Movement Disorder Medications

Question 1

Levadopa MOA

Answer 1

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

Question 2

Side effects levadopa

Answer 2

Nausea/vomiting, dyskinesias, orthostatic hypotension

Question 3

Why is carbadopa given with levadopa?

Answer 3

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

Question 4

Is levodopa safe in pregnancy?

Answer 4

Yes

Question 5

COMT inhibitors (tolcapone and entacapone) MOA

Answer 5

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

Question 6

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

Answer 6

Levadopa

Question 7

COMT inhibitor side effects

Answer 7

Severe diarrhea and discoloration of urine

Question 8

MAO-B inhibitors (rasageline and selegiline) MOA

Answer 8

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

Question 9

When can MAO-B inhibitors be used as monotherapy?

Answer 9

Early PD

Question 10

Side effect of MAO-B inhibitors

Answer 10

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

Question 11

Direct dopamine agonist (DDA) MOA

Answer 11

Agonists to the dopaminergic D2 receptors

Question 12

DDA medications

Answer 12

Bromocriptine, pramipexole, ropinirole, rotigotine, and apomorphine

Question 13

DDA side effects

Answer 13

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

Question 14

Which DDAs are known to worsening driving drowsiness?

Answer 14

Pramipexole and ropinirole

Question 15

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

Answer 15

Dyskinesias

Question 16

Amantadine MOA

Answer 16

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

Question 17

Amantadine side effects

Answer 17

Livedo reticularis, confusion, hallucinations, ankle edema, constipation

Question 18

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

Answer 18

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

Question 19

Side effects of trihexyphenidyl and benztropine?

Answer 19

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

Question 20

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

Answer 20

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

Question 21

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

Answer 21

Pimavanserin
* Serotonin 5-HT2A receptor inverse agonist and antagonist

Question 22

DBS only has effect on which symptoms of PD?

Answer 22

Motor symptoms

Question 23

Neurosurgical interventions for PD

Answer 23

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

Question 24

Location for DBS placement

Answer 24

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

Question 25

First line treatment for restless leg syndrome

Answer 25

Gabapentin encarbil
Alpha-delta-2 calcium-channel ligand

Question 26

What can a lesion in the ventral posterior lateral thalamic nucleus case?

Answer 26

Contralateral sensory loss, paresthesia and pain.
Input from contralateral for joint and vibration sense

Question 27

What physical finding will almost all patients have with Wilson’s disease?

Answer 27

Kayser-fleisher rings

Question 28

What is the first line medication for sydenham chorea?

Answer 28

Dopamine receptor agonists (typical or atypical antipsychotic) -> fluphenazine

Question 29

When does sydenham chorea usually appear after group A strep infection?

Answer 29

1-8 months

Question 30

What is first line treatment for cervical dystonia?

Answer 30

Botox

Question 31

What type of tremor is seen with cervical dystonia?

Answer 31

“Yes-yes” or “no-no” tremor

Question 32

What is “geste antagnoiste”?

Answer 32

Sensory trick
Where symptoms improve when affected body part if touched
Seen in dystonia

Question 33

Features of hemifacial spasms?

Answer 33

Twitching involving the orbicularis oculi
Can spread to perioral facial muscles and platysma
Worse with stress and can occur in sleep

Question 34

What is a possible cause of hemifacial spasms?

Answer 34

HTN from compression on CN IX and X due to vascular compression

Question 35

Features of blepharospasms?

Answer 35

b/l synchronous contractions pf periocular muscles