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neuro > antiparkinson's > Flashcards

antiparkinson's Flashcards

1
Q

familial PD

A

10%

gene that codes for synuclein

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2
Q

sporadic PD

A

90%

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3
Q

PD risk factors

A 
infections
trauma
endocrine
drugs/toxins:
neuroleptics
metoclopramadine
reserpine
pesticides
MPTP
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4
Q

gene mutations

A

mitochondrial dysfunction
impaired protein/organelle degradation
axonal transport
synaptic homeostasis

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5
Q

motor S/S (TRAP)

A

tremor at rest
rigidity
akinesia
postural reflex impairment

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6
Q

nonmotor S/S (early)

A

sleep abnormalities
autonomic dysfunction
sensory

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7
Q

nonmotor S/S (late)

A

psychiatric disorders

cognitive disorders

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8
Q

nigrostriatal pathway

A

fine motor control

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9
Q

medium spiny striatal neuron

A

ACh
regulate direct/indirect pathways
overactivated in PD

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10
Q

mesolimbic/mesocortical pathway

A

memory, motivation, emotions, reward, desire, addiction

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11
Q

tuberoinfundibular pathway

A

hormonal regulation

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12
Q

Rx goals

A

1 - restore DAergic transmission

2 - inhibit AChergic transmission

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13
Q

Levodopa (L-dopa)

A

precursor to DA
doesn’t cross BBB (1-3% enters brain)
extracerebral metabolism: rapidly converted to DA by DDC

indirect (D2)
direct (D1) - stimulate adenyl cyclase

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14
Q

L-dopa loses effectiveness

A

progressive loss of nigral DA neurons

downregulation of D1/D2 receptors

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15
Q

L-dopa SE

A 
dyskinesias
on/off effect (use DA agonists)
nausea
anorexia
hypotension
confusion
insomnia
nightmares
schizophrenia
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16
Q

AADH inhibitor (carbidopa)

A

inhibit decarboxylation of peripheral L-da

doesn’t cross BBB

SE:
increased L-dopa SE
increase COMT degradation of L-dopa

17
Q

COMT inhibitors

A

diminish peripheral metabolism of L-dopa

reduce on/off fluctuations

18
Q

entacapone

A

COMT inhibitor

orange urine

19
Q

tolcapone

A

COMT inhibitor

hepatotoxic

20
Q

DA receptor agonists

A

early PD: monotherapy
late PD: adjunctive

reduces on/off motor fluctuations

21
Q

pramipexole

A

DA receptor agonist
binds D2/D3/D4

neuroprotective/antioxidant

SE: sleep attacks

22
Q

ropinirole

A

DA receptor agonist
D3, then D2/D4

mild disease

neuroprotective/antioxidant

SE: orthostatic hypotension

CYP1A2 metabolism

23
Q

amorphine

A

DA receptor agonist

short duration: temp relief of akinesia

SE: dyskinesias, drowsiness, sweating, hypotension

24
Q

MAO inhibitors

A

early PD: monotherapy
late PD: adjunctive

reduce on/off motor fluctuations

irreverisble inhibitors of MAO, inhibit degradation of DA

25
Q

selegiline

A

MAO inhibitor

SE: forms toxic metabolite in elderly

26
Q

rasagiline

A

MAO inhibitor

no toxic metabolite

27
Q

hypertensive crisis

A

tyramine rich diet causes peripheral accumulation of NE

28
Q

fatal hyperthermia

A

meperidine, cocaine, fluoxetine + selegine

29
Q

anticholinergics

A

block central cholinergic receptors

mild cases, younger pts, pts on neuroepileptic drugs

no improvement of bradykinesia

blocks M1 receptors on striatal neurons (presynaptic inhibition of Da release)

SE: atropine-like

30
Q

amantadine

A

NMDA receptor antagonist

early PD: monotherapy
late PD: adjunct to reduce L-dopa induced dyskinesias

interferes w/Glu transmission

indirectly modifies DA cycle, binds DA receptors

excreted unchanged in urine

31
Q

amantadine SE

A

elderly - restlessness, depression, instability, insomnia, agitation, excitement, hallucinations, confusion

headache, edema postural hypotension, heart failure, GI upset

32
Q

amantadine OD

A

acute toxic psychosis

33
Q

early-onset PD

A

1) DA agonists
2) adjunctive L-dopa
3) adjunctive MAO-B inhibitors

**lower risk of L-dopa induced dyskinesias

34
Q

late-onset PD

A

1) L-dopa
2) adjunctive DA agonists, COMT inhibitors, or MAO-B inhibitors

**best control of motor S/S

neuro (12 decks)

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