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Neuro > PHARM: Movement Disorders > Flashcards

PHARM: Movement Disorders Flashcards

1
Q

What are the 4 main clinical symptoms of Parkinson’s Disease?

A
  • Bradykinesia
  • Muscular Rigidity
  • Resting tremor
  • Postural instability/impaired gait
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2
Q

What is the pathological hallmark of Parkinson’s Disease?

A

selective loss of 70-80% of the pigemented neurons in the substantia nigra pars compacta

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3
Q

What effect does the direct pathway have on the thalamus?

A

increase thalamic output

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4
Q

What effect does the indirect pathway have on the thalamus?

A

decrease thalamic output

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5
Q

What part of the basal ganglia is responsible for the tonic inhibition of the thalamus?

A

GPi

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6
Q

What initiates the direct pathway?

A

SN pars compacta stimulates striatum D1 receptors

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7
Q

What is the result of stimulating D1 receptors in the striatum?

A

GABAergic/SP neurons from striatum are sent out to inhibit GPi

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8
Q

What stimulates the indirect pathway?

A

cortex stiulates the striatum

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9
Q

What occurs when the cortex stimulates the striatum?

A

sends out GABA/ENK neurons to inhibit GPe

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10
Q

What does GPe do naturally?

A

inhibits the subthalamic nucleus (STN)

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11
Q

What does the STN do when not inhibited by GPe?

A

sends out glutamergic neurons to stimulate GPi (for increased tonic inhibition)

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12
Q

How are D2 receptors involved in the indirect pathway?

A

the SNpc can stimulate them to inhibit the inhibitory pathway (via blockage of the cholinergic interneurons that also stimulate GABA/ENK neurons)

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13
Q

What are the 5 strategies to treat PD?

A
  • Replace DA
  • Stimulate D2 receptors
  • Enhance DA release
  • Inhibit DA metabolism
  • Alter DA/Ach balance
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14
Q

What drugs are employed in the “replace DA” strategy to treat PD?

A

L-Dopa

L-Dopa + Carbidopa

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15
Q

What drugs are employed in the “stimulate D2 receptors” strategy to treat PD?

A

Bromocriptine
Parmipexole
Ropinirole
Apomorphine

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16
Q

What drug is employed in the “enhance DA release” strategy to treat PD?

A

Amantadine

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17
Q

What drugs are employed in the “inhibit DA metabolism” strategy to treat PD?

A

Selegiline
Rasagiline
Entacapone
Tolcapone

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18
Q

What drugs are employed in the “alter DA/Ach balance” strategy to treat PD?

A

Benztropine
Diphenhydramine
Trihexyphenidyl
(anti-cholinergics)

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19
Q

What are some issues with the fact that L-Dopa is an oral drug?

A

-Competes with L-amino acids in food in the GI tract (so you need to NOT take it with food)

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20
Q

What problem does L-Dopa have with B6?

A

Need to give with a decarboxylase inhibitor because B6 breaks it down

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21
Q

Why does L-Dopa have to be given in such large oral doses when given alone?

A

99% is converted in the periphery to DA by ALAD

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22
Q

How long is L-Dopa effective, and what consequence does this have on prescribing it?

A

Only good for 3-5 years, so save it for later stages

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23
Q

Which drug has the following contraindications?

  • Psychosis
  • Peptic ulcers
  • Glaucoma
  • Cardiac Disease
  • Melanoma
  • MAOI Use
A

L-dopa

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24
Q

What is carbidopa?

A

ALAD (aromatic L-amino acid dicarboxylase) inhibitor that prevents the peripheral metabolism of L-Dopa to DA

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25
Q

What drug needs to be given with L-Dopa + carbidopa?

A

antipsychotics (because carbidopa has behavioral side effects)

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26
Q

What are the major side effects of L-Dopa + carbidopa?

A

Behavioral changes and dyskinesias (reduces dosage of L-Dopa needed by 75%, so those side effects are not problematic)

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27
Q

What are the major side effects of L-Dopa?

A

GI (anorexia or N/V)

Cardiac (orthostatic hypotension, Tachycardia, Arrhythmias)

28
Q

True or false: L-Dopa may exascerbate PD progression.

A

TRUE

29
Q

What drug is a D2 and partial D1 agonist?

A

Bromocriptine

30
Q

What drug is a D2 selective agonist and free radical scavenger?

A

Pramipexole

31
Q

What drug is a D2 selective agonist?

A

Ropinirole

32
Q

What drug is a D1 and D2 agonist?

A

Apomorphine

33
Q

What is the major advantage of using dopamine agonists to treat parkinson’s disease?

A

more selective so less adverse effects

34
Q

What drug is an antiviral agent that may enhance release and synthesis of DA and inhibit DA uptake?

A

Amantadine

35
Q

What drugs are selective MAO-B inhibitors?

A

Selegiline

Rasagline

36
Q

What is MAO-B?

A

MOA-B is the enzyme that pre-synaptically metabolizes dopamine to DOPAC so that it is not packaged into vesicles for release

37
Q

What drugs are selective inhibitors of COMT?

A

Entacapone

Tolcapone

38
Q

What is the role of COMT?

A
  • metabolizes DA in the synaptic terminal to HVA

- increases production of 3OMD which competes with L-Dopa for transport across the GI an BBB

39
Q

What drugs block cholinergic activation in the striatum to decrease GABAergic output to the GPe (to inhibit the indirect pathway)?

A

Benztropine
Diphenhydramine
Trihexyphenidyl

40
Q

What drugs CANNOT be taken with meperidine, TCAs or SSRIs?

A

Selegiline

Rasagiline

41
Q

What drug causes restlessness, depression, irritability, confusion, and psychosis with overdose?

A

Amantadine

42
Q

What drugs are contraindicated in prostatic hyperplasia, OBD, glaucoma, and in people taking antimuscarinics?

A

Benztropine
Diphenhydramine
Trihexyphenidyl

43
Q

What drug is contraindicated with a history of seizures or heart failure?

A

Amantadine

44
Q

Which of the COMT inhibitors has central and peripheral effects?

A

Entacapone

45
Q

What COMT inhibitor requires signed patient consent? Why?

A

Tolcapone leads to elevated liver enzymes and hepatic failure

46
Q

What drugs lead to dry mouth, constipation, N/V, drowsiness, mental slowness, and inattenation?

A

Benztropine
Diphenhydramine
Trihexyphenidyl

47
Q

What drugs are given as early treatment for PD?

A

Dopamine agonists

Anticholinergics

48
Q

What drug can be used in early PD alone but has modest and short-lived effects?

A

amantadine

49
Q

What dopamine agonist is metabolized by CYP1A2?

A

Ropinirole

50
Q

What drug is used in patients who are losing responsiveness to L-Dopa and is NEVER used alone?

A

Selegiline

51
Q

Which is more potent, selegiline or rasagiline?

A

Rasagiline (can be used alone in early PD)

52
Q

Which drugs are used to increase the bioavailability of L-dopa and decrease “off time”?

A

Entacapone

Tolapone

53
Q

What is a potential new target for the treatment of PD?

A

L-type Ca2+ channels (if you block these with isradipine, it will convert them to a more juvenile state that may prevent disease progression)

54
Q

What converts tyrosine to DOPA?

A

tyrosine hydroxylase

55
Q

What converts DOPA to DA?

A

ALAD

56
Q

What packages DOPA into vesicles in the pre-synaptic membrane?

A

VMAT

57
Q

In what gene does the trinucleotide expansion for HD occur?

A

IT15 (causes huntingtin to become a transcriptional regulator–gain of function)

58
Q

What neurons are lost in HD?

A

cholinergic neurons in striatum
GABAergic neurons projecting to the GPe

(which typically stimulate the indirect pathway)

59
Q

What are the major clinical symptoms of HD?

A
  • Chorea
  • Unsteady gait
  • Slowing of mental processing (ex. planning)
  • Reducitons in memory (how to process/acquire new information)
60
Q

What classes of drugs are used to treat HD related depression?

A

SSRI (fluoxetine)

Anti-epileptic (Carbamazepine)

61
Q

What other classes of drugs are used to treat HD?

A
  • VMAT inhibitors (deplete central DA)

- D2 receptor antagonists (inhibit inhibition of indirect pathway)

62
Q

What VMAT inhibitors are used in HD?

A

Reserpine

Tetrabenazine

63
Q

What D2 receptor antagonists (drugs that lead to parkinsonism) are used in HD?

A

Chlorpromazine

Haloperidol

64
Q

What calss of drugs are used in early HD to prevent chorea?

A

Reserpine

Tetrabenazine

65
Q

What drugs are used in the alter stages of HD?

A

Chlorpromazine

Haloperidol

Neuro (10 decks)

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