Lec 17: Pharmacologic Management of Movement Disorders Flashcards Preview

[OS 211] Exam 1 Adre > Lec 17: Pharmacologic Management of Movement Disorders > Flashcards

Flashcards in Lec 17: Pharmacologic Management of Movement Disorders Deck (27)
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1

What is the mean age of onset for Parkinson's Disease?

55

2

What are the pathological hallmarks of Parkinson's Disease?

* loss of pigmentation in the substantia nigra
* appearance of abnormal cytoplasmic inclusions (Lewy Bodies)

3

What is the main dopamine subtype in basal ganglia neurons?

D2 receptor

4

Which dopamine receptor subtypes are important for movement?

D1, D2, D3

5

What drugs can contribute to the development of Parkinson's Disease?

older antipsychotics (ex. chlorpromazine, haloperidol)

6

What is the rate-limiting step in the process of dopamine production?

conversion of tyrosine to L-dopa through tyrosine hydroxylase

7

What substances metabolize dopamine?

COMT and monoamine oxidase - B (MAO-B)

8

What neurotransmitter and receptor changes are observed in PD?

* loss of dopamine-producing cells in the substantia nigra
* loss of norepinephrine-containing cells in the locus ceruleus
* increased acetylcholine turnover
* striatal GABA increased
* depleted serotonin levels

9

What effect does the lowering of dopamine levels have on the direct and indirect pathways?

The indirect pathway predominates resulting in the inhibition of the thalamus and VL-VA nuclei. This results in the inhibition of motor function (ex. akinesia, rigor, tremor).

10

How are akinesia and rigors/tremors controlled?

akinesia - dopaminergic agonists
rigidity/tremors - anticholinergics

11

What is the precursor of dopamine?

levodopa

12

What dopamine agonists are used?

bromocriptine, pergolide, pramipexole, ropirinole, rotigotine, apomorphine

13

What drugs are used to inhibit the breakdown of levodopa?

MAO-B - inhibitors: selegeline, rasagiline
COMT - inhibitors: entacapone, tolcapone

14

What drugs are used to inhibit the cholinergic and glutaminergic transmitter system?

amantadine, anticholinergics

15

(T/F) levodopa penetrates the blood-brain barrier

T

16

What vitamin enhances the extracerebral metabolism of levodopa?

pyridoxine (B6)

17

What are the contraindications for levodopa?

psychosis, acute angle-closure glaucoma, active peptic ulcer, melanoma or undiagnosed skin lesions, hallucinations

18

What drugs are selective inhibitors of peripheral L-dopa conversion?

carbidopa, benzerazide

19

Which dopamine agonists are eliminated exclusively renally?

pramipexole, ropinirole

20

Which dopamine agonist has the longest half-life?

cabergoline (65 hrs)

21

Which dopamine agonist has the shortest half-life?

lisuride (2-3 hours)

22

Which dopamine agonist is associated with the development of valvular heart disease?

pergolide

23

Which dopamine agonist was pulled out of the market in the US due to crystalline formation in the patch?

rotigotine

24

Which dopamine agonist is used for temporary relief of akinesia in patients on dopaminergic therapy?

apomorphine

25

Which dopamine agonist scavenges hydrogen peroxide?

pramipexole

26

Which COMT-inhibitor acts centrally AND peripherally?

tolcapone

27

Which COMT-inhibitor can cause acute fulminant liver failure?

tolcapone