Test 3 Pharm (MS, Tremors, Parkinson's, etc.)

Question 1

What is the pharmacologic treatment for ALS? What is the MOA and toxicity?

Answer 1

Riluzole

Inhibits glutamate release by inactivating voltage-gated Na+ channels

Hepatotoxic

Question 2

What is the treatment for myasthenia gravis and how does it work? What is the toxicity?

Answer 2

Acetylcholinesterase inhibitors (pyridostigmine, neostigmine, physostigmine)

Toxicity: DUMBBLS

diarrhea

urination

miosis

bronchospasm

bradycardia

lacrimation

salivation

Question 3

Name three drugs that can treat narcolepsy and what symptom each drugs helps alleviate.

Answer 3

1. Modafinil is a stimulant
2. Sodium oxybate is a sleep-inducer and helps with daytime sleepiness and cataplexy cuz people get better sleep during the night
3. Venlafaxine (SSRI) helps with cataplexy

Question 4

Name four drugs that can treat restless leg syndrome.

Answer 4

Pramipexole, rotigotine, gabapentin, methadone

Question 5

For suvorexant…

State the clinical indication, MOA, and toxicity

Answer 5

Treatment for insomnia

Orexin receptor antagonist

Toxicities: CNS depression and sleep paralysis

Question 6

For gabapentin…

State the clinical indication, MOA, and toxicity

Answer 6

Used for nerve pain and restless leg syndrome

Voltage dependent Ca2+ channel blocker

Toxicity: dizziness, ataxia, fatigue

Question 7

Name all the drugs to treat glaucoma and how they work.

Answer 7

Travoprost is a prostaglandin analogue that increases uveoscleral outflow of aqueous humor.

Timolol is a beta blocker and reduces aqueous humor production (beta-1 receptors are in the ciliary body).

Brimonidine is an alpha agonist that both increases outflow and reduces production of aqueous humor.

Dorzolamide is a carbonic anhydrase inhibitor that reduces aqueous humor production.

Acetazolamide is another carbonic anhydrase inhibitor.

Pilocarpine is a cholinergic agonist that increase aqueous humor outflow (see sketchy).

Question 8

What should a normal eye do when you put cocaine drops in it? What does it mean if a patient presents with Horner’s syndrome-like symptoms and cocaine makes the eyes dilate?

Answer 8

Normal eye should dilate.

If cocaine makes them dilate in a patient who otherwise seems to have Horner’s, they may have a lesion in the first or second neuron in the sympathetic pathway (1st is in the hypothalamospinal tract - can be damaged with vertebral a. dissection or lat. medullary syndrome; 2nd can be damaged with a pancoast tumor).

Question 9

What Parkinson drug is only used in tremor-dominant forms of the disease? What is its MOA?

Answer 9

Trihexyphenidyl (antimuscarinic)

Question 10

Name two drugs to treat essential tremor and how they work.

Answer 10

Propranolol (non-selective beta blocker)

Primidone (metabolized to phenobartibal -> GABA-A blocker; see sketchy)

Question 11

What is the first line treatment for Huntington’s chorea and how does it work?

Answer 11

Tetrabenazine - MOA transporter type 2 inhibitor (keeps dopamine from being put into secretory vesicles) to ultimately reduce cortical stimulation by the basal ganglia/thalamus

Question 12

How do you treat acute MS exacerbations?

Answer 12

IV steroids (solumedrol) or a shit-ton of oral steroids (not done often)

Question 13

Name eight disease-modifying treatments for MS.

Answer 13

1 & 2. IFN-betas (avonex and betaseron)

3. Dimethyl fumarate
4. Teriflunomide
5. Fingolimod
6. Mitoxantrone
7. Glatiramir acetate
8. Natalizumab (2nd line)

Question 14

What drugs for MS treatment can potentially cause PML?

Answer 14

Natalizumab and dimethyl fumarate

Question 15

Which MS drug is safe in pregnancy?

Answer 15

Glatiramir acetate