Movement Disorders Drugs (Wolff)

Question 1

What are the 4 cardinal features of Parkinson’s disease?

Answer 1

bradykinesia
muscular rigidity
resting tremor
impairment of postural balance

Question 2

Normal function of dopamine in the basal striatum?

Answer 2

releases the brakes on motor neurons by inhibitinh GABAnergic neurons; GABA inhibits (acts as break) to motor neurons

Question 3

What are the 3 dopamine receptor agonist?

Answer 3

1. Ropinirole
2. Apomorphine (sublingual film or subQ injection)
3. Rotigotine (24 hr transdermal patch)

Question 4

Ropinirole

Answer 4

dopamine receptor agonist (D2 and D3) used to treat the symptoms of Parkinson’s disease; does not slow the disease process; also indicated in restless leg syndrome; toxicity of impulse control disorders/compulsive behaviors

Question 5

What is the one dopamine analog used in Parkinson’s disease?

Answer 5

Levodopa

Question 6

MOA-B inhibitors

Answer 6

Selegiline; MOA-B metabolizes dopamine (breaks down); irreversibly (potent) inhibits MAO; adjunct in PD management; given as tablet, need to taper dose off over 2-4 weeks; increased risk for suicidal thoughts and behaviors; may cause patients to fall asleep while engaged in activities of daily living

Question 7

Selegiline

Answer 7

irreversibly (potent) MOA-B inhibitor; adjunct in PD management; given as tablet, need to taper dose off over 2-4 weeks; increased risk for suicidal thoughts and behaviors; may cause patients to fall asleep while engaged in activities of daily living

Question 8

Adverse effects of selegiline

Answer 8

increased risk for suicidal thoughts and behaviors; may cause patients to fall asleep while engaged in activities of daily living

Question 9

Which drug has an adverse affect of impulse control disorders/compulsive behaviors?

Answer 9

Ropinirole; dopamine receptor agonist (D2 and D3) used to treat the symptoms of Parkinson’s disease

Question 10

Adverse effects of Ropinirole?

Answer 10

impulse control disorders/compulsive behaviors (gambling, hyper sexuality, compulsive buying); dyskinesias, orthostatic hypotension, somnolence (falling asleep while engaging in daily activities)

Question 11

24 hr transdermal patch dopamine receptor agonist?

Answer 11

Rotigotine

Question 12

Sublingual film or subQ injection dopamine receptor agonist?

Answer 12

Apomorphine; used to treat “off” episodes

Question 13

COMT inhibitors

Answer 13

“capones”
Tolcapone** and Entacapone

Question 14

Tolcapone

Answer 14

LAST RESORT DRUG; reversible COMT inhibitor; blocks the degradation of levodopa degradation; given in adjunct to levodopa and carbidopa; potentially fatal acute fulminant liver failure

Question 15

Why is Tolcapone a last resort drug in PD treatment?

Answer 15

potentially fatal acute fulminant liver failure

Question 16

Anti-cholinergic drug used to treat Parkinson’s disease?

Answer 16

Benztropine (sounds like atropine)
cholinergic antagonist; indicated for tremor and dystonia in younger population; avoided in elderly and those with cognitive impairments; reduces saliva and drooling

Question 17

Benztropine

Answer 17

cholinergic antagonist; indicated for tremor and dystonia in younger population; avoided in elderly and those with cognitive impairments; reduces saliva and drooling

Question 18

amantadine

Answer 18

weak, noncompetitive NMDA antagonist; indicated for drug induced extrapyramidal symptom of PD; can cause CNS depression, sleeping while engaged in activities; psychosis, suicidal ideation and depression and livedo reticularis (purplish mottled discoloration of the skin - usually the legs)

Question 19

What is the most potent antiparkinson therapy?

Answer 19

levodopa

Question 20

Which antiparkinson therapy can cause purplish mottled discoloration on the skin?

Answer 20

amantadine; weak, noncompetitive NMDA antagonist; livedo reticularis (purplish mottled discoloration of the skin - usually the legs)