Drugs for Movement Disorders - Kinder

Question 1

sinemet

Answer 1

levodopa/carbidopa

Question 2

bromocriptine

Answer 2

ergot DA agonist

Question 3

pramipexole

Answer 3

non-ergot DA agonist

Question 4

rasagaline

Answer 4

monoamine oxidase inhibitor

-MAOI

Question 5

entacapone

Answer 5

catechol-O-methyltransferase inhibitor

-COMT

Question 6

benzotropine

Answer 6

antimuscarinic agent

Question 7

athetosis

Answer 7

slow/writhing movement

Question 8

dystonia

Answer 8

sustained athetosis

Question 9

rigidity, postural instability, bradykinesia, tremor

Answer 9

parkinsons disease

Question 10

path of PD

Answer 10

loss of dopaminergic neurons in substantia nigra

• disinhibition of GABA neurons
• that normally inhibit corpus striatum output

Question 11

levodopa

Answer 11

precursor to DA - crosses BBB

via - L-amino acid transporter

Question 12

levodopa MOA

Answer 12

stimlate D2 receptors

Question 13

carbidopa

Answer 13

dopa decarboxsylase inhibitor
-reduces peripheral metabolism of levodopa

more to CNS

Question 14

levodopa ADR

Answer 14

anorexia, N/V - without carbidopa

with carbidopa <20%

Question 15

other levodopa ADR

Answer 15

postural hypotension
depressin, anxiety, agitatition
dyskinesia

Question 16

dyskinesia and levodopa

Answer 16

80% >10yr treatment

-choreathetosis of face and distal extremities

Question 17

wearing off phenomenon

Answer 17

end of dose akinesia

rigid and akinetic at end of dosing interval

Question 18

on-off phenomenon

Answer 18

unrelated to tx timing

off periods of akinesia over cours eof ew hours

Question 19

vitamin B6

Answer 19

pyridoxine

-increase peripheral metabolism of levodopa

Question 20

levodopa CI

Answer 20

angle closure glaucoma - mydriasis

psychosis
PUD
malignant melanoma (melanin precursor)

Question 21

DA agonist MOA

Answer 21

act on postsynaptic DA receptors

Question 22

1st line for parkinsons

Answer 22

dopamine agonist

-no long term changes that happen with levodopa

Question 23

ergot alkaloid derivative D2 agonist

Answer 23

bromocriptine

Question 24

D3 agonist

Answer 24

pramipexole

Question 25

two types of MAOIs

Answer 25

MAO A - metabolize NE, serotonin, DA MAO B - metabolize DA selectively

Question 26

rasagiline MOA

Answer 26

MAO-B - potent

Question 27

rasagiline DDI

Answer 27

avoid admin of levodopa with nonselective MAO inhibitor | -hypertensive crisis

Question 28

entacapone MOA

Answer 28

inhibit dopa dexarboxylase (carbidopa) - associated with compensatory activation of other pathways - especially COMT -increased levels of 3O methyldopa prolongs action of levodopa

Question 29

orange discoloration of urine

Answer 29

entacapone

Question 30

benztropine mesylate

Answer 30

anti-muscarinic agent central acting - mAChR antagonist

Question 31

therapy of benztropine mesylate

Answer 31

improve tremor/rigidity of parkinsonism

Question 32

tx of tremors

Answer 32

respond to beta-1 receptor blockers - propranolol and metoprolol

Question 33

huntington disease

Answer 33

auto dom - chromosome 4 chorea and dementia

Question 34

exacerbation of chorea in huntingtons

Answer 34

levodopa

Question 35

restless leg syndrome

Answer 35

associated with iron deficient anemia

Question 36

wilsons disease

Answer 36

decreased ceruloplasmin - reduced serum copper tx - penicillamine and potassium disulfide

Question 37

tx PD

Answer 37

increase DA, decrase ACh

Question 38

nausea and vomiting with levodopa

Answer 38

D2 receptors - chemoreceptor trigger zone

Question 39

lower dyskinesia threshold

Answer 39

for long term tx of PD

Question 40

hepatotoxic

Answer 40

with tolcapone so use IV drug - apomorphine

Question 41

DA agonist vs. levodopa

Answer 41

levodopa - more side effects, more effective DA agonist - less side effects, not as effective

Question 42

older PD patient (>65yo)

Answer 42

levodopa

Question 43

younger PD patient (<65yo)

Answer 43

DA agonist

Question 44

mottled skin purple, tx of PD

Answer 44

adverse of amantidine - levido reticularis

Question 45

trihexphenidyl

Answer 45

anti-muscarinic - correct DA/ACh imbalance in younger patients

Question 46

COMI location

Answer 46

decreased peripheral metabolism

Question 47

MAOI location

Answer 47

decrased central metabolism

Question 48

tx of restless leg syndrome

Answer 48

no haloperidol

Question 49

haloperidol

Answer 49

GABA-A - used for tx of huntingtons