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?
  15. Is drug holiday useful
  16. Best results of drug use?
    First 5-7 yrs. Range 2-15 yrs
  17. 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
  18. Sleep attacks can occur without warning
    Ropinerole and Paramipexole
  19. Rescue therapy for the on-off phenomena and mechanism of drug
    Apomorphine- D1 and D2 agonist
  20. 2nd generation agonists that work on the D3-Da receptors
    Ropinerole and Paramipexole
  21. 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.
  22. Antiviral drug for PD
  23. Which one can cause red/purple skin blotches
  24. MAO-B Inhibitors
    Rasagiline, Deprenyl
  25. Used in young patients with severe tremor
  26. Other drug that can be used to treat resting tremor
  27. 3 types of tremors
    Resting, postural, kinetic/intentional
  28. Medications for postural tremors, Other meds for postural tremor
    • Beta-blockers
    • Pregabalin, wine, benzos, botox
  29. Medication for postural hand tremor
  30. Pathophys of Huntington's
    Selective degeneration of the neurons of the basal ganglia esp GABA and Ach. Loss of the basal ganglia
  31. Are DA neurons affected in Huntington's
  32. In general what type of drugs do you want for Huntington's
    Ones that decrease DA levels
  33. What drug must you monitor depression in. what drug do you also give because of this?
    • Reserpine, tetrabenazine.
    • Fluoxetine(Prozac)
  34. Drugs that deplete vesicle storage levels of DA
    Reserpine, Tetrabenazine
  35. Drugs that block DA receptors
    Haloperidol, Chloropromazine
  36. Drug to treat the early rigid signs
  37. Treats the spastic effects of Huntington's
  38. What can you give in the late stages
  39. Disorder of copper metabolism
  40. What happens if D/O or copper metabolism is left untreated
    • (Wilson's)
    • Death
  41. Drugs to treat D/O of copper metabolism
    • (Wilsons)
    • Penacillamine, Potassium disulfide, Zinc acetate
  42. Which med to treat D/O of copper metabolism is a chelating agent
    • (Wilsons)
    • Penacillamine
  43. What can you give is resistant to Penicillamine
  44. What can you give with Penicillin to decrease absorption of copper
    Potassium disulfide
  45. Can you give potassium disulfide alone
  46. Explain mechanism of Zinc acetate
    It increases the production of a metabolite that binds with copper to prevent it from being absorbed
  47. Which medication can you use for long term maintenance tx
    Zinc acetate
  48. Can you start with zinc acetate right away?
    No- give it in combo with a chelating agent and slow go to just this drug
  49. 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
  50. Tx for Tourettes
    DA receptor blockers- Haloperidol or clonidine
  51. Tx for focal dystonia
  52. 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

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Movement Disorders - Pharmacology
2014-12-08 16:04:40

Pharmacology PAP-570
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