Pharmacotherapy of movement disorders Flashcards Preview

Clinical Neuroscience weeks 1-3 > Pharmacotherapy of movement disorders > Flashcards

Flashcards in Pharmacotherapy of movement disorders Deck (28):
1

4 Cardinal symptoms of Parkinson's Disease

1) Bradykinesia- slow movements
2) Rigidity- inc muscle tone and resistance
3) Resting tremor that goes away with voluntary movement
4) Postural instability

2

Hallmark feature of Parkinsons pathophysiology

Loss of dopaminergic neurons in the substantia nigra pars compacta

3

When Basal Ganglia decides we need to move, how does it react?

Shuts down the indirect pathway and cranks up the direct.

4

Why do D2 blockers have the potential to cause parkinsonism?

Because they prevent dopamine from binding the D2 receptors inhibiting the indirect pathway. Indirect pathway is always on.

5

4 methods of parkinson dz treatment?

1) Replacement of Dopamine
2) Stmulate D2 receptor
3) Increase Dopamine release
4) Inhibit dopamine metabolism

6

Can dopamine cross the BBB

no

7

What do you give instead of just giving dopamine?

L- DOPA

8

L-Dopa tx is inhibited by?

Food

9

99% of L-Dopa is converted in the periphery to DA. This is problematic because as we just discussed, Dopamine cannot cross the BBB. How do you get around this?

Give L-DOPA with Carbidopa....Blocks peripheral L-AAD so that more of the L-DOPA enters the CNS before it is converted to Dopamine.

10

Adverse effects of L-DOPA

GI, CV (arrhythmias and orthostatic htn)

11

LDOPA + Carbidopa AE

Behavioral change and Dyskinesia

12

Treatment with L-DOPA usually quits working after how long

3-5 years

13

See Contraindications for L-DOPA

psychotics, CV dz, PUD, Melanoma

14

What is the preferred initial course of therapy for parkinsons

Stimulate the D2 receptor with a D2 receptor agonist

15

Amorphine

Non-specific dopamine receptor agonist

16

Bromocriptine

D2 and D1

17

Pramiprexole

D2 specific, free radical scavengar

18

Ropinirole

D2 specific. CYP 1A2

19

Amantadine

Antiviral that increases dopamine release

20

Adverese effects of Amantadine therapy

Psychosis with overdose

21

Dopamine is metabolized into what by what?

DOPAC by Monoamine oxidase- B

Then DOPAC is converted in HVA by COMT

22

Monoamine oxidase B inhibitors

Selegilline and Rasagilline

23

Depression in Huntington's disease is treated with

Fluoxetine (SSRI) and Carbamezapine (voltage gated Na blocker)

24

Reserpine in HD?

Reserpine depletes DA

25

Tetrabenzine in HD

Tetrabenzine depletes DA

26

Chlorpromazine

D2 Antagonist in parkinsons

27

Haloperidol in HD

D2 antagonists

28

D2 antagonists do what?

cause parkinsons