12. Neuro Pharmacology Flashcards
What are the clinical features of Parkinsonism?
Tremor
Rigidity
Bradykinesia
Postural instability
What are the non motor manifestations of Parkinson’s disease?
Mood changes Pain Cognitive change Urinalysis symptoms Sleep disorder Sweating Low BP Restless legs Fatigue Hallucinations
What drug can be used for motor symptoms in Parkinson’s disease?
Levodopa
What is L-DOPA used in combination with?
Peripheral DOPA decarboxylase inhibitor to stop increased levels of dopamine in peripheral tissues
What are the side effects of L-DOPA?
Nausea/anorexia
Hypotension
Psychosis
Tachycardia
What are the drug interactions with L-DOPA?
Pyridoxine increases peripheral breakdown of L-DOPA
MAOIs (monoamine oxidase inhibitors) risk hypertensive crisis
Many antipsychotic drugs block dopamine receptors and Parkinsonism is a side effects
What are the dopamine receptor agonists?
Ropinirole
Pramipexole
Rotigotine (patch)
Apomorphine (s.c.)
What are the side effects of dopamine receptor agonists?
Impulse control disorders Sedation Hallucinations Confusion Nausea Hypotension
What is the function of monoamine oxidase B?
Metabolised dopamine
Predominates in dopamine containing regions in brain
MAOB inhibitors enhance dopamine
Name the monoamine oxidase B inhibitors
Selegiline
Rasagaline
Safinamide
What is the action of catechol-O-methyl transferase (COMT) inhibitors?
Reduce peripheral breakdown of L-DOPA to 3-O-methyldopa
Has no therapeutic effect alone
What is stalevo?
Combination tablet of COMT inhibitor and L-DOPA and peripheral dopa decarboxylase inhibitor
What are the side effects of anticholinergics?
Confusion
Drowsiness
Usual anticholinergic side effects
What symptoms does amantadine treat?
Dyskinesia
What is the action of amantadine?
NMDAR inhibition
What are the features of myasthenia gravis?
Fluctuating, fatiguable, weakness skeletal muscle
Extra-ocular muscles - blurred vision
Bulbar involvement - dysphagia, dysphonia, dysarthria
Limb weakness
Respiratory muscle involvement
What drugs can exacerbate myasthenia gravis?
Aminoglycosides Beta blockers, CCBs, quinidine, procainamide Chloroquine Succinylcholine Magnesium ACE inhibitors
What is the therapeutic management of myasthenia gravis?
Acetylcholinesterase inhibitors Corticosteroids Steroid sparing IV immunoglobulin Plasmapheresis
Name some acetylcholinesterase inhibitors
Pyridostigmine - main
Neostigmine
What are the side effects of pyridostigmine?
Salivation Sweating Lacrimation Urinary incontinence Diarrhoea GI upset and hyper mobility Emesis
