Pharm Exam 3: Movement Disorder Drugs

Front 1

Loss of pigmented cells occurs in what anatomic area in Parkinsons?

Back 1

Substantia nigra

Front 2

What are the inclusions called in the basal forebraine in Parkinsons?

Back 2

Lewy bodies

Front 3

What is the neurotransmitter deficit in Parkinsons?

Back 3

Dopamine

Front 4

What is the ideal pharmacologic treatment of Parkinsons?

Back 4

Levodopa/Carbidopa

Front 5

Direct pathway facilitates or inhibits movement?

Back 5

Direct pathway facilitates movement

Front 6

Indirect pathway facilitates or inhibits movement?

Back 6

Indirect pathway inhibits movement

Front 7

Direct pathway feeds into Gpi or Gpe?

Back 7

Gpi

Front 8

Direct pathway from Gpi goes to what part of the brain?

Back 8

Subthalamic nucleus

Front 9

Indirect pathway feeds into Gpi or Gpe?

Back 9

Gpe

Front 10

From Gpe, the indirect pathway can take two courses:

Back 10

1. Subthalamic nucleus
2. Gpi

Front 11

With Parkinsons, which pathway increases and what decreases - direct and indirect?

Back 11

Direct pathway increases (increased movement) and indirect pathway decreases (decreased movement pathway)

Front 12

D1 receptor is excitatory or inhibitory?

Back 12

D1 receptor is excitatory

Front 13

D2 receptor is excitatory or inhibitory?

Back 13

D2 receptor is inhibitory

Front 14

What class of drugs is ideal in EARLY treatment of idiopathic Parkinsons experiencing a prominent tremor?

Back 14

Anticholinergics

Front 15

What class of drugs is the mechanism of action: to compensate for reduced inhibitory actions of dopaminergic neurons from substantia nigra on the striatum?

Back 15

Anticholinergics

Front 16

What makes up the striatum?

Back 16

Caudate and putamen

Front 17

Name two anticholinergics used in Parkinsons?

Back 17

1. Trihexylphenidyl
2. Benztropine

Front 18

What class of drug is Trihexylphenidyl?

Back 18

Anticholinergic

Front 19

What class of drug is benztropine?

Back 19

anticholinergic

Front 20

What are adverse reactions of anticholinergics? Name 2:

Back 20

Dry mouth
Sedation
Blurred vision
Glaucoma exacerbation
Urinary retention
Impairment of cognitive function

Front 21

What drug crosses the BBB and taken up into dopaminergic neurons to be converted into dopamine?

Back 21

Levodopa

Front 22

Where does the conversion and production of dopamine occur?

Back 22

In dopaminergic neurons

Front 23

What drug is a peripheral dopa-decarboxylase inhibitor?

Back 23

Carbidopa

Front 24

What is the most effective and rapidly acting treatment form SYMPTOMS of idiopathic Parkinsons?

Back 24

Levodopa/Carbidopa

Front 25

Dyskinesias and motor fluctuations are adverse effects of what drug?

Back 25

Levodopa/Carbidopa

Front 26

Does levodopa/carbidopa help balance disorder of Parkinsons?

Back 26

No, it does not

Front 27

In the past, why was Levodopa weighed out in giant amounts of grams.

Back 27

So little of it gets to the BBB.
Rationale for giving with Carbidopa which is a peripheral dopa-decarboxylase inhibitor

Front 28

What enzyme rapidly breaks down levodopa in the periphery?

Back 28

Dopa-decarboxylase

Front 29

How much of ingested levodopa actually reaches the brain?

Back 29

<1%

Front 30

vazar

Back 30

to leak

Front 31

70% of levodopa is metabolized by what enzyme. 10% of levodopa is metabolized by what enzyme?

Back 31

70% by dopa-decarboxylase
10% by COM-T

Front 32

What does COM-T stand for?

Back 32

Catechol-o-methyltransferase

Front 33

What is the half-life of levodopa/carbidopa?

Back 33

1-1.5 hours

Front 34

What drug is a peripheral inhibitor of COM-T?

Back 34

Entacapone

Front 35

What drug increases the elmination half-life of levodopa by 50%?

Back 35

Entacapone

Front 36

What drug metabolite causes the urine to turn orange?

Back 36

Entacapone

Front 37

Can Entacapone cause dyskinesias and motor fluctuations?

Back 37

Yes it can. Adverse effects are similar to those of levodopa

Front 38

Dietary amino acids can have a competing effect on LNAA transporter in the GI tract and BBB?

Back 38

Yes it can
(LNAA = large neutral amino acid) transporter

Front 39

Levodopa + dopa decarboxylase produces what?

Back 39

Dopamine

Front 40

Levodopa + COMT produces what?

Back 40

3-O-methyldopa (inactive)

Front 41

What drug is a helper drug in treating Parkinsons?

Back 41

Amantadine

Front 42

What drug can cause livedo reticularis (Rsh)

Back 42

Amantadine

Front 43

What drug promotes dopamine release, inhibits DA reuptake, has anticholinergic actions and acts as a glutamate receptor antagonist?

Back 43

Amantadine

Front 44

Amantadine is indicated for early/late Parkinsons?

Back 44

Early Parkinsons

Front 45

Name an ergot derivative

Back 45

Bromocriptine

Front 46

What class of drugs mimic DA at receptors in the striatum?

Back 46

DA agonists

Front 47

What drugs are indicated as first-line treatment for symptomatic idiopathic Parkinsons?

Back 47

DA agonists

Front 48

"Sleep attacks" are a big problem associated with what drug?

Back 48

Bromocriptine (Ergot derivative)

Front 49

Ergot and non-ergot derivatives belong to what class of drugs?

Back 49

DA agonists

Front 50

Name two non-ergot derivatives

Back 50

Pramipexole
ropinirole

Front 51

Pramipexole is what kind of drug?

Back 51

Non-ergot derivative (DA agonist)

Front 52

Ropinirole is what kind of drug?

Back 52

Non-ergot derivative (DA agonist)

Front 53

What drugs are also indicated for restless legs syndrome? (2)

Back 53

Non-ergot derivative:
Pramipexole
Ropinirole

Front 54

"Sleep attacks" can/cannot also occur with non-ergot derivatives?

Back 54

Can also occur

Front 55

What is the indication for non-ergot derviatives?

Back 55

1st line treatment for symptomatic Parkinsons

Front 56

What was the first dopamine agonist shown to be effective in 1951?

Back 56

Apomorphine

Front 57

Subcutaneous injections of what drug is used as "rescue" treatment?

Back 57

Apomorphine

Front 58

Severe GI reaction is an adverse reaction of what drug?

Back 58

Apomorphine

Front 59

MAO-A or MAO-B causes the breakdown of DA?

Back 59

MAO-B

Front 60

Selegiline belongs to what drug class?

Back 60

MAO-B selective inhibitor

Front 61

Rasagiline belongs to what drug class?

Back 61

MAO-B selective inhibitor

Front 62

Which of the two are irreversible MAO-B selective inhibitors - Seligiline or rasagiline?

Back 62

Rasagiline

Front 63

Which of the two has amphetamine metabolite and has a higher side effect profile? Rasagiline and seligiline

Back 63

Selegiline

Front 64

Which of the two has less side effects b/c it does not have amphetamine metabolites? Rasagiline vs. seligiline?

Back 64

Rasagiline

Front 65

Motor fluctuations can/cannot occur with continuous dopaminergic stimulation?

Back 65

Yes - switch between dyskinesia and bradykinesia

Front 66

Continuous therapy with levodopa plus entacapone stabilizes plasma levodopa levels? (T/F)

Back 66

True - reduces motor fluctuations between dyskinesia and bradykinesia

Front 67

What drug increases synthesis of dopamine?

Back 67

Levodopa

Front 68

What drug increases the release of DA?

Back 68

Amantadine

Front 69

What drug has action at the dopamine receptor?

Back 69

DA agonists

Front 70

Degradation of DA by MAO-B is inhibited by what drugs?

Back 70

Seligiline and rasagiline

Front 71

Reuptake of DA is inhibited by what drug?

Back 71

Amantadine

Front 72

What is the percent of people with essential tremor and autosomal dominant pattern of inheritance?

Back 72

50%

Front 73

What movement disorder is very common with prevalence near 6%

Back 73

Essential tremor

Front 74

Propanolol, primidone, gabapentin, alprazolam, and clonazepam can be used to treat what movement disorder?

Back 74

Essential tremor

Front 75

Trihexylphenidyl, BZD, Baclofen (GABA-B agonist), and Botox are used to treat what movement disorder?

Back 75

Dystonia

Front 76

What drug is useful for focal dystonia?

Back 76

Botox