrease ACh signal

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4
Q

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

A

over activity of indirect pathway

-increase glutaminergic output from the subthalamic nucleus

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5
Q

what is the MOA for Levodopa

A

metabolic precursor of DA

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

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6
Q

what are the actions of Levodopa

A

decrease rigidity

decrease tremor

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7
Q

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

A

visual, auditory hallucinations

Dyskinesia

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8
Q

what are other side effects of Levodopa

A

occasional psychotic symptoms

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9
Q

Levodopa has what phenomenon

A

“on-off”

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

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10
Q

you should not give Levodopa with what

A

within 14 days of MAOI

Pyriodoxine ( B6): increases peripheral breakdown

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11
Q

what is a contraindication of Levodopa

A

avoid rapid discontinuation-syndrome similar to neuroleptic malignant syndrome

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12
Q

MOA of Carbidopa

A

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

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13
Q

when does the doctor prescribe Carbidopa

A

Levodopa

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14
Q

what type of drug is entacapone

A

COMT inhibitor

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15
Q

does Entacapone cross BBB

A

no

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16
Q

When is Entacapone used

A

conjunction with levodopa/carbidopa

patients who have end of dose wearing off

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17
Q

Tolcapone MOA

A

inhibits peripheral and COMT

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18
Q

domes Tolcapone cross BBB

A

yes

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19
Q

what is a side effect of Tolcapone

A

fulminating hepatic necrosis

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20
Q

what is the caution use for Tolcapone

A

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

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21
Q

Selegline is what type of drug

A

monoamine oxidase B inhibitor

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22
Q

Selegline is metabolized how

A

amphetamine, potentiating effects of DA in brain

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23
Q

compare Rasagiline and Selegiline

A

Rasagiline more potent

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24
Q

what are common side effects of Selegline

A

headache
insomnia
dizziness
nasuea

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25
Q

what are less common side effects of Selegline

A

hypotension
pain
weight loss

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26
Q

what should be avoided when taking Selegline

A

SSRI
tyramine food
other MAO inhibitors

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27
Q

Rasagiline is an adjunct therapy with wha

A

levadopa/carbidopa

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28
Q

MOA for Bromocriptine

A

potent D2 agonist

ergot

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29
Q

how should Pramipexole be dosed appropriately

A

lower dose for renal insufficiency patients

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30
Q

Pramiperxole is a dopamine agonist but what else does it treat

A

restless leg syndrome

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31
Q

MOA for Ropinirole

A

D2 receptor agonist

32
Q

Apomorphine is used when

A

rescue therapy

continuous infusions to treat “off” episodes

33
Q

Pergolide MOA

A

D1 and D2 agonist

ergot

34
Q

why was Rotigone withdrawn from markter

A

due to crystal formulation at site of patch inducing skin rash

35
Q

Dopamine agonists have side effects of what systems

A

GI
CV
dyskinesias
mental

36
Q

when do mental side effects occur with dopamine agonists

A

taken withLevodopa

37
Q

what are side effects of Ergot agnoists

and Pramiprexiole and roprinirole

A

uncontrollable tendency to fall asleep
pulmonary tendencies
-discontinue medication use

38
Q

What are CV symptoms seen with dopamine agonsts

A

postural hypotension

painless digital vasospasms

39
Q

Amantadine is what type of drug

A

antiviral drug

40
Q

MOA for Amantadine

A

enhances DA synthesis and release

inhibits DA reuptake

41
Q

when is Amantadine used

A

early stages of PD or as supplement

42
Q

compare the side effects of Amantadine with L-Dopa

A

Amentadine is less severe

43
Q

talk about the half life of Amantadine

A

variable

44
Q

how do Antimuscarinic agents work

A

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

45
Q

what is the most common antimuscarnic given for Parkinsons in US

A

Trihexyphenidyl

46
Q

when would a doctor prescribe an antimuscarnic

A

younger patients with initial mild tremors

47
Q

MOA of Tetrabenazine

A

blocks dopamine reuptake into presynaptic vesicles

48
Q

side effect of Tetrabenazine

A

mostly dose related and related to dopamine loss

49
Q

what are drug interactions with Tetrabenazine

A

MAOI: use with or within 14 days

use with or within 20 days of reserpine

50
Q

what are the atypical antipsychotic dopamine antagonist

for Huntingtons

A

Risperidone

Alanzapeine

51
Q

what are the typical antipsychotic dopamine antagonist for Huntington’s

A

chlorpromazine

Haloperidol

52
Q

MOA for Baclofen

A

GABA analog

GABAb agonist

53
Q

how does Baclofen work in the brain

A

low penetration of brain

slow clearance from brain

54
Q

what happens when Baclofen interacts with other drugs

A

CNS depression of other drugs

55
Q

Who is more prone to CNS effects of Baclofen

A

elderly patients

56
Q

MOA of Riluzole

A

inhibitory effect on glutamate release

inactivation of voltage-dependent sodium channels

57
Q

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

A

Insomnia

titrate dose slowly

58
Q

what was the first approved agent for Alzhiemers

A

Tacrine

59
Q

what drug is used to treat mild to moderate AD

A

Donepezil

60
Q

what is the drug interaction with Acetylcholine esterase inhibitor

A

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

61
Q

MOA for Memantine

A

NMDA antagonist

62
Q

how is Memantine elimination reduced

A

by alkaline urine pH

63
Q

what is the drug interaction of Memantine

A

carbonic anhydrase inhibitor my inhibit excretion

64
Q

what should be avoided when taking Memantine for AD

A

drugs and diet that alter urine pH

65
Q

What vitamin can help AD

A

E

66
Q

Methylene Bue MOA

A

strong MAOI

67
Q

what are interferon B-1a and b used for

A

Relapsing remitting multiple sclerosis

68
Q

how is IFN beta 1 a administered
Avonex?
Rebif?

A

A: IM
Rebif: SC

69
Q

how is IFN beta 1b administered

A

SC

70
Q

what is Glatiramer used for

A

RRMS

relapsing remitting multiple sclerosis

71
Q

Glatiramer is used in combination with

A

IFNs

72
Q

what is Mitoxantrone used for

A 
worsening RRMS (relapsing remitting multiple sclerosis)
PMS ( progressive multiple sclerosis)
73
Q

what is Natiluzamab used for? when is it used

A

RRMS

generally second line agent due to side effects

74
Q

Side effect of Natiluzamab

A

potential for progressive multifocal leukoencephalopathy

75
Q

what is Methylprednisolone used for

A 
PMS 
acute relapse (first choice)
76
Q

what is used as an antispasmodics for MS

A

Baclofen

D&T2 Exam 1 (22 decks)

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