Drugs For Motor Disorders

Front 1

What is the biological defect in PD?

Back 1

1. Excessive cholinergic activity

2. Deficient dopaminergic activity

In the striatum

Front 2

What is the most effective agent to tx PD?

Back 2

1. Levodopa

Front 3

What is the MOA of levodopa?

Back 3

1. Converted to dopamine in striatal neurons

2. Dopamine responsible for therapeutic effects

Front 4

Why can't you use dopamine to tx PD?

Back 4

1. Does not cross BBB

Front 5

What are the adverse effects of levodopa?

Back 5

1. Dyskinesia

2. N/V

3. Postural hypotension

4. Psychosis

Front 6

What is the effect of conventional antipsychotics on levodopa?

Back 6

1. Decrease efficacy

Front 7

What will MAO inhibitors+levodopa cause?

Back 7

1. HTN crisis

Front 8

What is the use of carbidopa?

Back 8

1. Used in combo with levodopa

Front 9

What is the MOA of carbidopa?

Back 9

1. Inhibits decarboxylating enzymes in intestines and peripheral tissue

2. Increases levodopa levels

Front 10

What is the advantage of using levodopa/carbidopa?

Back 10

1. Decrease levdopa dose--- decrease adverse effects

Front 11

What are the disadvantages to levodopa/carbidopa use?

Back 11

1. Dyskinesias and psychiatric problems may occur sooner

Front 12

When do levodopa effects tend to peak? When does it wear off?

Back 12

1. Peak-- middle of interdose period

2. Wear off--- constant time interval after last dose

Front 13

How can you keep levodopa from "wearing off"?

Back 13

1. More frequent dosing

2. Controlled release formulation

3. Prolong levodopa half-life

Front 14

What is the use of Sinemet CR?

Back 14

1. Controlled release of levodopa

Front 15

What is the use of COMT inhibitor?

Back 15

1. Prolong levodopa half-life

Front 16

What are the dopamine agonists?

Back 16

1. Pramipexole

2. Ropinirole

Front 17

What is the use of dopamine agonists in the tx of PD?

Back 17

1. Patients with mild or moderate ssx

Front 18

What are the advantages to the use of dopamine agonists?

Back 18

1. Don't depend on nigrostriatal neurons to convert levodopa

2. Don't compete with dietary protein

3. Better for long-term use

4. Can be combine with levodopa

Front 19

What are the adverse effects of dopamine agonists?

Back 19

1. Hallucinations

2. Daytime sleepiness

3. Postural hypotension

Front 20

What is the MOA of apomorphine?

Back 20

1. Dopaminergic agonist

2. High affinity for D4

Front 21

What is the clinical use of apomorphine?

Back 21

1. Rescue tx for intermittent off states

2. Adjunct drug for advanced Parkinson's

Front 22

What are the COMT inhibitors?

Back 22

1. Entacapone

Front 23

What is the MOA of entacapone?

Back 23

1. Blocks peripheral conversion of levodopa

Front 24

What is the advantage of entacapone use?

Back 24

1. Less hepatotoxicity than tolcapone

2. May reduced wearing off of levodopa/carbidopa

Front 25

What are the adverse effects of entacapone use?

Back 25

1. Raise plasma levodopa levels---

2. Dyskinesias

3. Vomiting

4. Diarrhea/constipation

5. Urine discoloration

Front 26

What is Stalevo?

Back 26

1. Levodopa/carbidopa/entacapone combo

Front 27

What leads to the "on-off" effect in PD drugs?

Back 27

1. Incomplete delivery of DA

2. Variations in levodopa absorption

3. Competition from dietary substrates

4. Progressive loss of DA neurons

Front 28

What are the selective MAO-B inhibitors?

Back 28

1. Selegiline

2. Rasagiline

Front 29

What is the advantage of MAO-B inhibitor use?

Back 29

1. May be neuroprotective

2. Less amphetamine-like side effects

Front 30

What are the centrally-acting muscarinic antagonists?

Back 30

1. Trihexyphenidyl

2. Benztropine

Front 31

What is the use of centrally-acitng muscarinic antagonists?

Back 31

1. Reduce tremor and rigidity

Front 32

What is the 2o drug for tremors?

Back 32

1. Cholinergic antagonists

Front 33

What are the adverse effects of cholinergic antagonists?

Back 33

1. Sedation, confusion, delusions, hallucinations

2. Dry mouth, blurred vision, urinary retention

Front 34

What is the MOA of amantadine in the tx of PD?

Back 34

1. Inhibit dopamine uptake

2. Stimulate dopamine release

3. Block cholinergic receptors

4. Block glutamate receptors

Front 35

What are the adverse effects of amantadine?

Back 35

1. Confusion, light-headedness, anxiety

2. Dry mouth, blurred vision, urinary retention

Front 36

How do you tx restless leg syndrome?

Back 36

1. Tx iron deficiency

2. Ropinirole/pramipexole

3. >50 y/o= carbidopa/levodopa

Front 37

What is used to tx essential tremor?

Back 37

1. Propranolol

2. Primidone (anticonvulsant)

Front 38

How do you tx chorea in Huntington's?

Back 38

1. Tetrabenazine

2. Reserpine

3. Antipsychotics

Front 39

How do you tx ALS? What is its MOA

Back 39

1. Riluzol--- antiglutaminergic