Movement Disorder Medications Flashcards

1
Q

Levadopa MOA

A

Converted into dopamine after it crosses the blood-brain barrier thus increasing intraparenchymal levels of dopamine (dopamine precursor)

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2
Q

Side effects levadopa

A

Nausea/vomiting, dyskinesias, orthostatic hypotension

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3
Q

Why is carbadopa given with levadopa?

A

Reduce the GI side effects and reduce levodopa’s peripheral plasma breakdown

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4
Q

Is levodopa safe in pregnancy?

A

Yes

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5
Q

COMT inhibitors (tolcapone and entacapone) MOA

A

Reduces methylation of levodopa and dopamine, which increases levodopa’s half-life

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6
Q

What medication do COMT inhibitors need to be given with to work?

A

Levadopa

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7
Q

COMT inhibitor side effects

A

Severe diarrhea and discoloration of urine

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8
Q

MAO-B inhibitors (rasageline and selegiline) MOA

A

Decreases the catabolism of dopamine, resulting in a greater peak effect and less wearing off when used in combination with levodopa

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9
Q

When can MAO-B inhibitors be used as monotherapy?

A

Early PD

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10
Q

Side effect of MAO-B inhibitors

A

Tyramine heavy foods -> severe tachycardia and hypertensive crisis (can be fatal)
Serotonin syndrome - rare

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11
Q

Direct dopamine agonist (DDA) MOA

A

Agonists to the dopaminergic D2 receptors

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12
Q

DDA medications

A

Bromocriptine, pramipexole, ropinirole, rotigotine, and apomorphine

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13
Q

DDA side effects

A

First generation: cardiac valvulopathy
Impulse-control disorder, hallucinations, nausea, orthostatic hypotension, peripheral edema

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14
Q

Which DDAs are known to worsening driving drowsiness?

A

Pramipexole and ropinirole

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15
Q

If combined with levodopa, what symptoms can worsen with DDAs?

A

Dyskinesias

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16
Q

Amantadine MOA

A

Anti-dyskinetic effect by reducing the frequency of abnormal involuntary movements due to levodopa; helpful for resting tremor
N-methyl-d-aspartate (NMDA) receptor antagonist

17
Q

Amantadine side effects

A

Livedo reticularis, confusion, hallucinations, ankle edema, constipation

18
Q

When would anticholinergics (trihexyphenidyl and benztropine) be used for PD?

A

Patients younger than 60 because of cognitive concerns with tremor-predominant dysfunction, bradykinesia, postural instability, and/or rigidity

19
Q

Side effects of trihexyphenidyl and benztropine?

A

Cognitive dysfunction, urinary retention, dry mouth, and GI disturbance

20
Q

What is the antipsychotic of choice for PD-related psychosis?

A

Clozapine
* Preferential inhibition of dopamine receptors in the frontal lobe
* Side effects: bone marrow suppression

21
Q

What is the only FDA approved medication specifically for Parkinson’s disease psychosis?

A

Pimavanserin
* Serotonin 5-HT2A receptor inverse agonist and antagonist

22
Q

DBS only has effect on which symptoms of PD?

A

Motor symptoms

23
Q

Neurosurgical interventions for PD

A

Targeting of the basal ganglia;
High-frequency stimulation (deep brain stimulation)
Lesioning (focused ultrasound)

24
Q

Location for DBS placement

A

Ventral intermediate nucleus (VIM) of the thalamus (for tremor)
Globus pallidus interna (GPi)/subthalamic nucleus (STN) (tremor, bradykinesia, and rigidity)

25
First line treatment for restless leg syndrome
Gabapentin encarbil Alpha-delta-2 calcium-channel ligand
26
What can a lesion in the ventral posterior lateral thalamic nucleus case?
Contralateral sensory loss, paresthesia and pain. Input from contralateral for joint and vibration sense
27
What physical finding will almost all patients have with Wilson's disease?
Kayser-fleisher rings
28
What is the first line medication for sydenham chorea?
Dopamine receptor agonists (typical or atypical antipsychotic) -> fluphenazine
29
When does sydenham chorea usually appear after group A strep infection?
1-8 months
30
What is first line treatment for cervical dystonia?
Botox
31
What type of tremor is seen with cervical dystonia?
"Yes-yes" or "no-no" tremor
32
What is "geste antagnoiste"?
Sensory trick Where symptoms improve when affected body part if touched Seen in dystonia
33
Features of hemifacial spasms?
Twitching involving the orbicularis oculi Can spread to perioral facial muscles and platysma Worse with stress and can occur in sleep
34
What is a possible cause of hemifacial spasms?
HTN from compression on CN IX and X due to vascular compression
35
Features of blepharospasms?
b/l synchronous contractions pf periocular muscles