Drugs for Movement Disorders Flashcards
(28 cards)
What is the MOA of amantadine?
weak, noncompetetive NMDA receptor antagonist
What is the MOA of selegiline?
potent, reversible inhibitor of monoamine oxidase (MAO)
greater affinity for MAO-B
When is tolcapone used in the treatment of Parkinson’s
as an adjunct to levodopa and carbidopa
What is a common toxic effect of dopamine agonists?
impulse control issues
What is the MOA of ropinirole?
D2 and D3 DA receptor agonist
What are the toxicities associated with taking ropinirole
dyskinesias Impulse control disorders increased risk of MELANOMA orthostatic hypotension psychotic effects somnolence N/V, constipation headaches
What toxicities are associated with amantadine
CNS depression impulse control disorders psychosis suicidal ideation/depression livedo reticularis
What is a reversible MAO-B inhibitor alternative to selegiline
safinamide
What is the MOA of tolcapone?
reversible inhibitor of COMT
leads to more sustained levels of levodopa and carbidopa
What is the most dangerous toxicity of tolcapone?
When should tolcapone be used
1) potentially fatal acute fulminant liver failure
2) only use in parkinson disease pts on L-dopa/carbidopa who are experiencing symptom fluctuations and are not responding satisfactorily to other agents
toxicities of tolcapone
behavior changes CNS depression Impulse control loss orthostatic hypotension and syncope exacerbation of preexisting dyskinesia
What is a COMT inhibitor that cannot cross the blood brain barrier?
What is it used to treat?
Entacapone
Acts in the periphery to treat ‘off’ symptoms
What are the toxicities of using levodopa and carbidopa
GI effects (decreased with carbidopa) postural hypotension Wearing-off and on-off phenomena hypertension/cardiac arrhythmias dyskinesias behavioral effects
Why is carbidopa given with levodopa?
Carbidopa blocks peripheral DOPA decarboxylase
This decreases the amount metabolized by the first pass system and allows a decrease in the dosage of levodopa
What is the on-off phenomenon in Parkinson disease?
Refers to a back and forth switch between mobility and immobility in levodopa treated patients
What are the options for managing the on off phenomenon
controlled release form of levodopa
shorten the interval between levodopa doses
adding a medication
benztropine is an anticholinergic agent that should be avoided in which patient populations?
The elderly
People with cognitive impairment
What is benztropine used to treat
1) Primarily for tremor and dystonia in younger people
2) Reducing the amount of saliva to treat excessive drooling
What is the most potent antiparkinson therapy?
levodopa
What is treatment is used for patients wanting meds for mild symptoms
MAO-B inhibitor
amantadine
What is used in a patient <65 yo with PD diminished daily function and quality of life?
What about >65?
1) either a DA agonist or levodopa
2) immediate-release levodopa
What are agents that reduce serum copper levels?
Penicillamine (copper chelating agent)
Potassium disulfide
What is the only drug to have any impact on survival in ALS?
riluzole
- only prolongs by a few months
- and/or time to tracheostomy
How do you treat Huntington disease
treat the non-motor symptoms bc there’s no known way to slow disease progression
