Pharmacology of Movement disorders--Caldwell Flashcards
what are the three dopaminergic pathways
nigrostriatal
mesolimbic
tuberinfundibular
treatment for off periods (akinesia)
Sub Q apomorphine (effect can be seen 10 minutes lasting up to 2 hours)
selective COMT inhibitors
entacopone and tolcapone
seletive irreversible inhibitor of MAO-B
selegiline
MOAB inhibitor
Rasagiline
what are the uses for selegiline
prolongs antiparkinsonism effect of L-dopa allowing for lower doses and may potentiate the adverse effects of L dopa
Mechanisms of action of rasagiline
more potent to prevent MPTP induced parkinsonism and is neuroprotective
MAO of tolcapone
reduces metabolism of L dopa to DA
adverse effect of entacopone
organge urine
adverse effects of tolcapone
lincreased liver toxicitiy
stalevo
L dopa
carbidopa
entacopone
anticholinergics drugs help what in PD patients
tremor and rigidity
what are the limitations to PD
less potent than L dopa
benefits are short lived and treatment only lasts a few weeks
what are four advantages of dopamine over L dopa
does NOT require enzymatic conversion
no toxic metabolites
do NOT compete with other substances to actively cross into the blood and the BBB
have fewer adverse side effects
indication for apomorphine
temporary relief of off periods of akinesia in patients on dopamine therapy
what beta blocker can be used to treat tremors
propanolol
why cant metaprolol be used
need to act on B2 receptors and metaprolol acts on B1 receptors
what are the neurons that die off in huntington disease
medium sized spiny GABA neurons in the basal ganglia
mechanism of tetrabenazine
inhibits vesicular monoamine transporter 2 which is used for treatment of huntingtons diseasee
drug approved for ALS
riluzole (protects motor neurons from toxic effects of excitatory amino acids)
what is a class of drugs that is contraindicated with L dopa
antipsychotics–haloperidol and fluphenazine
population of patients that should be careful with L dopa
psychotic patients, acute angle glaucoma, history of melanoma
indication for selegiline
pro-longs antiparkinsonism effects
indication of apomorphine
temporary relief of off periods of akinesia in patients on dopamine therapy