Neuro: Drugs for Movement Disorders Flashcards
In parkinsons, ____ cannot be released from the substantia nigra so these patients cannot put on the brake
Dopmaine
MOA of amantadie
increases dopamine release and prevents reuptake
Weak NMDA receptor antagonist (less glutamate excitement)
What is the clinical application of amantadine?
Mono or adjuctive therapy for PD
Adverse effects of amantadine
CNS depression, Impulse Control Psychosis Suicidal ideation Livedo reticularis and ataxia
MOA of ropinirole
D2 and D3 non-ergot receptor agonist
Adverse effects of ropinirole
Dyskinesias Impulse control Increase risk for melanoma Orthostatics Psychosis Somnolence
MOA of Selegiline and Rasagiline
IRREVESIBLE MAO-B inhibitor, so dopamine doesn’t get converted to DOPAC
Adverse effects of selegiline?
Antidepressants increase risk of suicidal thoughts and behaviors in peds and young adults
What MAO-B inhibitors are reversible?
safinamide
MOA of tolcapone
Peripheral and Central COMT inhibitor
-DA not broken down into 3-MT
When are tolcapone/entacapone used?
adjunctive therapy to Carbidopa/L-DOPA
Toxicity of tolcapone
Hepatoxicity (BB warning) CNS depression Impulse control issues Orthostatics Dyskinesia exacerbation
Does entacapone work in CNS or periphery?
Periphery only
-cannot cross BBB
MOA of carbidopa
inhibits peripheral L-DOPA decarboxylase
-L-DOPA not converted to dopamine
Adverse effects of carbidopa? (6)
GI effects Postural hypotension Cardiac arrythmias Dyskinesias Behavioral effects Wearing off and On-Off phenomena
What are some non-pharm treatment options for PD?
Deep brain stimulation of the subthalamic nucleus or globus pallidus
What is the on-off phenomenon?
the switching back and forth between mobility and immobility in carbidopa-LDOPA pts
-happens at end of dose
MOA of benztropine
M1 cholinergic antagonist
Clinical indications of benztropine?
Tremor and rigidity in PD
-NOT bradykinesia
Can also be used to reduce drooling
When is benztropine avoided?
Elderly
Psychosis
Adverse effects of benztropine
antimuscarinic effects:
Hot as a hare
Made as a hatter
Blind as a bat
etc
How would you treat mild PD?
May not treat, or add MAO-B (selegiline) or amantadine
How would you treat PD once motor symptoms start, if pt is <65?
DA agonist (ropinirole) or start LDOPA-carbidopa
How would you treat PD once motor symptoms start, if pt is >65?
Immediate release LDOPA-carbidopa
How would you treat sialorrhea in those with PD?
Botuilism injection in the the salivary glands
What drugs could you add to treat orthostatic hypotension of PD?
midodrine Domperidone (D2 antag) Fludrocortisone
Treatment fo REM sleep behavior in PD?
melatonin or clonazepam
Treatment for psychosis in PD?
Quetiapine and clonzapine
Pimavanserin
Treatment for dementia in PD?
Doneprazole, Rivastigmine, Galantamine
Don Riva Gala
Treatment for the nausea and vomiting caused by PD treatment?
Metoclopramide
-D2 blocker
How would you go about treating Huntingtons disease?
Since you cannot treat the actual movement disorder, treat other symptoms:
- depression,
- irritability
Treatment for persistent Restless leg syndrome symptoms?
Correct iron deficiency if present
D2 agonist: Ropinirole
Ca+ channel agonist: gabapentin
Treatment for intermittent restless leg syndrome symptoms?
DA agonist, carbidopa-levodopa, or benzos/opiates
First line treatment for essential tremor?
Propranolol or primidone (barbituate)
if persists can do botulism toxin injection
Treatment to slow ALS?
Riluzole
Treatment for wilson disease?
Penicillamine
-copper chelator
Potassium disulfide
-reduces copper absorption
