Movement disorders

Question 1

What path = MORE movement when it’s stimulated? (how)

Answer 1

Direct

(Substantia Nigra is ON
= Subnigra to deactivate the antagonist to cause movements.)

More dopamine = relief of movement suppression.

Question 2

What path = LESS movement when it’s stimulated?

Answer 2

Indirect

(substantia Nigra is OFF
= subthalamic glutamate agonism activation, turning the antagonists off at thalamic nuclei.)

Less dopamine = movement suppression

Question 3

Cause of Parkinson & %

Answer 3

Genetics load the gun the environment pulls the trigger.

70-80% before symptoms develop.

Question 4

Parkinson What is the treatment?

Answer 4

No Cure

L-Dopa - precursor to DA

1-2hr DOA

Could give Dopamine Agonist… but has side effects

Question 5

Sinemet (use & MOA)

Answer 5

No BBB, Inhibits AAAD in peripheria.
Decreases Dose by 1/4, and less GI side effects.
Avoid taking near meals.

Question 6

Rescue Drug for Parkinson

Answer 6

Apomorphine

Question 7

Ropinirole (use & S/Effects)

Answer 7

DA agonist, Restless Leg Syndrome

Less side effects:
fatigue, nausea, hypotension, constipation, insomnia

Question 8

Pramipexole (use & S/Effects)

Answer 8

DA agonist

Less side effects:
fatigue, nausea, hypotension, constipation, insomnia

Question 9

COMT Inhibition (Is What?)

Answer 9

If AAAD is blocked COMT becomes primary peripheral pathway for L-Dopa to DA = Side Effects

Question 10

Tolcapone (use & S/Effects)

Answer 10

COMT Inhibitor

Dyskinesia, diarrhea, nausea, hallucinations

Liver Toxic

Question 11

Entacapone (use & S/Effects)

Answer 11

COMT Inhibitor

Dyskinesia, diarrhea, nausea, hallucinations

No Liver Toxicity, Orange urine

Question 12

Amantadine (use & S/Effects)

Answer 12

Antiviral Rx

Enhances DA release and Less reuptake.

First Line tx early-on.

Question 13

Anticholinergics for PD (use & S/Effects)

Answer 13

Severe Tremors & Dystonia only

Too many side effects

Question 14

How to treat PD? (RX)

Answer 14

1st - Amantadine, Pramipexole OR Ropinirole
2nd - L-Dopa (Sinemet)
3rd - \Sinemet & start agonists OR COMT OR Amantadine

Question 15

Rasagiline (class)

Answer 15

MAO-B

Question 16

Huntington’s (receptors & progression)

Answer 16

GABA & ACh

lose indirect Stop first.
then lose direct GO function.

Question 17

Huntington’s (Treatment)

Answer 17

Drugs suck at working.

Remove DA (reserpine)
Block receptors (Haldol)
PD & Hunt... your screwed, CHOREA

Question 18

Wilson’s disease (receptors & progression)

Answer 18

Copper metabolism
Liver damage and neuron in basal ganglia=bizar movements
Untreated=DEATH.

Question 19

Wilson’s disease (Treatment)

Answer 19

Penicillamine OR Trientine (chelation)

Question 20

Restless leg syndrome (treatments)

Answer 20

DA agonist
Ropinirole
&
Pramipexole