movement disorder pharm

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movement disorder pharm
2012-11-14 17:13:45

huntington's, MS, ALS
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  1. 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
  2. antipsycholtics
    • huntington's disease
    • MOA: D2 antagoinst
    • USES: typical antipsychotic, severe chorea, paranoia, delutional states
    • AE: may decrease fine motor control
  3. antidepressants
    • huntington's disease
    • MOA: inhibition of serotonin reuptake (SSRI)
    • USES: depression if present
  4. 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
  5. 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
  6. 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
  7. 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
  8. 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
  9. 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)
  10. 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