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62 Cards in this Set
- Front
- Back
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What is myoclonus?
What is it usually due to? |
Brief muscle contraction
Usually secondary to meds of metabolic change (esp. renal failure) |
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Treatment for myoclonus
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Treat underlying cause
5-hydroxytryptophan w/ carbidopa (useful when due to hypoxic brain injury) |
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What types of drugs may exacerbate myoclonus?
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Seizure drugs
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What is the treament for tics?
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Neuroleptics
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What drugs can often cause tremors (3)?
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Li
Caffeine Valproate |
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Treatment for non-PD tremors (5)
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Can be relieved by small amounts of EtOH
Non-selective beta-blocker BDZs Primidone If severe, Deep Brain Stimulation |
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What is dystonia?
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Painful, abnormal muscle contractions
Entails simultaneous agonist/antagonist muscle groups contracting |
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Blepharospasm
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Eyelids closing
(within category of dystonia) |
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Meige Syndrome
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Blepharospasm
Facial, jaw spasm (within category of dystonia) |
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Spasmodic torticollis
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Neck/shoulder dystonia
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Treatment options for focal dystonia (3)
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Botulinum toxin
BDZs Baclofen |
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Mechanism of Baclofen
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GABA-B agonist
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Treatment options for torsion dystonia (2)
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High dose anti-cholinergics
Stereotactic surgery |
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Side effect of Baclofen
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Sedation
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Chorea vs. athetosis
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Chorea -- faster, dance-like
Athetosis -- slower, more serpentine |
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Treatment of chorea/athetosis due to Wilson's disease
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Penicillamine - copper chelator
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Treatment options for chorea/athetosis (3)
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Reserpine
Tetrabenazine Clozapine |
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Mechanism of tetrabenazine
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Antagonist @ VMAT2 site
Decreases DA levels in vesicles |
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What is the risk entailed in using reserpine?
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HIGH depression/suicide risk
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How can the dose-limiting SE of baclofen be reduced?
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Continuous, intrathecal baclofen administration
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Treatment options for spasticity (4)
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Baclofen
BDZs Botox (BUT, will need larger doses) Tizanadine |
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What is the mechanism of Tizanadine in spasticity?
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Alpha-1 antagonism
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What is the difference in receptor specificity between BDZs and baclofen?
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Baclofen - GABA-B
BDZs - GABA-A |
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After when do you start seeing PD motor symptoms?
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After 50 - 70% of nigrostriatal DA neurons are lost
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Where are most D1/D2 receptors located?
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Basal ganglia
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What is the structural difference between D1 and D2 receptors (2)?
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3rd cytoplasmic loop
Length of cytoplasmic carboxy terminus |
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What is the function of D1?
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Increaeses many ion currents
(does so via stimulating adenylate cyclase) |
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What G-protein does D1 couple with?
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Gs
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What G-protein does D2 couple with?
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Gi
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What is the function of D2?
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Increases K influx (hyperpolarization)
(does so via inhibiting adenylate cyclase) |
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What receptor is responsible for the psychiatric effects of DA agonists?
Where is it primarily located? |
D5
Cortex |
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Activation of what DA receptors is needed for maximum motor improvement?
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Simultaneous activation of D1 & D2
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Why is 3-O-methyl-DOPA important?
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It competes w/ L-DOPA for uptake
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What can abrupt withdrawal of L-DOPA induce?
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Severe akinetic-rigid syndrome similar to NMS
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Mechanism of Pergolide
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Weak D1 agonist
10x stronger D2 agonist NOTE: this is an ergot derivative like bromocriptine |
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Mechanism of Bromocriptine
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Mixed D1 agonist/antagonist
D2 agonist |
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Mechanism of Pramipexole and Ropinirole
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Highly selective D2 agonists
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What subtype of D2 does pramipexole prefer?
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D3
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Why are pramiprexole and ropinirole rarely used in early PD?
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Because they don't activate BOTH D1 & D2
(they only activate D2) |
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What additional beneficial effects does pramipexole have (2)?
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Anti-depressant
Neuroprotection - slows loss of DA terminals |
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What type of drugs are tolcapone and entacapone?
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COMT inhibitors
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What beneficial effects do COMT inhibitors cause?
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Reduce required L-DOPA dosage
Prolong "on" time by 1 - 2 hrs. NOTE: these are effective only in a minority |
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What is the very serious potential side effect of tolcapone?
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Fatal hepatic necrosis
LFTs have to be obtained every two weeks |
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When does any neuroprotective effect of selegline wear off?
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In about 2 years
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Mechanism of amantadine in PD
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Increased DA release from DA terminals
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What is needed in order for amantadine to be effective in PD?
(hint: this is why it is used in early PD) |
NEED existing DA neurons
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What is a side effect of amantadine in PD?
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Confusion in the elderly
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What symptoms of PD can amantadine treat?
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Dyskinesias
Freezing |
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What type of drugs are benztropine and trihexyphenidyl?
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Anti-cholinergics
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What do benztropine and trihexyphenidyl do in PD?
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Block tremor
Can also be helpful for freezing |
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What are the side effects of anti-cholinergics?
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Peripheral - dry mouth, constipation, etc.
Central - memory loss, confusion |
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What can clozapine and quietapine do in PD?
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Both -- suppress L-DOPA induced dyskinesia
Quietapine -- reduce psychosis assoc. w/ DA agonists |
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What is apomorphine?
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"Oldest" D2 agonist
D2 > D1 activity, BUT ACTS ON BOTH |
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What could apomorphine be used for in PD?
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For acute bradykinesia
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Effects of DBS (2)
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Treats dyskinesias
Smoothes out treatment fluctuations |
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What are the benefits of starting PD therapy w/ DA agonist instead of L-Dopa?
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Fewer dyskinesias
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What is the time frame of efficacy for PD treatment as a whole?
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5 - 10 years
ALL of the drugs, so far, eventually fail |
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What drugs treat ocular gaze palsies?
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TCAs
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Treatment options for Shy-Drager syndrome (3)
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Increase salt intake
Mineralocorticoid Alpha-agonist for BP |
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What is corticonigral degeneration manifested as?
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Limb apraxia
UMN symptoms |
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What is striatonigral degeneration manifested as?
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Progressive bradykinesia W/O rigidity or tremor
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What is olivopontocerebellar atrophy manifested as?
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Ataxia
Bulbar CNS deficits |
