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17 Cards in this Set

  • Front
  • Back
Rasagiline (Azilect)
- early/mild/late P.D. treatment
- early
- MAO-B inhibitor - slows breakdown of DA in striatum
Amantidine (Symmetrel)
- early/mild/late P.D. treatment
- early
- augments DA release, blocks re-uptake. benefits are modest.
- HELPS WITH DYSKINESIAS
Anticholinergic drugs (muscarinic antagonists)
- early/mild/late P.D. treatment
- early
- most effective FOR TREMOR!
- cholinergic side effects
Pramipexole (Mirapex)
- early/mild/late P.D. treatment
- adverse effects
- mild
- DA receptor agonist
- agonist at D2 and D3 - symptomatic relief
- sudden attacks of sleep, and gambling/compulsive behavior
- DA receptor agonists in combination with levodopa is good
Ropinirole (Requip)
- early/mild/late P.D. treatment
- adverse effects
- mild
- DA receptor agonist
- agonist at D2 and D3 - symptomatic relief
- sudden attacks of sleep,and gambling/compulsive behavior
- DA receptor agonists in combination with levodopa is good
Levodopa (Sinemet = carbidopa + levodopa)
- early/mild/late P.D. treatment
- adverse effects
- diet?
- late/severe
- levodopa is a DA precursor, crosses the bbb, and converted to DA in striatum
- carbidopa inhibits peripheral decarboxylation of levodopa to DA
- most effective tx for PD! a lack of response to levodopa raises the q if patient has PD or not
- low protein diet - protein competes with absorption of levodopa in duodenum and at bbb
adverse effects of BOTH levodopa and dopamine receptor agonists
- nausea
- hallucinations
- vivid dreams
- hypotension
- dyskinesias (more with levodopa)
- confusion (treatment of PD in a demented patient is very challenging)
Entacapone (Comtan)
- type of med
- indicated for?
- COMT inhibitor
- indicated for the "wearing-off" effect. ONLY taken with levodopa. COMT breaks down DA peripherally. Inhibition of COMT prolongs effects of levodopa
surgical options
- pallidotomy - surgical lesion placed in the internal segment of the globus pallidus
- thalamotomy - lesion in the thalamus - more helpful for tremor
- deep brain stimulation (DBS) - battery-powered neurostimulator intoglobus pallidus. advantage: can be adjusted!!
Secondary Parkinsonsim
- drugs that cause
- toxins
- MPH - Metoclopromide, Prochlorperazine, Haloperidol
- MPTP (methyl-phenyl-tetrahydropyridine) is destructive to neurons in the substantia nigra
disorders that commonly present with hyperkinetic movement
1. wilson's dz
2. huntington's dz
3. hemiballismus
4. tourette's syndrome
5. tardive dyskinesia
Hyperkinetic movement disorders
- idiopathic focal dystonias
- tx?
- blepharospasm, torticollis, spasmodic dysphonia (strained or breathy voice), writer's cramp
- BOTULINUM TOXIN lasts for few months
Wilson's dz
- what
- who
- lab tests?
- inborn error of copper metabolism
- ALL YOUNG PATIENTS with a movement disorder should be checked!
- LOW CERULOPLASMIN BLOOD LEVEL
- HIGH 24HR URINE COPPER LEVEL
huntington's dz
- genetics
- traits
- autosomal dominant (family hx). ^ CAG trinucleotide repeats (recall myotonic dystrophy had CTG)
- traits
1. dementia - generalized brain atrophy
2. choreiform movements - degeneration in the striatum (especially CAUDATE nucleus)
3. gait often affected
Hemiballismus
- stroke of the contralateral subthalamic nucleus
- acute onset of wild, flinging, "ballistic" movements in contralateral arm/leg
- b/c is a small vessel stroke, no other clinical features! (sensory, motor, etc)
tourette's syndrome
- what
- timeline for dx
- **association
- motor/vocal tics
- onset before age 21, present for > 1 year
- a/w OCD (atleast 50%)!!!
tardive dyskinesia
- cause
- trait
- chronic tx with neuroleptic medications
- repetitive sterotypic movements particularly of the LOWER FACE (chewing, "flycatcher tongue", etc)