Movement Disorders 2
Terms
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- Shy Drager
- Parkinson's with disfunctinal autonomic nervous system funtion
- Familial or essential tics are aggravated by 1) and relieved by 2)
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1) Caffeine
2) Ehtanol - Torsion dystonia is more common in this racial lineage
- Ashkenazi jewish lineage
- Two methods of break down for L-DOPA
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Methylation (COMT)
Decarboxylation (DOPA) - Where caridopa works
- In periphery to block decarboxylation of L-DOPA
- Like carbidopa, these two drugs inhibit L-DOPA break down, but the act on COMT
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Tolcapone
Entacapone - A few incidents of fatal hepatic necrosis with this drug
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Tolcapone (COMT inhibitor)
Monitor liver enzyems every 2 weeks while using - Rare side effect of Tolcapone
- Fatal Hepatic Necrosis
- 4 dopamine agonists
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Bromocriptine
Pergolide
Pramipexole
Ropinirole
Last two are highly selective for D2 and more effective - Cardiac valve thickening
- Associated with pergolide use (dop agonist)
- Amantidine
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Used for dyskinesias
Increases dopamine release from dopamine terminals - Anticholinergic drugs
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Work to lower ACh effects but have typical side effects
Benztropine
Trihexiphenidyl - Selegiline
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MAO-B Inhibitor
May have neuroprotective effect for 1-2 years, but it is falling in popularity - Antispasticity drugs
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Baclofen
Benzodiazapines
Tizanidine - Baclofen
- GABA-B agonist used for antispasticity
- Tizanidine
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antispasticity drug
alpha adronergic antagonist - Good neuroletpcis for treatment of psychosis and hyperkinesis
- Clozapine better than typical AP's because no tardive dyskinesia
- trihexyphenidyl
- anticholinergic for parkinson's
- metabolite of selegiline
- amphetamine (undesirable)
- 5-hydroxytryptophan
- useful for suppresing myclonus and helping ataxia
- suppresses myoclonus
- 5-hydroxytryptophan
- Tx for Tourett's
- Use a neuoleptics with breaks to prevent tardive diskinesia
- Tx for essential tremor
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Propanolol
Mysoline
Benzodiazepines (or alcohol) - New Tx for dystonia
- Clostridium Botulinum
- Tx for movement disordres in Wilson's disease
- Penicillamine (chelator)