12.1 Neuropharmacology

Question 1

proportion of basal ganglia lost to give PD symptoms

Answer 1

> 50%

Question 2

where do dopamingeric neurones project to?

Answer 2

caudate nucleus and putamen

Question 3

abnormal protein in PD

Answer 3

alpha synuclein, misolds

Question 4

why does dopamine reduce in PD, aside from less substantial nigra?

Answer 4

increased cell turnovers upregukate receptors so uses up remaining dopanine

Question 5

describe the tremor of PD

Answer 5

asymmetric, low freq, pill rolling, at rest, goes away on touching somethign

Question 6

describe the rigidity in PD

Answer 6

lead pipe: resistance constant throughout arc

Question 7

describe the bradykinesia of PD

Answer 7

issue maintaining amplitude of movement
cant keep a rhythm

Question 8

cog wheeling

Answer 8

jolting of joints throughout movement

Question 9

describe the gait in PD

Answer 9

difficult to start/stop
forward flexed
unilateral
reduced arm swing
turn around as whole
reduced fluidity of movement

Question 10

hallucinations in PD

Answer 10

frightening, aggressive

Question 11

levodopa half life is 2 hours. consequences of this?

Answer 11

fluctuations in blood levels and symptoms

Question 12

why is levodopa given with peripheral dopa decarboxylase inhibitor?

Answer 12

reduced dose
reduced side effects
more levodopa reaches brain

Question 13

tablet formulations of levodopa

Answer 13

-standard
-controlled release
-dispersible non soluble

Question 14

huntingtons chorea

Answer 14

hypo/hyperrelfexia, long term effect of too much levodopa

Question 15

why cant COMT inhibitors be used alone? how to overcome?

Answer 15

no therapeutic effect
use with levodopa and dopa decarboxylase inhibitor

Question 16

can dopamine receptor agonists be first line?

Answer 16

yes, if levodopa less good

Question 17

punding

Answer 17

rearranging stuff needlessly
repetitive compulsive activity

Question 18

why could people be quite susceptible to side effects of PD treatment?

Answer 18

elderly

Question 19

drug for PD patients with severe motor fluctuations

Answer 19

apomorphine s.c. bolus continuous infusion

Question 20

role of anticholinergics in PD

Answer 20

problematic tremor relief
NO EFFECT ON OTHER SYMTPOMS

Question 21

whos considered for surgery for PD?
what’s done?

Answer 21

dopamine responsive
but levodopa giving big side effects
no psychiatric illness
tried meds and increased doses

deep brain stimulation

Question 22

what’s MG?

Answer 22

fluctuating, fatiguable, weakness skeletal muscle

Question 23

what could happen in cholinergic crisis?

Answer 23

resp failure, aspiration, DVT

Question 24

action of pryidostigmine (AChE inhibitor)

Answer 24

prevents ACh breakdown in NMJ, so ACh more likely to engage with remaining receptors

Question 25

onset, peak, duration of pyridostigmine

Answer 25

30 mins
60-120
3-6 hours

Question 26

important dose timing for pyridostigmine

Answer 26

40 mins before food