Flashcards in Movement Deck (21):
What are the most notorious anti-psychotic drug classes for drug induced parkinsonism?
Butyrophenones and phenothiazines
What are the 2 reasons why dopamine is not effective for PD in its pure form?
1. Dopamine has low bioavailability
2. Dopamine does not readily cross the BBB
What enzyme does carbidopa inhibit?
Dopa decarboxylase in the peripheral tissues
What are the 2 enzymes in the periphery are inhibited by Entacapone and Carbidopa to prevent metabolism of Levodopa before it makes it into the brain?
Entacapone and tolcapone: COMT Catecholamine-O-methyltransferase
Carbidopa: Dopa decarboxylase
Tolcapone acts in both the central and peripheral compartments. Entacapone acts only in the periphery similar to carbidopa
How does pramipexole affect the sleep pattern of PD patients?
They may cause an uncontrollable urge to sleep
Indicate which dopamine agonist receptor the following drugs act on
Why is bromocriptine not a first line medication for PD?
It is an ergot and can causes erythromelalgia and pulmonary infiltrates.
What PD medication has onset of action in 10 minutes?
What are the two commonly used MAO-B inhibitors, which of them is more potent and which is known to cause serotonin syndrome when used with SSRI's
Rasagiline more potent
Selegiline serotonin syndrome
Which COMT inhibitor can act both centrally and peripherally?
Tolcapone. Entacapone periphery only
BUT tolcapone causes liver damage-- need consent prior to use out of many markets already
Which group of PD drugs causes the urine to turn orange?
What are the 3 theoretical MOA of amantadine?
1. Increase in dopamine synthesis and release
2. Inhibition of dopamine uptake
3. NMDA antagonist
What are the two adverse effects that are specific to amantadine among PD drugs?
Peripheral edema and livedo reticularis
What is the MOA of the following drugs, benztropine, biperiden and ophenadrine? What PD symptoms/ signs do they address the best?
Anticholinergics address tremor and rigidity but very little effect on bradykinesia
What movement disorder can be treated by the following: haloperidol, clonidine and pimozide?
What are the top 2 first line medications for essential tremor?
What is the first line treatment of Wilson Disease?
Penicillamine a chelating agent
What medication can be given for restless legs syndrome?
Pramipexole and Ropinirole (Dopaminergic therapy)
What CA may be
activated by levodopa?
What eye condition is levodopa a relative contraindication?
Because of its mydriatic action it can cause increase in IOP therefore relative CI to open angle glaucoma but ABSOLUTE CONTRAINDICAITON TO ANGLE CLOSURE GLAUCOMA