Movement Disorders

Question 0

Carbidopa

Answer 0

• inhibits peripheral DOPA decarboxylase

- *given with L-DPA to increase bioavailability

Question 1

Levadopa

L-dopa

Answer 1

-dopamine can’t cross BBB
-L-DOPA is precursor to dopamine
-gold standard for PD
MOA
-increase bioavailability of dopamine
ADE
-GI- nausea, vomiting, anorexia
-dyskinesia
-behavioral effects - depression, anxiety, agitation, hallucinations
-on-off phenomenon (in movement) fluctuations in response. related to timing of doses
Contra
-psychotic pts
-angle-closure glaucoma

Question 2

Pramipexole

Answer 2

-dopamine D3 receptor agonist
-for pts w/ mild to advanced disease
-permits reduction in L-DOPA
-may ameliorate affective symptoms
ADE
-GI-anorexia, nausea, vomitting
-CV-postural hypotension
-dyskinesia
-mental disturbances
Contra
-psychotic illness
-recent myocardial infarction
-peptic ulcers

Question 3

Ropinerole

Answer 3

-Dopamine D2 receptor agonist
-monotherapy beneficial in pts w/ mild to advanced disease
-smoothing of response to L-DOPA pt in advanced states
-also used to treat restless leg syndrome
ADE
-GI-anorexia, nausea, vomitting
-CV-postural hypotension
-dyskinesia
-mental disturbances
Contra
-psychotic illness
-recent myocardial infarction
-peptic ulcers

Question 4

Rotigotine

Answer 4

-Dopamine D2 receptor agonist
-efficacy in advanced states of PD unclear
ADE
-GI-anorexia, nausea, vomitting
-CV-postural hypotension
-dyskinesia
-mental disturbances
Contra
-psychotic illness
-recent myocardial infarction
-peptic ulcers

Question 5

Apomorphine

apokyn

Answer 5

-dopamine D2 receptor agonist
-temporary relief of on-off periods of akinesia
-used acutely and briefly w/ L-DOPA in PD tx, esp w/ L-DOPA in of-off periods
ADE
-nausea
-vomiting
-dyskinesia
-hypotension

Question 6

Amantadine

Answer 6

-used for PD (acute), bradykinesia, rigidity, tremor
-*antiviral agent for influenza type-A and rubella
MOA
-increases dopaminergic transmission by 1. increase synthesis & release 2. decrease reuptake
-or antagonize adensine
ADE
-hallucinations, depression, agitation
-GI disturbances

Question 7

Selegiline

Answer 7

-Monoamine oxidase inhibitor (MAO) metabolizes dopamine
MOA
-inhibits MAO-B=increase bioavailability of dopamine
-enhances and prolongs L-DOPA action
ADE
-may enhance ADE of L-DOPA
-pt using SSRIs or TCAs

Question 8

Rasagiline

Answer 8

-MAO metabolizes dopamine
MOA
-inhibits MAO-B=increase bioavailability of dopamine
-used to prolong L-DOPA/carbidopa in pts w/ advanced disease
ADE
-may enhance ADE of L-DOPA
-pt using SSRIs or TCAs

Question 9

Entacapone

Answer 9

-COMT metabolizes dopamine
-given w/ L-DOPA+carbidopa
MOA
-inhibits COMT->decrease metabolism of L-DOPA in periphery->prolongs action
ADE
-dyskinesia
-nausea
-confusion
-sleep disturbances
-postural hypotension

Question 10

Benztropine

Answer 10

-Ach blocking agent
-used for tremor and rigidity
-little effect for bradykinesia
MOA
-muscarinic receptor antagonist
-curb excess cholinergic activity
ADE
-mydriasis
-loss of accommodation
-dry mouth