Br Pharmacology: Parkinsonism And Movement Disorders

Front 1

What is another name for parkinsons?

Back 1

paralysis agitans

Front 2

Signs of parkinsons include?

Back 2

rigidity,akinesia, flat facies, tremor

Front 3

Pathologically what occurs in Parkinsons?

Back 3

decrease dopamine in nigrostriatal tract that inhibit striatal GABAergic neurons

Front 4

Most postsynaptic receptors on GABAergic neurons are what?

Back 4

D2 which are negatively coupled to adenylyl cyclase

Front 5

Which drugs cause parkinsons?

Back 5

Antipsychotics
1) butyrophenone
2) phenothiazine
Others
1) resperpine

Front 6

What byproduct of synthetic heroine production can cause irreversible parkinsonism?

Back 6

MPTP is a meperidine analog that destroys dopaminergic neurons in the nigrostriatal tracts

Front 7

Antiparkinson drugs act on what receptor?

Back 7

D2

Front 8

What is the MOA of carbidopa? Where in body does it work?

Back 8

1) given Levodopa
2) can NOT cross blood brain barrier
3) Inhibits DOPA decarboxylase peripherally

Front 9

What are toxicities of levodopa?

Back 9

1) anorexia, Nausea, emesis
2) postural hypotension
3) tachycardia, asystole, arrythmias
4) chorea, ballismus, myoclonus, tics, tremor
5) anxiety, agitation, confusion, delusions, hallucinations, depression

Front 10

Who is levodopa contraindicated in?

Back 10

people with psychosis

Front 11

What is the MOA of bromocriptine and pergolide?

Back 11

ergot alkaloids that are partial agonists of D2 receptors in brain

Front 12

What are toxic effects of bromocriptine and pergolide?

Back 12

1) anorexia, nausea, vomiting
2) postural hypotension, arrythmias
3) dyskinesias
4) confusion, hallucinations, delusions

Front 13

Who is bromocriptine contraindicated in?

Back 13

psychotic patients

Front 14

Why was pergolide removed from the market?

Back 14

it was implicated in cardiac valvular disease

Front 15

What are ergot related effects of bromocriptine?

Back 15

pulmonary infiltrates and erythromelalgia

Front 16

What is the MOA of ropinirole and pramipexole?

Back 16

ropinirole: D2 receptor agonist
pramipexole: D2 and D3 receptor agonist and is neuroprotective by scavenging H2O2

Front 17

What are toxicities of pramipexole and ropinirole?

Back 17

1) anorexia, nausea, vomiting
2) dyskinesias,
3) postural hypotension, lassitude

Front 18

What enzyme metabolizes ropinirole? What other drugs does it metabolize?

Back 18

1) CYP1A2
2) caffeine and warfarin

Front 19

What is the MOA of apomorphine?

Back 19

dopamine receptor agonist providing relief for 1-2 hours

Front 20

What are the side effects of apomorphine?

Back 20

1) nausea
2) have to take with antiemetic trimethobenzamide
3) dyskinesia
4) hypotension
5) drowsiness
6) sweating

Front 21

What is the MOA of amantadine?

Back 21

1) enhances dopaminergic neurotransmission
2) may block muscarinic receptors

Front 22

Taking amantadine can improve what?

Back 22

1) bradykinesia
2) rigidity
3) tremor
4) influenza type a

Front 23

What are side effects of amantidine?

Back 23

1) restlessness, agitation, insomnia, confusion, hallucinations, acute toxic psychosis
2) LIVEDO RETICULARIS ( mottled reticulated vascular pattern that appears like a lace-like purplish discoloration of the lower extremities)
3) GI problems, urinary retention, postural hypotension and EDEMA

Front 24

What is the MOA of selegiline rasagiline?

Back 24

inhibitor of MAO-B which metabolizes dopamine in preference of NE and epinephrine

Front 25

What are the toxic effects of selegiline and rasagiline?

Back 25

1) insomnia, mood change
2) dyskinesia
3) GI distress
4) hypotension

Front 26

Meperidine in combination with selegiline has resulted in what?

Back 26

1) agitation
2) delerium
3) death

Front 27

What anti-parkinson drug has been implicated in serotonin syndrome when patients are also taking an SSRI?

Back 27

selegiline

Front 28

What is the MOA of entacapone and tolcapone?

Back 28

inhibit COMT which converts levodopa to 3-O-methyldopa
Note: 3OMD competes with levodopa for transport into the CNS

Front 29

What are the toxic effects of entacapone and tolcapone?

Back 29

1) dyskinesias, GI and postural
2) ORANGE discoloration of urine
3) Tolcapone has caused liver failure

Front 30

Which antimuscarinic drugs are used in parkinsons?

Back 30

1) benztropine
2) trihexyphenidyl

Front 31

Which features of parkinsons do antimuscarinic effect? what don't they treat?

Back 31

Improve:
1) tremor
2) rigidity
3) reverse extrapyramidal symptoms caused by antipsychotics
***Do NOT help with bradykinesia***

Front 32

What are toxicities of antimuscarinics?

Back 32

1) drowsiness, inattention, confusion, delusions and hallucinations
2) peripherally act like atropine
3) exacerbate tardive dyskinesias from antipsychotic drugs

Front 33

How can tremors be treated?

Back 33

1) propanol = beta blocker
2) metoprolol = beta 1 selective blocker
3) antiepileptic drugs including primidone and topiramate

Front 34

Who should propanol be used with caution in?

Back 34

CHF, asthma, diabetes or hypoglycemia

Front 35

tremor in someone that also has pulmonary disease might benefit from?

Back 35

metoprolol

Front 36

How is essential tremor treated?

Back 36

1) propanol
2) primidone
2) topiramate

Front 37

How is Huntingtons treated?

Back 37

1) reserpine and tetrabenazine = amine depleting drugs
2) haloperidol = dopamine receptor antagonist

Front 38

How is tourettes treated?

Back 38

1) haloperidol
2) D2 receptor blockers (pimozide)
3) Carbamazepine, clonazepam, clonidine

Front 39

How are acute dystonias treated?

Back 39

1) benzotropine
2) diphenhydramine (anti-H1)
Note: levodopa and bromocriptine are not helpful because dopamine receptors are blocked by antipsychotics

Front 40

What causes tardive dyskinesias?

Back 40

older antipsychotics form a denervation supersensitivity

Front 41

How is Wilsons disease treated?

Back 41

pencillamine (dimethylcystiene) removes excess copper

Front 42

What are the toxic effects of pencillamine?

Back 42

1) GI distress
2) MYASTHENIA
3) optic neuropathy
4) BLOOD DYSCRIAS

Front 43

What is restless leg syndrome? who is it common in?

Back 43

1) idiopathic unpleasant creeping discomfort of limbs at rest
2) common in pregnant women, uremic and diabetic patients

Front 44

How is restless leg syndrome treated?

Back 44

1) dopaminergic therapy and ropinirole
2) can use opioid analgesics and benzos

Front 45

Dopamine (DA) agonist (for Parkinson's disease), used also for hyperprolactinemia

Back 45

Bromocriptine

Front 46

Irreversible condition resulting from the use of antipsychotics, reserpine at high doses, and MPTP (by-product of illicit meperidine analog)

Back 46

Drug induced Parkinsonism

Front 47

This is combined with L-dopa, inhibits DOPA decarboxylase (active only peripherally) which allows lower effective doses of L-dopa and allows for fewer SE's (GI distress, postural hypotension, and dyskinesias)

Back 47

Carbidopa

Front 48

Clinical response that may fluctuate in tx of Parkinson's dx

Back 48

"On-off-phenomenon"

Front 49

Anti-Parkinson's drug which increases intraocular pressure and is contraindicated in closed angle glaucoma

Back 49

Levodopa

Front 50

Ergot alkaloid that is a partial agonist at D2 receptors in the brain, used for patients who are refractory or cannot tolerate levodopa, causes erythromelalgia (severe burning, itching and swelling of hands)

Back 50

Bromocriptine

Front 51

Enhances dopaminergic neurotransmission SE's include CNS excitation, acute toxic psychosis and livedo reticularis

Back 51

Amantadine

livedo reticularis - mottled reticulated vascular pattern that appears like a lace-like purplish discoloration of the lower extremities

Front 52

Inhibitor of MAO type B which metabolizes dopamine, used adjunct to levodopa or as sole agent in newly diagnosed patients

Back 52

Selegiline

Front 53

Agent decreases the excitatory actions of cholinergic neurons. May improve tremor and rigidity but have LITTLE effect on bradykinesia. Atropine-like side effects

Back 53

Benztropine

Front 54

Agent effective in physiologic and essential tremor

Back 54

Propranolol

Front 55

What is sumatriptan used for? What is its MOA?

Back 55

1) acute migraine and cluster HA
2) 5-HT1B/1D agonist