Movement Disorders Drugs (Wolff) Flashcards
What are the 4 cardinal features of Parkinson’s disease?
bradykinesia
muscular rigidity
resting tremor
impairment of postural balance
Normal function of dopamine in the basal striatum?
releases the brakes on motor neurons by inhibitinh GABAnergic neurons; GABA inhibits (acts as break) to motor neurons
What are the 3 dopamine receptor agonist?
- Ropinirole
- Apomorphine (sublingual film or subQ injection)
- Rotigotine (24 hr transdermal patch)
Ropinirole
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
What is the one dopamine analog used in Parkinson’s disease?
Levodopa
MOA-B inhibitors
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
Selegiline
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
Adverse effects of selegiline
increased risk for suicidal thoughts and behaviors; may cause patients to fall asleep while engaged in activities of daily living
Which drug has an adverse affect of impulse control disorders/compulsive behaviors?
Ropinirole; dopamine receptor agonist (D2 and D3) used to treat the symptoms of Parkinson’s disease
Adverse effects of Ropinirole?
impulse control disorders/compulsive behaviors (gambling, hyper sexuality, compulsive buying); dyskinesias, orthostatic hypotension, somnolence (falling asleep while engaging in daily activities)
24 hr transdermal patch dopamine receptor agonist?
Rotigotine
Sublingual film or subQ injection dopamine receptor agonist?
Apomorphine; used to treat “off” episodes
COMT inhibitors
“capones”
Tolcapone** and Entacapone
Tolcapone
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
Why is Tolcapone a last resort drug in PD treatment?
potentially fatal acute fulminant liver failure
Anti-cholinergic drug used to treat Parkinson’s disease?
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
Benztropine
cholinergic antagonist; indicated for tremor and dystonia in younger population; avoided in elderly and those with cognitive impairments; reduces saliva and drooling
amantadine
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)
What is the most potent antiparkinson therapy?
levodopa
Which antiparkinson therapy can cause purplish mottled discoloration on the skin?
amantadine; weak, noncompetitive NMDA antagonist; livedo reticularis (purplish mottled discoloration of the skin - usually the legs)
