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102 Cards in this Set
- Front
- Back
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what are the names of receptor agonist
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apomorphine, bromocriphine, promipexole, ropinirole
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monoamine oxidase inhibitors
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rasagiline, selegiline
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what are some catechol o methyl transferase inhibitors
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entacapone, tolcapone
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when does the intention tremor of parkinsons stop and what makes it worse
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it stops when you go to do a voluntary movement and it is made worse by cold, fatigue, and strong emotions
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___ is an involuntary, compulsive, rapid, repetitive, movement or vocalization, experienced as irresistable although it can be surpressed for some length of time. it is made worse with stress. may be simple or complex
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tics
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in what disease do tics happen
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gilles de la tourette syndrome
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what is dopamines normal role
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to inhibit the GABAergic (inhibitory) output from the striatum (caudate and putamen) ..so in PD GABA is no longer inhibited and causes unstoppable inhibition
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what can people with PD be treated with
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dopaminergic drugs or antimuscarinic agents
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what is the immediate metabolic precusor to dopamine
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levodopa
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how does levodopa enter the cns
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LAT
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what is the moa of levodopa
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binds to d2 as an agonist
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what is levodopa coadministered with and why
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carbidpoa (dopamine decarboxylase inhibitor) because it reduced the peripheral metabolism , increased plasma levels, increases the half life, which means there is more levodopa available to get into the brain and decreases the daily req
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does levodopa stop the PD dz progression
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no but it does decrease mortality when initiated early in the dz
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what is the wearing off phenomenon of levodopa
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from long term tx. its is where each dose effectively improves symptoms for a limited time and by the time the dose wears off the rigidity and akenesia return..so you can try and increase the dose but this is limite by dyskinesias
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what are the main SE of Levodopa
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GI: if given without a decarboxylase it can cause nausea, vomiting and anorexia, so carbidopa minimizes SE-- vomiting is caused by activation of the chemoreceptor trigger zone
CV:postural hypotensio, hypertension (if take w MOA or symp mimetics) Dykinesias: choreoanthetosis bw quick and slow movements of the face behavioral changes: mood, insomnea, confusion--may take antipsychotics for these |
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what is the on off phenomena of levodopa
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in the off period- akinesia alternate over the course of a few hours with on periods of improved mobility but still marked dyskinesia
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what drug can provide temp relief for pts with severe off periods
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SQ injections of apomorphine
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why would you take a drug holiday from levodopa
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to increase responsiveness and alleviate some adverse effects, may cause risk of immobility, this is no longer recommended
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what drug drug interaction result happens when levodopa and MOA inhibitors
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hypertensive crisis
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who should not get levodopa
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psychos, angle closure glaucoma, melanoma hx, suspicious skin lesions, pt with active peptic ulcer dz may cause GI bleeding
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what kind of drug is Bromocriptine
what is a SE |
D2 receptor agonist that is an ergot alkaloid derivative
SE: digital vasospasm |
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what is bromocriptine used for
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PD and endoctine disorders, hyperprolactinemia, prolactin secreting adenomas,
-half life 15 hours -extensive first pass |
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what does pramipexole bind to
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d3 receptors
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what is pramipexole used to treat
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PD and restless leg syndrome
half life 8 hours |
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how is pramipexole excreted
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unchanged in the urine
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what does ropinirole bind to
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d2 recpetors
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what is ropinirole used for
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RLS and PD
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how long is the half life of ropinirole and what is it metabolized with and coadministered with
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6 hr
coadmin with agents that may also reduce the clearance of ropinirole and are also metabolized by CYP1A2 |
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what are adverse effects of Dopamine receptor agonists
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GI: anorexia, nausea, vom- dec symp if take with meal, constipation, dyspepsia, and reflux esopagitis
CV: postural hypotension, peripheral edema and cardiac arrythmias Dyskinesias mental probs-confusion, hallucinations, mental probs more severe than with levodopa |
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what SE is assoc with ergot derivatives that are dopamin receptor agonist
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HA, nasal congest, increased arousal, pulm infiltrates, pleural and retroperitoneal fibrosis
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what SE is assoc with pramipexole and ropinirole
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uncontrollable urge to fall asleep at inappropriate times
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who should not get dopamin receptor aagonists
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ppl with psychotic dz, recent MI, or active peptic ulceration
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who should not get Bromocriptine
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ppl with peripheral vasc dz
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what does MAO A metab
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norep and serotonin
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what does MAO B metb
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phenylethylamine and benzylamine
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what does MAO A and B equally metab
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dopamine and tryptamine
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what is the MOA of selegiline
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irreverible MAO B inhibitor and MAO A at high doses-
- slows the breakdown of dopamine and prolongs the antiparkinsonian effects of levodopa, may reduce mild on off or wearing off phenomena |
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what is selegiline used for
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pt with declining or flucating responses to levodopa
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who should not take selegiline
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pt taking meperidine, tricyclic antidepressants, or serotonin reuptake inhibitors
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what is does Rasagiline inhibit
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irreversible inhibitor of MAO-B more potent than selegiline
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what is Rasagiline used for
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neuroprotective agent and early symptomatic treatment of PD
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the combined administration of levodopa and non selective MAO inhibitor must be avoided why?
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because it may lead to a hypertensive crisis due to peripheral accum of norep
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what is the function of COMT
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metabolizes levodopa to 3-O methyldopa which compted with levodopa for transport across the intestinal mucosa and the BBB
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what is the role of COMT inhibitors
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prolong the activity of levodopa by inhibiting its peripheral metabolism, which decreases clearance and increases bioavail
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what are COMT inhibitors used for
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ppl getting levodopa that are experiences fluctations in response
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what are two COMT inhibitors and what is the diff between them
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Tolcapone and entacapone
tolcapone has both central and peripheral effects whereas entacapone has peripheral effects only |
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what is a side effect of tolcapone
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death from increase in liver ensymes- bc it leads to hepatic failure
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what are SE of COMT inhibitors
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orange urine, diarrhea, abdominal pain and sleep probs
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what is the MOA of Apomorphine
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dopamine agonist that stim postsynaptic d2 recpetors in the caudate -putamen
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what is apomorphine used for
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injected sq for pt in off period of dopamine tx- works in ten min
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what are side effects of Apomorphine and what can they be treated with
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nausea ( can pretreat with trimethobenzamide) dyskinesia, sweating, hypotension,
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what is amantadine
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antiviral that might potentiate dopaminergic effects used to treat PD
-short half life |
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what are side effects of amantadine
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restlessness, depression, irritabilty, insomnia, agitations,HA, heart failure, urinary retention GI probs
***livido reticularis- purpleish mottled discoloration on skin |
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who should use amantadine with severe caution
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ppl w hx of seizures, or heart failure
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what part of PD are antimuscarinics used to treat
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the rigidity and tremor but have little effect on bradykenisia
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what are the names of the antimuscarinics that can be used to tx pd
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benzotropine, biperiden, orphenadrine, procyclidine, trihexyphenidyl
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what are tremors that are associated with B1 receptors treated with
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metoprolol and propanolol
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what antiepileptic drug can be used to treat a symptomatic tremor
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primidone- used in a smaller dose
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what serotonin receptor agonist has been shown effecting in tremor tx
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topirimate
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what benxodiazepine has been shown to help tremor
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alprazolam
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which drugs impair dopaminergic activity and alleviate chorea
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resperine, tetrabenazine, olanapine, perphenazine, halpperidol
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what is reduced in the BG of peeople w HD
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GABA and choline transferase
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what is the MOA of resperine and tetrabenazine
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block the vesicular monoamine transporter adn deplete cerebral dopamine stores
tetrabenazine- has less peripheral activty and a shorter duration of action |
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what is the first choice of tx for hd
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dopamine antagonist or anxiolytics which reduce involuntary movement
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what is the most predictive and effective pharm tx for tics
and what is the backup plan |
neuroleptic antipsychotics- ex pimozide
back up for less SE: alpha adrenergic agents ex. clonidine, guanfacine |
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what is the first line tx for RLS
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non ergot dopamine agonist pramipexole and ropinirole
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what is the MOA of penicillamine
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chelatin agent that forms a stable complex with copper and is readily exctreted by the kidney
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what are SE of penicillamine
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nephritic syndome, myasthenia, optic neuropathy, blood disorders
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what agent reduced the intestinal absorption of copper and can be prescribed with penicillamine
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potassium disulfide
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what is the MOA of zince acetate and zinc sulfate
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increase pooping of copper by decreasing copper absorption
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why is levodopa more effective for PD treatment than dopamine
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bc it can cross the BBB and dopamin can not
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what is the most commonly used drug for PD
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levodopa/carbidopa=Sinemet
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what are SE of levodopa
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nausea, hypotension, and nightmares, psychosis and aggression
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what are the two newest and best tolerated dopaminergic drugs where do they bind and what do they do
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Pramipaxole and ropinirole
they bind to d2 in striatum |
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what are the side effects of pramipaxole and ropinirole
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hypotension and behavioral changes, psychosis and hallucinations! more than with levodopa(sinemet)
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what is the role of amandatine in tx PD
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helps release dopamine, also anticholinergic ( antagonizes glutamate)
helps with wearing off of leva -loses effect after 6 mo |
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what is an example of an anticholinergic that can be used for PD and what is its fxn
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trihexyphenidyl,used to counter the loss of dopamine
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what is a SE of trihexyphenidyl
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delerium esp in elderly
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what are the trade names of two monoamine oxidase inhibitors and which one is neuroprotective
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Eldepryl, and Azilect
Azilect is neuroprotective |
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which COMT inhibitor can be combined with levodopa and is not hepatotoxic
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entacapone when combined its called stalveo
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what is the best treatment for an essential tremor
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propanolol
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what other drug is also good for essential tremor but may cause delerium and sedation
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primidone
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what is used for severe cases of essential tremor
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deep brain stim or ablation of C/L thalmus
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what is Tourette's treated with
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Haloperidol a d2 blocker
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___ is sustained abnormal movements, minutes, hr or even days of sustained muscular contractions, with twisting. will cause abnorm posture
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dystonia
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what is another name for oppenheim dystonia
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DYSTONIA MUSCULORUM DEFORMANS
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what is the prob in oppenheim dystonia
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possibly and atpase prob
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what age group gets oppenheim dystonia
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second or third decade= aka 13
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what are symtpoms of dystonia
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bizzarre twisting movement of one leg while running or playing. body may become horridly distorted, trunk and head involved/
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what is the time frame of oppenheim dystonia
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flexion over 5-10 years an then a plateua
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what drugs are used for oppenheim dystonia
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levo-dopa, diazepam ( is a benzo), tetrabenazine (anticholinergic)
or botulinum toxin |
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what is char of adult onset dystonia
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they stay focal Blepharospasm of the eyes, writer’s cramp of the forearm, hemifacial spasm, spastic dysphonia of the vocal cords
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what is another name for toricollis
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cervical dystonia
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what is the best treatment for tortilcollis
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botulinum toxin- which prevents ach release
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what is a blepharospasm
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severe contractions of the orbicular oculi, bilateral, interfering with vision; associated with Parkinson’s disease
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what all types of dystonias are responsive to botinum toxin
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blepharospasm, hemifacial spasm, writers cramp, dystonia of vocal cords
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what are choreas treated with
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dopamine antagonist ie haloperidol if the known cause can not be treated
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what disease is this: chorea, dementia, depression, irritable, impulsive, psychosis, decreased muscle tone and weakness, weight loss, ultimately fatal in all cases
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Huntigtons
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what age group gets huntingtons
what causes it |
30-40. genetics=AD
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what is visible on CT or MRI if HD pt
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destruction of caudate or putamen and other areas of brain
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what are the early signs of HD
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irritability, fault-finding, nagging, angry, fidgety, neglect of personal care
then chorea begins- worse in the head and face |
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what are some drugs that can be tried with HD
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haloperidol, Reserpine. tetrabenazine-limits dementia, dimebon (stabilize mito)
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