Movement Disorder Pharm

Question 1

Levadopa/Carbidopa (Sinemet)

Answer 1

Gold standard of treatment
Generally used 1st line
Relieves akinesia, rigidity and tremor in 80%
Increases vigor and well-being
Symptomatic relief only

Question 2

Levadopa/Carbadopa MOA

Answer 2

Immediate metabolic precursor to dopamine, penetrates the brain, where it is converted into dopamine.
Carbadopa prevents levadopa from being metabolized, making it more effective.

Question 3

Sinemet SE

Answer 3

Hypotension
Arrhythmia
GI effects
Hair loss
Dyskinesias (80%)
Confusion, anxiety, hallucination, vivid dreams

Question 4

Best dosage for Sinemet

Answer 4

Multiple small doses on empty stomach
Liquid form
Controlled release formulation

Question 5

Sinemet CI

Answer 5

Concurrent use with MAOI’s
Psychotic patients
Angle closure glaucoma
Hx of melanoma

Question 6

Sinemet wearing off effect

Answer 6

WIthin 4-6 years medication becomes less effective.

Question 7

Selegiline

Answer 7

MAO-B inhibitor
Stops breakdown of dopamine
Enhances Levodopa

Question 8

Rasagiline (Azilect)

Answer 8

MAO-B Inhibitor
More potent than Seligiline
Enhances peak levodopa levels

Question 9

MAO-B SE

Answer 9

Insomnia
Jitteriness
Dyskinesias
Orthostatic hypotension

Question 10

Pramipexole (Mirapex)

Ropiranole (Requip)

Answer 10

Dopamine agonists
Stimulate dopamine receptors in substantia nigra
Improves movement and disability
May delay need for levodopa

Question 11

Dopamine agonist SE

Answer 11

Drowsiness and sleepiness
Nausea and constipation
HA
Orthostatic hypotension
Nightmares, hallucinations, psychosis
Dyskinesias

Question 12

Apomorphine (Apokyn)

Answer 12

Dopamine agonist
Treats acute episodes of hypermobility and freezing
Given SQ, very expensive
Must be given with antiemetic

Question 13

Apomorphine (Apokyn) SE

Answer 13

N/V (profound)
Yawning
Dyskinesias
Sedation
Dizziness

Question 14

COMT Inhibitors

Answer 14

Entacapone (Comtan)
Tolcaptone (Tasmar)
Inhibits breakdown of dopamine in brain
Only taken concordantly with levadopa/carbadopa

Question 15

COMT inhibitor SE

Answer 15

Involuntary muscle movements
Confusion, hallucinations
Cramps, N/Diarrhea
Insomnia
HA
Urine discoloration

Question 16

Amantadine

Answer 16

Stimulates synthesis, release and uptake of dopamine.
Useful for early mild symptoms
Improves akinesia and tremor
Used as adjunct therapy

Question 17

Amantadine SE

Answer 17

Sedation
Vivid dreams
Dry mouth
Depression
Hallucinations

Question 18

Acetylcholine blocking agents

Answer 18

Trihexyphidyl (Artane)
Benztropine (Cogentin)
Anticholinergic
Used primarily for tremor

Question 19

Acetylcholine blocking agents CI

Answer 19

BPH
Obstructive GI dz
Angle closure glaucoma