BB1b Flashcards
- Name the neurotransmitters released by the corticostriatal and striatopallidal pathways. (1 mark)
Glutamate and GABA, respectively (1 mark).
- Describe the effects of D1 receptor activation on striatal efferent circuitry. (2 marks)
D1 receptor activation causes the activation of the direct pathway (½ mark)
by which the internal globus pallidus (GPi) is inhibited (½ mark).
This causes the disinhibition of the thalamus (½ mark)
and consequently the activation of the cortex (½ mark).
- What is alpha-synuclein, where is it found in the brain and what is its genetic link with Parkinson’s disease? (2 marks)
Alpha-synuclein is a protein found in Lewy bodies in neurons (½ mark).
Lewy bodies are a major histopathological feature of Parkinson’s disease (½ mark).
The gene for alpha-synuclein is the SNCA gene; mutations associated with this gene (e.g. PARK1/4) have been identified as a genetic risk factor for Parkinson’s disease (1 mark).
- List and briefly describe three long-term complications of levodopa (L-DOPA) therapy. (3 marks)
- Motor fluctuations: include the ‘on-off’ phenomenon in which sudden and dramatic fluctuations of motor performance occur; periods of normal mobility (on) followed by sudden ‘freezing’ (off). End of dose deterioration and delayed (or ‘no on’ - freezing) responses also occur.
- Dyskinesias: include choreiform movements (purposeless involuntary dance-like movements) and dystonias (sustained intense muscle contractions).
- Non-motor complications: tingling, pain, akathisia, and autonomic dysfunction.
- Neuro-psychiatric problems: hallucinations, delirium, mood changes, sleep disturbance and nightmares.
- What is rotigotine and what is its route of administration? (2 marks)
Rotigotine is a dopamine receptor agonist (non-selective agonist), with affinity for both the D1 family and D2 family receptors (1 mark). It is applied transdermally as a patch (1 mark).
Name a drug for PD that can be continously provided over a 24 hr period [1]
TN
rotigotine: due to transdermal patch
Which drugs are best used to treat milder PD symptoms? [5]
TN
selegiline (an MAOB inhibitor) or the newer drug rasagiline
amantadine: causes release of dopamine
anticholinergic drugs (e.g. orphenadrine, procyclidine, trihexyphenidyl)
These drugs are less efficacious than L-DOPA, and are mainly used as adjunctive therapy
Which vitamin may be useful for treating PD? [1]
Why? [1]
TN
Vitamin E is an anti-oxidant, and there is convincing evidence that Parkinson’s disease is associated with increased oxidative stress in the nervous system
DBS of which region may be useful to treat PD? [1]
TN
deep brain stimulation of the subthalamic nucleus
Which hypothesis explains many pro-dromal non-motor symptoms of PD? [1]
Braak hypothesis:
* Parkinson’s disease start many years before the clinical diagnosis is made, and involve a particular propagation of neurodegeneration
What is the Hz of PD tremor? [1]
Tremor
* most marked at rest, 3-5 Hz
more likely than levodopa to cause hallucinations in older patients. Nasal congestion and postural
hypotension are also seen in some patients
This applies to which drug class? [1]
Dopamine agonists
Decribe the differences between the following?
* individual CBT
* individual behavioural activation (BA
* counselling
* short-term psychodynamic psychotherapy (STPP)
* interpersonal psychotherapy (IPT)
Which drug class is considered first-line treatment for the majority of patients with depression? [1]
Which two drugs are most commonly prescribed? [2]
SSRIs
Citalopram; Fluoxetine
Which drug is useful post myocardial infarction as there is more evidence for its safe use in this situation than other antidepressants? [1]
sertraline
