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Flashcards in movement disorders Deck (23):
1

Levodopa

-used for parkinson
-can enter CNS via L-amino acid transporter
-dopamine receptor agonist (mainly D2)
-1-3% enters brain, the rest is metabolized by decarboxylation into dopamine. adding carbidopa (DOPA decarboxylase inhibitor) increases amount to brain and lowers the necessary dose.
-without decarboxylase inhibitor, causes anorexia, nausea, vomiting. more cabidopa can help symptoms
-postural hypotension. hypertension in large doses or with MOA inhibitors
-may cause dyskinesias, depression, anxiety, agitation, insomnia, hallucinations, euphoria
-apomorphine injection used to help with severe off-periods
-do not give to psychotic pts, with angle closure glaucoma, history of melanoma

2

bromocriptine

-D2 agonist
-used in parkinsons
-extensive first pass metabolism (CYP3A4)
-can cause digital vasospasm during long term treatment
-do not give to those with peripheral vascular disease

3

pramipexole

-D3 agonist
-parkinsons, restless leg syndrome
-90% excreted unchanged in urine (lower dose if renal insufficiency)
-uncontrollably fall asleep

4

ropinirole

-D2 agonist
-parkinsons, restless leg syndrome
-metabolized by CYP1A2
-uncontrollably fall asleep

5

selegiline

-irreversible MAO-B inhibitor
-parkinsons, prolongs levodopa, reduce on-off affect

6

rasagiline

-irreversible MAO-B inhibitor
-more potent than selegiline
-parkinsons

7

tolcapone

-COMT inhibitor
-prolong activity of levodopa by inhibiting its metabolism
-has central and peripheral effects
-can increase liver enzymes and death by hepatic failure
-orange discoloration of urine

8

entacapone

-COMT inhibitor
-prolong activity of levodopa by inhibiting its metabolism
-has peripheral effects only
-orange discoloration of urine

9

apomorphine

-D2 agonist in caudate-putamen
-temporarily relief of on-off therapy
-nausea (pretreat with trimethobenzamide), dyskinesias, drowsiness, sweating, hypotension

10

amantadine

-antiviral agent
-parkinsons
-excreted unchanged in urine
-can cause restlessness, depression, irritability, insomnia, agitation, headache, heart failure
-can cause livedo reticularis, vascular condition of purplish mottled discoloration of skin

11

anticholinergic drugs

-mAChR antagonists
-parkinsons tremor and rigidity
-benztropine, biperiden, orphenadrine, procyclidine, trihexyphenidyl

12

metoprolol

-B1 antagonist
-treats tremors

13

propranolol

-B1 antagonist
-treats tremors

14

primidone

-AED
-can be used to treat tremors with lower doses

15

topirimate

-serotonin receptor agonist
-treats tremors

16

alprazolam

-a benzodiazepine
-can treat tremors

17

botulinum toxin A

-used to treat tremors

18

reserpine

-impair dopaminergic neurotransmission by blocking VMAT
-used to treat chorea in hunting tons
-irreversible

19

tetrabenzine

-impair dopaminergic neurotransmission by blocking VMAT
-used to treat chorea in hunting tons
-reversible

20

primozide

-antipsychotic
-used to treat tics
-weightgain, sedation, irritability,

21

riluzole

-for ALS
-inhibits glutamate release and blocks post synaptic NMDA receptor and inhibits voltage-dependent Na+ channels
-nausea and weakness

22

penicillamine

-used in wilsons disease
-chelating agent that stabilizes copper and allows excretion by kidney
-nausea, vomiting, nephritic syndrome

23

potassium disulfide

-used in wilsons disease
-reduces intestinal absorption of copper