Drugs for movement disorders

Question 1

Levodopa

Answer 1

Dopamine precursor crosses BBB (1-3% to brain)
Stim D2 receptors
take before meals
benefits diminish after 3-4 years
ADR - GI, anorexia, nausea, vomiting
CV - postural HTN, tachycardia
Behavioral - depression, anxiety, delusions, nightm
Dyskinesia - 80% after ten years of use - choreathetosis
DDI - pyridoxine - increases extracerebral metabolism
MAOIs
CI: angle closure glaucoma, psychosis, peptic ulcer, melanoma

Question 2

Carbidopa

Answer 2

Dopadecarboxylase inhibitor - reduces peripheral metabolism of levodopa - 75% daily reduction of Levodopa
reduces GI effects of Levodopa

Question 3

Carbidopa/levodopa

Answer 3

Sinemet

Question 4

Carbidopa/levodopa/entacapone

Answer 4

Dopa

Question 5

Bromocriptine

Answer 5

Dopamine 2 agonist - ergot alkaloid derivative
extensive first pass metabolism
also for endocrine disorders

Question 6

Pramipexole

Answer 6

Dopamine 3 agonist

Restless leg syndrome

Question 7

Ropinirole

Answer 7

Dopamine 2 agonist

Restless leg syndrome

Question 8

Rotigotine

Answer 8

Dopamine agonist - early parkinsons

serious applicaiton site reactions

Question 9

Apomorphine

Answer 9

non ergot dopamine agonist D2 receptors in caudate and pons - Sub Q
temporary relief of off-periods of akinesia
ADR - nausea dyskinesias, drowsy, sweating, bruising

Question 10

Rasagiline

Answer 10

MAOI - MAO B more potent

Question 11

Selegiline

Answer 11

MAOI - MAO B
adjunct for declining response to levodopa
take breakfast and lunch

Question 12

Entacapone

Answer 12

COMT(catechol o methyltransferase) inhibitor
diminish levodopa peripheral metabolism pathways other than carbidopa
for patients with response fluctuations
peripheral effects only

Question 13

Tolcapone

Answer 13

COMT inhibitor - central and peripheral effects

increase liver enzymes and acute liver failure

Question 14

Amantadine

Answer 14

antiviral agent - weak anti parkinson properties
potentiate dopaminergic function??
short lived benefits
ADR - livedo reticularis
caution with heart failure/seizures

Question 15

Benztropine

Answer 15

antimuscarinic(centrally acting) - improve tremor and rigidity not bradykinesia - titrate up to fxnal dose
ADR common antimuscarinic effects

Question 16

Biperiden

Answer 16

antimuscarinic

Question 17

Orphenadrine

Answer 17

Antimuscarinic

Question 18

Procyclidine

Answer 18

Antimuscarinic

Question 19

Trihexyphenidyl

Answer 19

Antimuuscarinic

Question 20

ADRs of Dopamine agonists

Answer 20

GI - anorexia, nausea, vomiting
CV postural HTN
Dyskinesias - less w/ lower dose
Mental disturbance - disorders of impulse control
Misc: HA, congestion, arousal, fibrosis
sleep inappropriately w/ pramipexole or ropinirole

Question 21

MAO A metabolizes

Answer 21

NE, serotonin, dopamine

Question 22

MAO B metabolizes

Answer 22

dopamine

Question 23

drugs for tremors

Answer 23

propranolol
metoprolol
primidone
topiramate
alprazolam(benzo)
botulinum toxin A - IM

Question 24

drugs for Huntington

Answer 24

impair dopamine neurotransmission
reserpine
tetrabenazine
block D2R - olanzapine, perphenazine, haloperidol

Question 25

drugs for Tics

Answer 25

neuroleptic antipsycotics: tetrabenazine, haloperidol, pimozide alpha adrenergic agents: clonidine, guanfacine botulinum A injection - IM

Question 26

Restless leg syndrome drugs

Answer 26

levodopa, diazepam, clonazepam, opiates, D agonists | pramipexole, ropinirole - non ergot D agonists 1st

Question 27

Wilsons disease drugs - choreaform movements

Answer 27

penicillamine - chelating agent | potassium disulfide - reduce copper absorb GI