Movement Disorders - Pharmacology

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  1. Need loss of what % of neurons to see symptoms in Parkinson's?
  2. Compensation of DA loss
    Decreased reuptake due to loss of boutons, increased synthesis of DA, increased release of DA per bouton, increased receptors
  3. What is responsible for the release and removal of DA
  4. Type of tremor
  5. Is there a cure
  6. Do we use DA directly for tx? Why ?
    No-doesn’t cross BBB
  7. Do we use anticholinergics? Why?
    No- too many S/E
  8. Standard drug of choice for Parkinsons? Why?
    L-dopa-it is after the rate limiting step of TH
  9. How much L-dopa originally makes it to the brain? Why
    1/3- AAAD in the gut and blood
  10. What S/E are seen with L-dopa and why
    DA is precursor to NE and Epi- see those s/e
  11. What drug is ALWAYS given in combo with L-dopa. How does it work?
    Carbidopa. It is a peripheral AAAD inhibitor that cannot penetrate the BBB
  12. What combo drug is usually given
  13. Dietary consideration with L-dopa
    High protein food can interfere with absorption. Take with full glass of water, don’t take with meals. Most use XR anyway
  14. What is on-off phenomena?
    • Is drug holiday useful
    • No
  15. Best results of drug use?
    First 5-7 yrs. Range 2-15 yrs
  16. Drug interactions with L-dopa
    Don’t give with MAOis or MAO-As (lead to hypertensive crisis). Don’t give to psychotic patients (can make them worse) anticholinergics can decrease absorption
  17. Sleep attacks can occur without warning
    Ropinerole and Paramipexole
  18. Rescue therapy for the on-off phenomena and mechanism of drug
    Apomorphine- D1 and D2 agonist
  19. 2nd generation agonists that work on the D3-Da receptors
    Ropinerole and Paramipexole
  20. Tolcapone and Entacapone: what type of drug? Which one is longer-acting? Which one must you monitor liver enzymes for and why? Which one has orange urine?
    • COMT-inhibitors.
    • Tolcapone.
    • Tolcapone.
    • Entacapone.
  21. Antiviral drug for PD
  22. Which one can cause red/purple skin blotches
  23. MAO-B Inhibitors
    Rasagiline, Deprenyl
  24. Used in young patients with severe tremor
  25. Other drug that can be used to treat resting tremor
  26. 3 types of tremors
    Resting, postural, kinetic/intentional
  27. Medications for postural tremors, Other meds for postural tremor
    • Beta-blockers
    • Pregabalin, wine, benzos, botox
  28. Medication for postural hand tremor
  29. Pathophys of Huntington's
    Selective degeneration of the neurons of the basal ganglia esp GABA and Ach. Loss of the basal ganglia
  30. Are DA neurons affected in Huntington's
  31. In general what type of drugs do you want for Huntington's
    Ones that decrease DA levels
  32. What drug must you monitor depression in. what drug do you also give because of this?
    • Reserpine, tetrabenazine.
    • Fluoxetine(Prozac)
  33. Drugs that deplete vesicle storage levels of DA
    Reserpine, Tetrabenazine
  34. Drugs that block DA receptors
    Haloperidol, Chloropromazine
  35. Drug to treat the early rigid signs
  36. Treats the spastic effects of Huntington's
  37. What can you give in the late stages
  38. Disorder of copper metabolism
  39. What happens if D/O or copper metabolism is left untreated
    • (Wilson's)
    • Death
  40. Drugs to treat D/O of copper metabolism
    • (Wilsons)
    • Penacillamine, Potassium disulfide, Zinc acetate
  41. Which med to treat D/O of copper metabolism is a chelating agent
    • (Wilsons)
    • Penacillamine
  42. What can you give is resistant to Penicillamine
  43. What can you give with Penicillin to decrease absorption of copper
    Potassium disulfide
  44. Can you give potassium disulfide alone
  45. Explain mechanism of Zinc acetate
    It increases the production of a metabolite that binds with copper to prevent it from being absorbed
  46. Which medication can you use for long term maintenance tx
    Zinc acetate
  47. Can you start with zinc acetate right away?
    No- give it in combo with a chelating agent and slow go to just this drug
  48. How do you treat the other hyperkinetic disorders
    DA depleting drugs-reserpine, tetrabenazine. Or neuroleptic drugs-Haloperidol, chloropromazine. Or benzos. Or anti-seizure (carbamazepine). And anticholinergics in kids
  49. Tx for Tourettes
    DA receptor blockers- Haloperidol or clonidine
  50. Tx for focal dystonia
  51. Tx plan for Parkinsons
    Start with amantadine, ropinerole, paramipexole. Then go to L-dopa when needed. When L-dopa becomes less effective decrease the dose and supplement with DA agonists
Card Set:
Movement Disorders - Pharmacology
2014-12-08 16:04:40

Pharmacology PAP-570
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