19 Pharm of Movement Disorders

Question 1

MOA of bromocriptine

Answer 1

D2 agonist, D1 partial agonist

Question 2

ADE of bromocriptine

Answer 2

GI (anorexia, N/V), tachycardia,orthostatic hypotension

Question 3

MOA of pramipexole

Answer 3

D2 selective agonist. Free radical scavenger

Question 4

ADE of pramipexole

Answer 4

GI (anorexia, N/V), tachycardia,orthostatic hypotension

Question 5

MOA of ropinirole

Answer 5

D2 selective, metabolized by CYP1A2

Question 6

ADE of ropinirole

Answer 6

GI (anorexia, N/V), tachycardia,orthostatic hypotension

Question 7

MOA of amantadine

Answer 7

enhance DA release (antiviral). may also inhibit uptake. interact with NMDA receptors

Question 8

ADE of amantadine

Answer 8

restlessness, depression agitation, hallucinationss. Overdose = psychosis

Question 9

MOA of selegiline

Answer 9

MAO-B. inhibits DA metabolism

Question 10

ADE of selegiline

Answer 10

may potentiate advese effects of L-DOPA

Do not give with meperidine, TCAs or SSRIs

Question 11

MOA of rasagiline

Answer 11

MAO-B. inhibits DA metabolism. more potent than selegiline

Question 12

ADE of rasagiline

Answer 12

GI (anorexia, N/V), tachycardia,orthostatic hypotension

Question 13

MOA of entacapone

Answer 13

COMT. inhibits DA metabolism. Reduces production of 30MD which competes with L-DOPA for transport into BBB and GI.
Strictly has peripheral effects

Question 14

ADE of entacapone

Answer 14

GI (anorexia, N/V), tachycardia,orthostatic hypotension

Question 15

MOA of tolcapone

Answer 15

COMT. inhibits DA metab. has both peripheral and central effects. Entacapone is better.

Question 16

ADE of tolcapone

Answer 16

hepatic failure and increased LFT

Question 17

MOA of benztropine

Answer 17

antimuscarinic

Question 18

ADE of benztropine

Answer 18

drowsiness, mental slowness, confusion, delusions, hallucinations
anticholinergic Dry mouth, blurred vision, mydriasis, urinary retention, N/V, constipation, tachycardia, arrhythmias.
Contraind in prostatic hyperplasia, OBD or gluacoma

Question 19

MOA of diphenhydramine

Answer 19

antimuscarinic

Question 20

ADE of diphenhydramine

Answer 20

drowsiness, mental slowness, confusion, delusions, hallucinations
anticholinergic Dry mouth, blurred vision, mydriasis, urinary retention, N/V, constipation, tachycardia, arrhythmias.
Contraind in prostatic hyperplasia, OBD or gluacoma

Question 21

MOA of trihexyphenidyl

Answer 21

antimuscarinic

Question 22

ADE of trihexyphenidyl

Answer 22

drowsiness, mental slowness, confusion, delusions, hallucinations
anticholinergic Dry mouth, blurred vision, mydriasis, urinary retention, N/V, constipation, tachycardia, arrhythmias.
Contraind in prostatic hyperplasia, OBD or gluacoma

Question 23

MOA of reserpine

Answer 23

VMAT inhibitor - depletes DA

Question 24

MOA of tetraenazine

Answer 24

VMAT inhibitor - depletes DA

Question 25

MOA of chlorpromazine

Answer 25

D2 receptor antagonist

Question 26

MOA of haloperidol

Answer 26

D2 receptor antagonist

Question 27

What is L-DOPA given with and why?

Answer 27

given with carbidopa, an L-AAD inhibitor that can not cross BBB to prolong L-DOPA and reduce amount requrired. Prevents conversion of L-DOPA to dopamine. Also reduces peripheral DA side effects.

Question 28

MOA of carbidopa

Answer 28

L-AAD inhibitor that prevents L-DOPA conversion to dopamine in the periphery.

Question 29

ADE of L-DOPA

Answer 29

GI (anorexia, N/V), tachycardia,orthostatic hypotension

Question 30

ADE of carbidopa

Answer 30

behavioral, dyskinesias in on-off phenomenon

Question 31

contraindications of L-DOPA

Answer 31

bitamin B6 increases L-DOPA metab so decarboxylase inhibitors must be given. MAO-A inibhitors can cause hypertensive crisis with L-DOPA. Contraindicated in psychotic, glaucoma and cardiac disesase or melanoma.

Question 32

MOA of apomorphine

Answer 32

D1/D2 agonist

Question 33

What are the D2 selective agonists?

Answer 33

pramipexole and ropinirole

Question 34

Contrainds of amantadine

Answer 34

seizures or heart failure patients

Question 35

What is a possible treatment of HD?

Answer 35

D2 antagonists, to stimulate indirect pathway.