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Neuro II > Movement disorders pharm > Flashcards

Movement disorders pharm Flashcards

1
Q

dopamine agonists (DA)

A 
bromocriptine
pramipexole
ropinirole
rotigotine
apomorphine
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2
Q

monoamine oxidase inhibitors

A

rasagiline

selegiline

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3
Q

COMT inhibitors

A

entacapone

tolcapone

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4
Q

antimuscarinic agents

A 
benztropine
biperiden
orphenadrine
procyclidine
trihexyphenidyl
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5
Q

levodopa MOA

A

agonist at D2R

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6
Q

levodopa PK

A

take 30-60min before meals
only 1-3% reaches brain
combo w/carbidopa reduces peripheral meta of levodopa

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7
Q

levodopa GI

A

w/o 80% experience anorexia, nausea, and vomiting

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8
Q

levodopa CV

A

postural hypotension
tachycardia, ventricular extrasystoles, rarely afib
d/t increased peripheral catecholamines
HTN can occur w/large doses

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9
Q

levodopa behavioral

A 
depression
anxiety
agitation
insomnia
somnolence
confusion
delusions
hallucinations
nightmares
euphoria
more common w/combo
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10
Q

levodopa dyskinesia

A

80% of pt taking drug >10yrs

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11
Q

wearing off phenomenon

A

each dose of L-dopa effective for 1-2hrs with rapid return of rigidity and akinesia

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12
Q

on-off phenomenon

A

marked akinesia alternating with improved movement with no coordination to timing of drugs

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13
Q

DDIs levodopa

A

Pyridoxine- increases extracerebral metabolism may prevent therapeutic effect unless peripheral decarboxylase inhibitor
MAOIs-HTN, do not give if taking MAOIs or w/in 2 wks of discontinuation

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14
Q

DA MOA

A

act directly on postsynaptic DRs
do not require enzymatic conversion
no potentially toxic metabolites
do not compete w/another substance for transport across BBB

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15
Q

uses of DAs

A

certain pts respond better to certain drugs
1st line therapy for parkinsons
use is associated w/less fluctuations and dyskinesias then L-dopa
generally those who do not respond to L-dopa do not respond to DAs
can be added to L-dopa

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16
Q

bromocriptine

A

ergot alkaloid derivative
D2 agonists
extensive first pass
can also be used for endocrine disorders

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17
Q

pramipexole

A

D3Rs
renal insufficiency- must be dose adjusted
RLS

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18
Q

ropinirole

A

D2Rs

RLS

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19
Q

rotigotine

A

DA

may have serious site application rxns

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20
Q

DA GI

A

anorexia, nausea, vomiting (should be taken w/meals)

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21
Q

DA CV

A 
postural hypotension
ergot derivatives (bromocriptine)- painless digital vasospasm
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22
Q

DA dyskinesias

A

dose dependent

23
Q

DA mental disturbances

A

confusion, hallucinations, delusions

disorders of impulse control

24
Q

DA misc ADRs

A

HA, nasal congestion
increased arousal
pulmonary infiltrates, pleural and retroperitoneal fibrosis
pramipexole and ropinirole can cause pts to fall asleep at inappropriate times

25
DA CIs
``` history of psychotic illness, recent MI, active peptic ulcer disease ergot derivatives (bromocriptine)- should be avoided in peripheral vascular disease ```
26
MAO types
monoamine oxidase A- metabolizes NE, serotonin, and dopamine | monoamine oxidase B- metabolizes dopamine selectively
27
selegiline MOA
selective inhibitor of MAO B decreasing dopamine breakdown
28
selegiline uses
adjuct for declining effectiveness of L-dopa | should be taken and breakfast and lunch to prevent insomnia
29
rasagiline MOA
irreversible inhibitor MAO-B | more potent then selegiline
30
rasagiline uses
neuro-protective and early parkinsons
31
MAOI DDIs
``` non-selective MAOIs should not be combined w/L-dopa b/c can cause HTN crisis cannot be combined w/: -meperdine -tramadol -methasone -propoxyphene -cyclobenzaprine -st. johns wort -dextropmethorphan -OTC cold preps ```
32
COMT inhibitors
inhibitions of dopa decarboxylase is associated w/compensatory activation of other pathways of L-dopa metabolism, especially COMT which increases 3-O-methyldopa which competes w/L-dopa to cross BBB
33
COMT inhibitors MOA
prolong action of L-dopa by diminishing peripheral metabolism
34
uses of COMT inhibitors
pts who have developed response fluctuations tolcapone- central and peripheral effects entacpone- peripheral only
35
COMT inhibitors ADRs
``` related to increased L-dopa diarrhea abdominal pain orthostatic hypotension sleep disturbances orange urine tolcapone- rare acute hepatic failure ```
36
apomorphine MOA
potent non-ergot dopamine agonists | post synaptic D2R in caudate and putamen
37
uses of apomorphine
temporary relief (rescue) of off perioids
38
ADRs of apomorphine
nausea at drug initiation can preTx with trimethobenxamide dyskinesias, drowsiness, sweating, hypotension, injection site bruising
39
amantadine MOA
antiviral | unclear, but may potentiate dopamangeric fnx
40
uses of amantadine
less efficasious then L-dopa benefits short lived (wks) may favorably impact bradykinesia, rigidity, tremor may help reduce iatrogenic dyskinesias in advanced disease
41
amantadine ADRs
restlessness, depression, irritability, insomnia, agitation, excitement, hallucinations, and confusion, as well as HA, heart failure, postural hypotension, urinary retention, and GI disturbances may cause livedo reticularis
42
amantadine CIs
Hx of seizures or heart failure
43
antimuscarinic MOA
centrally actin, mAChR antagonists
44
antimuscarinic use
may improve tremor and rigidity of parkinsonism, but little effect on bradykinesia
45
antimuscarinic ADRs
common peripheral antimuscarinic effects: | sedation, mental confusion, constipation, urinary retention, blurred vision
46
parkinson's disease
dopaminergic therapy early stage avoid Tx until disability start w/one of these: rasafiline, amantadine, and antimuscarinic w/progression switch to DA +/- carbidopa-levodopa end-stage ass COMT inhibitor
47
tremor
``` beta blockers antiepileptic drug primidone (small dose) topiramate alprazolam botulinum toxin A ```
48
Huntingtons Tx
reserpine and tetrabenzine to deplete dopamine stores block DRs: olanzapine, pehnothiazine, butyrophenones, can also use: GABA, glutamic acid decarboxylase, and choline acetyltransferase
49
Tics
ANTIPSYCHOTICS alpha adrengerics botulinum toxins
50
RLS
``` DAs levodopa diazepam clonazepam opitates ```
51
wilsons disease
penicillamine | potassium disulfide
52
penicillamine MOA
chelating agent
53
penicillamine ADRs
nausea, vomiting, neprhotic syndrome, myastehnia, optic neuropathy, blood disorders
54
potassium disulfide
reduces intestinal absorption of Cu

Neuro II (22 decks)

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