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Control lectures > 18 Drug treatment of movement disorders. > Flashcards

18 Drug treatment of movement disorders. Flashcards

1
Q

Describe the progression of Parksinon’s disease:

A

Slow.
Occurs over 10-15 years.
Remission at times of high emotion.

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2
Q

What are the characteristics of a Parkinsonian tremor?

A

4-7Hz.
Sometimes unilateral.
‘Pin-rolling’.

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3
Q

Describe the symptoms of Parkinson’s disease:

A

Tremor.
Limb rigidity.
Akinesia: difficulty starting to walk, serpentine stare.
Slurred and monotonic speech.
Postural: stoop, shuffle, little arm swinging.
Telegraph pole falls.

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4
Q

Describe the pathology of Parkinson’s disease:

A

Neuronal death in substantia nigra.
Lewy bodies.
Dopaminergic cells affected.

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5
Q

What are the causes of Parkinson’s? (4).

A

Idiopathic.
Drug induced.
MPTP induced.
Post-encephalitic.

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6
Q

How is dopamine synthesised?

A

Tyrosine -> tyrosine hyroxylase -> L-DOPA -> DOPA decarboxylase -> Dopamine

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7
Q

How does L-DOPA work?

A

Increases dopamine release from remaining neurones.

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8
Q

What is the main problem with L-DOPA delivery and how is this overcome?

A

99% is metabolised before reaching the brain.

Carbidopa. Inhibits DOPA decarboxylase, but can’t cross BBB.

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9
Q

What are the side effects of L-DOPA? (7).

A 
On-off effect.
D + V.
Dyskinesias.
Tachycardia + extrasystoles.
Hypotension.
Insomnia + schizophrenia.
Effect wears off over time.
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10
Q

Which drugs are given to minimise the side effects of L-DOPA? (2).

A

Domperidone to stop tachycardia + extrasystoles.

Clozapine for insomnia and schizophrenia.

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11
Q

How is dopamine broken down?

A

Via COMT to 3-MT then MAO to homovanillinic acid.
OR
MAO to DOPAC then COMT to homovanillinic acid.

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12
Q

How do MAO inhibitors work?

Name one:

A

Inhibit the breakdown of dopamine.

Selegiline. (MAOB selective).

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13
Q

How is selegiline used in Parkinson’s? (2).

A

Effective alone in early stages.

Used to prolong L-DOPA effect in later stages.

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14
Q

Pro’s and con’s of selegiline use in Parkinson’s?

A

Few side effects of it’s own. Possibly neuroprotective.

Potentiates central side effects of L-DOPA.

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15
Q

How does COMT act? (2).

A

Breaks down dopamine to homovanillinic acid.

Breaks down L-DOPA to 3-O-methyl DOPA.

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16
Q

Name a COMT inhibitor:

A

Entacapone.

17
Q

What are the adverse effects of entacapone? (4).

A

Aggravates L-DOPA dyskinesias.
N + V.
Dry mouth.
Abdominal pain.

18
Q

Name two dopamine agonists:

State their specificity:

A

Bromocriptine (D1+2)

Pergolide (D2).

19
Q

What are the side effects of dopamine agonists?

A

Similar to L-DOPA.

Plus hallucinations.

20
Q

Name two antimuscarinics used in Parkinson’s:

Who are they used in?

A

Benzhexol, orphenadrine.

Only in young with severe tremor.

21
Q

What are the adverse effects of antimuscarinics in Parkinson’s? (4).

A

Peripheral side effects rare.

Confusion, delusions, hallucinations, mood changes.

22
Q

Which types of surgery are used in Parkinsons? (4)

A

Thalamotomy (motor thalamus).
Pallidotomy (globus pallidus).
Subthalamotomy (sub thalamus).
Implantable stimulators.

23
Q

Describe the clinical features of Huntington’s (2):

Prognosis:

A

Chorea and dementia.

Starts at 30/50. Death in 10-20 years.

24
Q

What does a CT/MRI show in Huntington’s?

A

Cerebellar atrophy.

25
Q

Where does cell loss occur in Huntington’s?

A

Selective cell loss in corpus striatum and cerebral cortex.

26
Q

Which cells are affected in Huntington’s?

A

Medium sized spiny neurones containing GABA and encephalin.

27
Q

How are neurotransmitter levels affected in Huntington’s? (5).

A

GABA ↓, GAD ↓

ACh ↓, choline acetyltransferase ↓ DA ↔ or ↑

28
Q

What is the genetic basis of Huntington’s disease?

Position. Change. Inheritance.

A

4p16.3.
Polyglutamine (CAG repeat).
Autosomal dominant.

29
Q

What is the treatment for Huntington’s? (2,2)

A

D2 antagonists: haloperidol, chlorprozamine.

DA depletion: reserpine, tetrabenzine.

30
Q

What are the adverse effects of D2 antagonists? (2).

Used in Huntington’s.

A

Parkinsonism.

Restlessness.

31
Q

What are the adverse effects of DA depletion? (4).

Used in Huntington’s.

A

Hypotenison.
Depression.
Sedation.
GI disturbances.

32
Q

Which drugs are used to treat dystopias? (5)

A 
DOPA replacement.
Anticholinergics.
Benzodiazepines.
Baclofen.
Botulinum toxin.

Control lectures (17 decks)

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