Movement Disorder Meds Flashcards
levodopa
immediate precursor to dopamine, crosses BBB
carbidopa
peripheral DOPA decarboxylase inhibitor
given with levodopa to increase bioavailability (if not given, most used up in periphery)
LIMITS peripheral side effects (N, V, hallucinations, arrhythmias, postural hypotension)
selegiline
inhibitor of MAO-B
MAO-B eats dopamine, so selegiline inhibits it to increase dopamine
with antidepressants: increase SI risk in pediatric population
adjunct with carbidopa/levodopa to help with on-off/wearing off phenomenon
amantadine
previously treated flu
enhances endogenous dopamine: increases release, decreases reuptake so more in system
monotherapy (mild motor sx) or adjunct with levodopa
side effects: CNS depression, impulse control probs, psychosis, SI/depression, livedo reticularis
ropinirole
D2 agonist to increase dopamine
side effects: N,V, constipation, headaches, CNS problems, increase melanoma risk, orthostatic hypotension
pramipexole
D3 agonist
also treats restless leg syndrome (RLS)
tolcapone
central and peripheral COMT inhibitor (stops inactivation of levodopa)
risk of liver failure
entacapone
peripheral COMT inhibitor (can’t cross BBB)
helps treat on-off/wearing off sx of levodopa
benztropine
antimuscarinic
helps tremor and rigidity
doesn’t affect bradykinesia
reduce saliva with drooling problems
avoid in cognitive impairment and elderly
What MAO preferentially eats dopamine?
MAO-B
inhibited by selegiline
What MAO preferentially eats dopamine?
MAO-B
inhibited by selegiline
What is on-off/wearing off effect in levodopa treated patients?
switch between mobility and immobility
–> worsening of motor fxn and being normal
What is on-off/wearing off effect in levodopa treated patients?
switch between mobility and immobility
–> worsening of motor fxn and being normal
Do you want to start with levodopa with mild Parkinson’s?
no d/t wearing off effect
start with amatidine or selegiline
What to use with essential/initiation tremor?
propranolol
primidone
BOTOX
