Neuro: Drugs for Movement Disorders

Question 1

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

Answer 1

Dopmaine

Question 2

MOA of amantadie (2)

Answer 2

increases dopamine release and prevents reuptake

Weak NMDA receptor antagonist (less glutamate excitement)

Question 3

What is the clinical application of amantadine?

Answer 3

Mono or adjuctive therapy for PD

Question 4

Adverse effects of amantadine

Answer 4

CNS depression,
Impulse Control
Psychosis
Suicidal ideation
LIVEDO RETICULARIS and ataxia

Question 5

MOA of ropinirole

Answer 5

D2 and D3 non-ergot receptor agonist

Question 6

Adverse effects of ropinirole

Answer 6

Dyskinesias
Impulse control
Increase risk for MELANOMA
Orthostatics
Psychosis
Somnolence

Question 7

MOA of Selegiline and Rasagiline

Answer 7

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

Question 8

Adverse effects of selegiline?

Answer 8

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

Question 9

What MAO-B inhibitors are reversible?

Answer 9

safinamide

Question 10

MOA of tolcapone

Answer 10

Peripheral and Central COMT inhibitor

-DA not broken down into 3-MT

Question 11

When are tolcapone/entacapone used?

Answer 11

adjunctive therapy to Carbidopa/L-DOPA

Question 12

Toxicity of tolcapone

Answer 12

HEPATOTOXICITY (BB warning)
CNS depression
Impulse control issues
Orthostatics
Dyskinesia exacerbation

Question 13

Does entacapone work in CNS or periphery?

Answer 13

Periphery only

-cannot cross BBB

Question 14

MOA of carbidopa

Answer 14

inhibits peripheral L-DOPA decarboxylase

-L-DOPA not converted to dopamine

Question 15

Adverse effects of carbidopa? (6)

Answer 15

GI EFFECTS
Postural hypotension
Cardiac arrythmias
Dyskinesias
Behavioral effects
ON-OFF PHENOM

Question 16

What are some non-pharm treatment options for PD?

Answer 16

Deep brain stimulation of the subthalamic nucleus or globus pallidus

Question 17

What is the on-off phenomenon?

Answer 17

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

Question 18

MOA of benztropine

Answer 18

M1 cholinergic antagonist

Question 19

Clinical indications of benztropine?

Answer 19

Tremor and rigidity in PD
-NOT bradykinesia

Can also be used to reduce drooling

Question 20

When is benztropine avoided?

Answer 20

Elderly

Psychosis

Question 21

Adverse effects of benztropine

Answer 21

antimuscarinic effects:

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

Question 22

How would you treat mild PD?

Answer 22

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

Question 23

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

Answer 23

DA agonist (ropinirole) or start LDOPA-carbidopa

Question 24

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

Answer 24

Immediate release LDOPA-carbidopa

Question 25

How would you treat sialorrhea in those with PD?

Answer 25

Botuilism injection in the the salivary glands

Question 26

What drugs could you add to treat orthostatic hypotension of PD? (M,D,F)

Answer 26

midodrine ( alpha-agonist)
Domperidone (D2 antag)
Fludrocortisone (mineralocorticoid)

Question 27

Treatment fo REM sleep behavior in PD? (M,C)

Answer 27

melatonin or clonazepam

Question 28

Treatment for psychosis in PD? (Q,C,P)

Answer 28

Quetiapine and clonzapine (atypical antipsych)

Pimavanserin (selective 5-HT2a inverse agonist)

Question 29

Treatment for dementia in PD? (SKETCHY GALA)

Answer 29

Doneprazole, Rivastigmine, Galantamine

Don Riva Gala

Question 30

Treatment for the nausea and vomiting caused by PD treatment? (M)

Answer 30

Metoclopramide

-D2 blocker

Question 31

How would you go about treating Huntingtons disease?

Answer 31

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

• depression,
• irritability

Question 32

Treatment for persistent Restless leg syndrome symptoms? (R,G)

Answer 32

Remember, Non-pharm first…Correct iron deficiency if present

D2 agonist: Ropinirole
Ca+ channel agonist: gabapentin

Question 33

Treatment for intermittent restless leg syndrome symptoms? (3)

Answer 33

DA agonist, carbidopa-levodopa, or benzos/opiates

Question 34

First line treatment for essential tremor?

Answer 34

Propranolol or primidone (barbituate)

if persists can do botulism toxin injection

Question 35

Treatment to slow ALS?

Answer 35

Riluzole

Question 36

Treatment for wilson disease? (P, PD)

Answer 36

Penicillamine
-copper chelator

Potassium disulfide
-reduces copper absorption