Movement Disorders Pharm

Question 1

Levadopa/Carbidopa (Sinemet)

Answer 1

Known as “Gold standard of treatment”
May be useful to treat dysphasia, seilorrhea, seborrhea and improve functional ability and other secondary motor symptoms.
Most effective against rigidity and slowness.
Less benefit for tremor, balance and gait.

Question 2

Wearing off effect

Answer 2

May occur within 4-6 years of treatment
Initially may be bradykinesia or tremor in am before next dose.
on/off
add COMT inhibitor to prevent

Question 3

Levadopa/Carbidopa (Sinemet) CI

Answer 3

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

Precautions:
Cardiac disease
PUD

Question 4

MAO-B Inhibitors: Selegiline (Eldepryl, Zelapar)

Answer 4

Stops the breakdown of dopamine
Enhances peak levadopa levels (use in combo, not alone) Rasagiline (Azilect)
NEUROPROTECTIVE properties by reducing oxidative metabolism of dopamine
Lipophilic and penetrates blood-brain barrier rapidly

Question 5

MAO-B Inhibitors CI

Answer 5

Concurrent use with TCA’s, SSRI’s and Demerol (Psychiatric disorders)

Question 6

Dopamine Agonists:

Pramipexole (Mirapex) and Ropirinole (Requip)

Answer 6

Stimulate dopamine receptors in the substantia nigra
Effective in delaying motor complications during the first years of treatment
Studies also report improvement in impaired movements and disability.

Question 7

Dopamine Agonists: Apomorphine (Apokyn)

Answer 7

To treat acute episodes of “hypermobility” or “freezing”
Given SQ
Very expensive
Cause profound nausea, must be given with antiemetic

Question 8

COMT Inhibitors: Entacapone (Comtan), Tolcapone (Tasmar)

Answer 8

Increases concentration of existing dopamine in the brain by inhibiting its breakdown.
Only indicated in patients taking levadopa/carbidopa
Diminishes peripheral metabolism of Levodopa
*check LFT’s

Question 9

Amantadine Adverse Effects:

Answer 9

Sedation
Vivid dreams
Dry mouth
Depression
Hallucinations

Caution with renal dysfunction*

Question 10

Anticholinergic Acetylcholine-blocking Drugs CI

Answer 10

BPH
Obstructive GI disease
Angle closure glaucoma