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Movement Disorders
Exam 1
34
Pharmacology
Graduate
06/13/2013

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Cards

Term
Variations of Movement Disorders
Definition
Parkinson's (Idiopathic, Drugs)
Tremors
Huntington's
Tics
Restless Leg Syndrome (RLS)
Term
Pathophys of IPD, Reverse correlation
When are motor features detectable?
Definition
Degeneration of Dopaminergic neurons in the nigrostriatal pathway in combination with aging, environmental exposure, and genetics (especially if <50yo)... Imbalance in dopaminergic and cholinergic pathways
*Reversed correlation w/ smoking cigarettes and caffeine
**Motor features detectable at 70-80% loss
Term
IPD Clinical Presentation &
Diagnostic Testing
Definition
At least TWO of the following:
Limb Muscle Rigidity
Resting Tremor (gone w/ movement)
Bradykinesia
**Rule out drug-induced (antipsychotics, metoclopramide, prochlorperazine)
***NO DX TESTING
Term
IPD Sx
Definition
Tremor of UE at Rest (MC-hands)
Rigidity in UE, LE - increased to passive range of motion *cogwheel
-->may involve face (hypomimia - masking of facial expressions)
Bradykinesia - festinating gait, difficulty initiating
Postural Instability - advanced IPD
Term
Goals of Therapy in IPD
Definition
Preserve ADLs, Improve mobility, Maintain best QOL, Improve nonmotor features
*Increase dopamine, Decrease Ach
Term
Trihexyphenidyl, Benztropin
Indication
ADEs
Definition
Anticholinergics - most effective for tremor early in disease (rarely effective for dyskinesia)
ADEs: Blurry vision, confusion, dry mouth, constipation, urinary retention
Term
Amantidine
Indication
ADRs
Definition
Unknown MOA
Short-lived for tremor, rigid, bradykin.
Suppresses dyskinesia from levodopa
**Adjust w/ low CrCl (100mg 30-50, 100mg QOD 15-29, 200 Qwk <15)
ADRS - confusion, dizzy, hallucinations, LIVEDO RETICULARIS *reversible; diffuse skin mottling and often LE edema
Term
___ can cross the BBB, but might get metabolized before it gets to the brain. To combat this, we use ____ to prevent the metabolism.
Definition
L-Dopa
Carbadopa
Term
Carbadopa/Levodopa
MOA
PK - avoid taking with?
Contraindications
Definition
MOA: direct L-dopa supp plus inhibition of conversation of L-dopa to DA by LAAD
*Don't take w/ protein meals, antacids
Contra: Narrow angle glaucoma, MAOIs
Term
Carbidopa/Levodopa DDIs, ADRs
Definition
DDI - Dopa Antag (antiemetics, antipsychs), MAOIs (hypertensive crisis), Bupropion (^side effects), PIs (toxicitiy), PHT, iron - reduce L-dopa efficacy
ADRs: GI, post hypotens, vivid dreams, long term motor complications
Term
End of Dose wearing off Options
Definition
Increase L Dopa frequency
Change to Long Actor
Add Short Actor to Long Actor
Add DA agonist, MAOB-i, or COMT-i
Term
In rapid transition from dyskinetic "on" to bradykinetic "off" states, what are your options?
Definition
Add MAOB-i, COMT-i, Dopa Agonist
Term
Dyskinesias often happen where?
Options to fix?
Definition
Happens in neck, trunk, UE, LE
Options: smaller but more frequent doses
CR formulation
ADD AMANTIDINE
If severe, go to surgery
Term
Selegiline, Rasagiline
MOA, Uses, ADRs
Definition
MAO-B inhibitors *block metabolism by MAO-B
Use: Extend l-dopa duraction of action
*Rasagiline is 1st line for managing motor fluctuations
Rasag ADR: orthost hypotension, dyskinesia, GI hemorrhage, N/V/C
Seleg ADR: N/dizzy, HA, hallucinations, a-fib
Term
Selegiline, Rasagiline Contras
Definition
Sele: Meperidine, opioids w/patch
Rasag: Cyclobenzaprine, St. John's, opioids
Term
_____ may slow the rate of disease progression in early IPD.
Definition
Rasagiline.
**First line**
Term
Entacapone, Tolcapone
MOA
Increase or decrease l-dopa?
Definition
COMT inhibitors
*Extend effects of l-dopa by inhibiting COMT induced metabolism
*Entacapone - peripheral
*Tolcapone - peripheral, central(minimal) **Contra w/hepatic impairment
-->May need to reduce L-dopa dose
Term
Entacapone, Tolcapone ADRs, DDIs
Definition
Tolca - fatal hepatotoxic
-Orange-brown urine, delayed diarrhea
DI = nonselective MAOIs
Term
Entacapone, Tolcapone Uses, Place in Therapy
Definition
Use: Wearing off, reduce "off" time
Place:
Entac - first line managing motor fluctuations
Tolca - pts not responding to other therapies
Term
Bromocriptine, Pergolide
Definition
Ergot Dopa Agonists (D2)
Term
Pramipexole, Ropinirole
Definition
Non-ergot Dopa Agonistss (D2)
Term
Apomorphine - special considerations
Rotigotine
Definition
Apo = Parenteral Non-Ergot Dopa Agonist - pre-med w/ trimethobenz 3 days prior; rapid temporary relief of off-period
Rotig = Transdermal early IPD; approved for use in early IPD; ADRs include N/V, HA, sleep attacks
Term
Dopa Agonists ADRs
Definition
post. hypo, LE edema, nausea, hallucinations, sedation, psychosis, pleuropulm fibrosis, sleep attacks, light headed
Term
Bromocriptine DIs
Definition
Azole antifungals, PIs, erythro all INCREASE bromo concentrations
Term
_____ can be used as monotherapy out of all dopamine agonists.
Definition
Non-ergots (pramipexole, ropinirole, apomorphine)
Term
Tremor Types and Tx
Definition
Essential: hands, arms; beta-ad defect
Tx-propranolol
Intention: present during movement
Tx-decrease offending agent
Rest tremor: Parkinsonism
Term
Huntington's Disease, Tx
Definition
AutoDom inherited resulting in chorea and dementia; overactive dopaminergic paths
*Tx - Reserpine, Tetrabenzine, Haldol,
Term
Tics, Tx
Definition
Gilles de la Tourette's; usually sx treatment.
Tx- Haldol, Clonidine in kids
Term
Restless Leg Syndrome, Tx
Definition
Creeping discomfort arising deep in legs; common in pregnancy, diabetic neurop.
Tx: Dopa Agonists
Term
First Line in IPD (nonpharm)
Definition
Rasagiline
Term
Additional Sx Control: Tremors
>65yo
<65yo
Definition
>65: amantidine
<65: Antichol, amantidine
Term
Additional Sx Control: Brady, rigidity, tremor
>65
<65
Definition
>65: amantidine, DA agon or Carbi/L-dopa
<65: amantidine, DA ag or carbi/l-dopa
Term
Switching from IR Carba/Levo to CR
Definition
Reduce frequency and increase dose 10-30%
Term
Carb/Levo: Drug-resistant off periods: How it happens and what are your options
Definition
Due to delayed gastric emptying or decreased GI absorption
Options:
Give on empty stomach
Crush tablet or take ODT formulation
Avoid CR formulation
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