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TERMS TO LEARN

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Blepharospasm Eyelid spasm.
Blood-to-Gas Partition Coefficient (B/G Coefficient) An expression of solubility or the tendency of dissolved gas to come out of solution (ie, blood); low values indicate a fast-acting anesthetic.
Dysphagia Difficulty swallowing.
Ergotism Vasoconstriction leading to limb ischemia, gangrene, hypertension, and CNS disturbances; associated with the ingestion of ergots.
Lennox–Gastaut Syndrome Childhood epileptic encephalopathy; syndrome of severe seizures, mental retardation, and characteristic EEG pattern.
Minimum Alveolar Concentration (MAC) An expression of the concentration of inhaled anesthetic needed to keep 50% of patients from moving in response to surgical stimulus. Because it is a statistical measurement, all anesthetics are titrated until they produce the desired effect.
Pneumothorax Air in the intrapleural space.
Strabismus Nonparallel visual axis of the eyes.
West's Syndrome Infantile spasms; age-specific form of generalized epilepsy.
Propofol-Related Infusion Syndrome Syndrome characterized dysrhythmias, metabolic acidosis, hyperkalemia and rhabdomyolysis (with renal failure) associated with propofol use. Mortality rate of 33%.

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I. DRUGS AFFECTING MOVEMENT DISORDERS

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CLASSIFICATION OF DRUGS USED TO TREAT PARKINSON'S DISEASE

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DRUGS FOR THE TREATMENT OF PARKINSON'S DISEASE

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Drug Pharmacokinetics Mechanism of Action Clinical Uses Cautions Side Effects
Antiviral
Amantadine
  • A: PO

  • E: Excreted unchanged in urine

  • Antiviral drug used to treat influenza by inhibiting viral uncoating

  • Blocks or increases DA release in presynaptic fibers

  • DA release in the striatum

  • Parkinson's disease

  • Drug-induced EPS

  • Treatment and prophylaxis for influenza A

  • CHF

  • Patients prone to seizures

  • Renal impairment

  • Hepatic impairment

  • Narrow-angle glaucoma

  • CNS disturbances (restlessness, depression, irritability, hallucinations, confusion)

  • GI disturbances (nausea, constipation, xerostomia)

Anticholinergics
Benztropine (Cogentin)
  • A: PO, IM, and IV

  • M: Hepatic (however, remaining pharmacokinetics are not well understood)

  • Anticholinergic (muscarinic)

  • May inhibit reuptake and storage of DA

  • Parkinson's disease

  • Dystonia

  • Drug-induced EPS

  • BPH

  • Obstructive GI disease

  • Renal impairment

  • Hepatic impairment

  • Narrow-angle glaucoma

  • Anticholinergic side effects

MAO B Inhibitors
Selegiline (Emsam, Eldepryl, Zelapar)
  • A: PO, TD

  • D: Crosses BBB

  • M: Hepatic (P450) metabolism to active metabolites

  • E: Metabolites excreted in urine

  • MAO B irreversible inhibitor

  • Prolongs action of DA by preventing its breakdown

  • Interferes with DA reuptake

  • DA action in striatal region decreasing the symptomatic motor deficits of Parkinson's disease

  • May have neuroprotective effects

  • Enhances effect of L-dopa thus may reduce on/off effects

  • Depression

  • ADHD in children

  • Parkinson's disease

  • Avoid concomitant use of TCAs, SSRIs, and SNRIs

  • Block MAO A as well at high doses

  • May increase adverse effects of L-dopa (psychosis, dyskinesia)

  • Nausea

  • Headache

  • Insomnia

  • Inhibits P450 enzymes

Rasagiline (Azilect)
  • A: PO

  • M: Hepatic (P450)

  • E: Metabolites excreted in urine

  • Parkinson's disease

  • Nausea

  • Headache

  • Dyskinesia

  • Orthostatic hypotension

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SECOND-LINE DRUGS FOR PARKINSON'S DISEASE

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