CNS 1: PD and MS Flashcards
6 major neurotransmitters in CNS
glutamate, norepinephrine, serotonin, acetylcholine, dopamine, GABA
Acetylcholine function and clinical relevance
-triggers mus contraction and stimulates the excretion of certain hormones
-Alzheimer’s
Dopamine function and clinical relevance
-involved with movement and posture
-PD and dopamine overactivity causes psychosis (Schizophrenia)
GABA function and clinical relevance
-inhibitory NT; contributes to motor control and vision; regulates anxiety
-treats epilepsy and Huntington’s disease
Glutamate function and clinical relevance
-excitatory NT
-associated w/ AD
Norepinephrine function and clinical relevance
-attentiveness, emotions, sleeping, learning; sympathetic actions
-mania and depression
Serotonin function and clinical relevance
-regulates body temp, sleep, mood, appetite, and pain
-imbalance = depression, suicide, impulsive behavior, aggressiveness
Primary pathological mechanisms and NT associated with PD
loss of nigrostriatal dopamine
loss of dopaminergic neurons presence of Lewy bodies in substantia nigra, reduces activation of motor cortex
Clinical symps of PD
TRAP
SOAP
-sleep disturbances, other misc symps (nausea, fatigue, speech, pain, dysesthesias, vision, seborrhea), autonomic symps, psychological symps
MAD
-motor fluctuations, akathisia, dyskinesia
5 generic names for PD drugs
-dopamine agonists
-dopamine precursor and related agents
-monoamine oxidase (MAO) inhibitors
-catechol-o-methyl-transferase (COMT) inhibitors
-amantadine
5 specific drugs for PD
levodopa, carbidopa, ropinirole, tolcapone, selegiline
Levodopa MOA
dopamine precursor
Levodopa SE
GI upset, arrhythmias, dyskinesias
Carbidopa MOA
Dopa decarboxylase (DDC) inhibitor
Carbidopa SE
GI upset, arrhythmias, dyskinesias
Ropinirole MOA
Dopamine D2 agonist
Ropinirole SE
hallucinations, OH, dyskinesias
Tolcapone MOA
Catechol-o-methyl transferase (COMT) inhibition
Tolcapone SE
dyskinesias, acute liver failure
Selegiline MOA
monoamine oxidase-B (MAO-B)
Selegiline SE
serotonin syndrome
4 clinical forms of MS
Relapsing-remitting, secondary progressive, primary progressive, progressive relapsing
Describe relapsing-remitting
-early 20-30s; women 2:1
-better prognosis
-most will develop secondary progressive MS
Describe secondary progressive
could represent different, advanced stage of relapsing-remitting MS
Describe primary progressive
-late 30-40s; men as likely as women
-worse prognosis: supporting equipment avg 6-7 years
Describe progressive relapsing
steadily worsening w/ clear acute relapses w/ or w/o recovery
3 key pathological hallmarks of MS
-demyelination causes axonal damage
-loss of myelin slows and disrupts signal transmission
-repeated damage leads to axonal destruction and permanent loss of function
8 disease modifying drugs used for the tx of MS
-avonex
-betaseron
-copaxone
-gilenya
-tecfidera
-novantrone
-ocrevus
-tysabri
9 drugs used for symptomatic mgt of MS associated symptoms
-amantadine
-methylphenidate
-baclofen
-dantrolene
-tizanidine
-oxybutynin
-prazosin
-gabapentin
-pregabalin
drugs used for tx of acute MS relapses (not sure if the answers are right)
-IV injection of corticosteroids; methylprednisolone
-oral prednisone
-adrenocorticotropic hormone (ACTH)?
Goal for rehab when a pt is on drug holiday
-maintain pt mobility, ROM, CV fitness
What type of sessions may be needed for MS pts
shorter and more frequent; accommodate pt’s fatigue levels
4 common SE of MS drugs
muscle weakness, fatigue, dizziness, heat sensitivity
