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monoamine depletors
- huntingon's disease
- MOA: vesicular monoamine transporter 2 inhibitor, depletion of presynaptic catecholamines
- USES: treatment of chorea, start with low dose to avoid AE
- AE: depression/suicidal ideation
- CI: pts who are suicidal and/or with untreated depression
-
antipsycholtics
- huntington's disease
- MOA: D2 antagoinst
- USES: typical antipsychotic, severe chorea, paranoia, delutional states
- AE: may decrease fine motor control
-
antidepressants
- huntington's disease
- MOA: inhibition of serotonin reuptake (SSRI)
- USES: depression if present
-
glucocorticoids
- MS
- MOA: activation of glucocorticoid receptor, relief of acute attacks, used for immunsuppression in this case, b/c autoimmune diseae
- IV bolus admin over 3-7 days - reduces risk potential of adrenal suppresion
-
interferon beta 1a
- MS
- MOA: suppress T cell proliferation, inhibit T cell movement to CNS
- USES: management of replapsing remitting MS, tx of 1st clinical episode
- AE: local injection site reaction
- human recombinant from E.coli, IM admin
-
interferon beta 1b
- MS
- MOA: suppress T cell proliferation, inhibit T cell movement to CNS
- USES: management of replapsing remitting MS
- AE: local injection site reaction
- human recombinant from mammillian cells
-
glatiramer acetate
- MS
- MOA: unclear, but thought to modify Ag presenting cells
- USES: management of relapsing-remitting MS, tx of first clinical episode with MRI features consistent with MS
- AD: injection site reaction, chest pain with heart palpitations
- random polypeptide HS to drugs
-
fingolimod
- MS
- MOA: prodrug of sphingosine
- USES: replasing-remitting MS, reduces relapses and delay disability progression
- AE: bradycardia, AV block, headahe diarrhea, increased liver enzymes
- CI: abnormal liver function, normal ECG for pts taking antiarrhythimc meds
-
natalizumab
- MS
- MOA: binding to alpha-4 integrin - believed to block trafficking of T cell to CNS
- USES: second line tx for RRMS, reduces relapses and delay disability progresion
- AE: progressive multifocal leukoencephalopathy (touch program)
-
riluzole
- ALS
- MOA: inhibits glutamate release, blocks postsynaptic NMDA, inhibits Na channels to inhibit AP propagation
- USES: extends survival or time to tracheostomy in ALS pts
- AE: nausea, weakness, decrease resp function
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