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Pharmacology > Neuro: Drugs for Movement Disorders > Flashcards

Neuro: Drugs for Movement Disorders Flashcards

1
Q

In parkinsons, ____ cannot be released from the substantia nigra so these patients cannot put on the brake

A

Dopmaine

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2
Q

MOA of amantadie

A

increases dopamine release and prevents reuptake

Weak NMDA receptor antagonist (less glutamate excitement)

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3
Q

What is the clinical application of amantadine?

A

Mono or adjuctive therapy for PD

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4
Q

Adverse effects of amantadine

A 
CNS depression,
Impulse Control
Psychosis
Suicidal ideation
Livedo reticularis and ataxia
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5
Q

MOA of ropinirole

A

D2 and D3 non-ergot receptor agonist

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6
Q

Adverse effects of ropinirole

A 
Dyskinesias
Impulse control
Increase risk for melanoma
Orthostatics
Psychosis
Somnolence
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7
Q

MOA of Selegiline and Rasagiline

A

IRREVESIBLE MAO-B inhibitor, so dopamine doesn’t get converted to DOPAC

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8
Q

Adverse effects of selegiline?

A

Antidepressants increase risk of suicidal thoughts and behaviors in peds and young adults

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9
Q

What MAO-B inhibitors are reversible?

A

safinamide

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10
Q

MOA of tolcapone

A

Peripheral and Central COMT inhibitor

-DA not broken down into 3-MT

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11
Q

When are tolcapone/entacapone used?

A

adjunctive therapy to Carbidopa/L-DOPA

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12
Q

Toxicity of tolcapone

A 
Hepatoxicity (BB warning)
CNS depression
Impulse control issues
Orthostatics
Dyskinesia exacerbation
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13
Q

Does entacapone work in CNS or periphery?

A

Periphery only

-cannot cross BBB

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14
Q

MOA of carbidopa

A

inhibits peripheral L-DOPA decarboxylase

-L-DOPA not converted to dopamine

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15
Q

Adverse effects of carbidopa? (6)

A 
GI effects
Postural hypotension
Cardiac arrythmias
Dyskinesias
Behavioral effects
Wearing off and On-Off phenomena
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16
Q

What are some non-pharm treatment options for PD?

A

Deep brain stimulation of the subthalamic nucleus or globus pallidus

17
Q

What is the on-off phenomenon?

A

the switching back and forth between mobility and immobility in carbidopa-LDOPA pts
-happens at end of dose

18
Q

MOA of benztropine

A

M1 cholinergic antagonist

19
Q

Clinical indications of benztropine?

A

Tremor and rigidity in PD
-NOT bradykinesia

Can also be used to reduce drooling

20
Q

When is benztropine avoided?

A

Elderly

Psychosis

21
Q

Adverse effects of benztropine

A

antimuscarinic effects:

Hot as a hare
Made as a hatter
Blind as a bat
etc

22
Q

How would you treat mild PD?

A

May not treat, or add MAO-B (selegiline) or amantadine

23
Q

How would you treat PD once motor symptoms start, if pt is <65?

A

DA agonist (ropinirole) or start LDOPA-carbidopa

24
Q

How would you treat PD once motor symptoms start, if pt is >65?

A

Immediate release LDOPA-carbidopa

25
Q

How would you treat sialorrhea in those with PD?

A

Botuilism injection in the the salivary glands

26
Q

What drugs could you add to treat orthostatic hypotension of PD?

A 
midodrine
Domperidone (D2 antag)
Fludrocortisone
27
Q

Treatment fo REM sleep behavior in PD?

A

melatonin or clonazepam

28
Q

Treatment for psychosis in PD?

A

Quetiapine and clonzapine

Pimavanserin

29
Q

Treatment for dementia in PD?

A

Doneprazole, Rivastigmine, Galantamine

Don Riva Gala

30
Q

Treatment for the nausea and vomiting caused by PD treatment?

A

Metoclopramide

-D2 blocker

31
Q

How would you go about treating Huntingtons disease?

A

Since you cannot treat the actual movement disorder, treat other symptoms:

  • depression,
  • irritability
32
Q

Treatment for persistent Restless leg syndrome symptoms?

A

Correct iron deficiency if present

D2 agonist: Ropinirole
Ca+ channel agonist: gabapentin

33
Q

Treatment for intermittent restless leg syndrome symptoms?

A

DA agonist, carbidopa-levodopa, or benzos/opiates

34
Q

First line treatment for essential tremor?

A

Propranolol or primidone (barbituate)

if persists can do botulism toxin injection

35
Q

Treatment to slow ALS?

A

Riluzole

36
Q

Treatment for wilson disease?

A

Penicillamine
-copper chelator

Potassium disulfide
-reduces copper absorption

Pharmacology (50 decks)

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