CNS degenerative disorders Flashcards
What two components do you see in almost all degenerative disorders?
- Cognitive
- Movement
When do you start to see manifestations of CNS degenerative disorders?
-Later in life
What are eight mechanisms that can cause CNS degenerative disorders?
- Hypoxia
- Excitatory Amino Acids
- Ion fluxes
- Free radicals
- Immune responses
- Infections
- Apoptosis
- Protein aggregation
What is an excitatory amino acid that can be neurotoxic?
-Glutamate (AMPA, NMDA, Kainate (receptors))
What ion fluxes can cause CNS degenerative disorders?
- Ca++ (if you get high concentrations in places they shouldn’t be it can really foul up a cell) #1
- Manganese
- Magnesium
What free radical elements can cause CNS degenerative disorders?
- Catecholamines (can make free radicals via the hydroxy groups) (Dopamine is a free radical culprit)
- Glutamate can generate nitric oxide
If you have an AB at the end of a drug what is a likely use of that drug?
-To target the immune system
What is Lewy bodies (aggregate of proteins) part of?
-Parkinsons disease
What are the clinical manifestations of Parkinsons disease?
- Tremor
- Rigidity
- Bradykinesia
- Forward tilt of body (postural abnormalities)
- Short, shuffling gate
What are some protein aggregations that cause CNS degenerative disorders?
- Lewy bodies (Parkinson’s)
- Beta-amyloid (Alzheimer’s)
T/F Amphetamines increase your chance of getting parkinsons
True
T/F Lots of salivation can be a sign of parkinsons disease if a person has dysphagia
True
If a person has parkinson’s disease what type of drug are they usually on?
-Anti-cholinergic drugs
What happens to the salivary secretions to a person with parkinson’s disease?
-They go down creating more viscous saliva
What are some of the late symptoms of parkinson’s disease?
- Depression
- Immobile
- Loss of bowel control (constipation)
What is the oral status of a person with Parkinson’s disease?
-Avg. 7 root canals
What are synthetic anticholinergic drugs?
- Glycopyrrolate
- Benzotropine mesylate
- Propantheline bromide
- Trihyxphenidyl HCl
What is Phsyotigmine?
-Acetylcholinesterase inhibitor
What causes parkinson’s disease?
Low or falling dopamine levels because dopiminergic neurons in the substantia nigra have died
Does Parkinson’s disease begin unilateral or bilateral?
-usually unilateral
How many people get parkinson’s disease?
1/200
After the age of 85 what percent of people have Parkinson’s?
-25%
How many dopamine neurons have to be dead before you see early symptoms of Parkinson’s?
-70%
How many new cases of Parkinson’s are diagnosed in the US per year?
-60,000
Where is the decreased activity found in a Parkinson’s patient?
-Striatum (mostly dopamine cells)
What are environmental causes of Parkinsons?
- Magnesium
- Mercury
- Pesticides
- Trauma
- Dopamine itself
What are environmental causes of Parkinsons?
- Magnesium
- Mercury
- Pesticides
- Trauma
- Dopamine itself
What does Dopamine turn into the make it neurotoxic?
-Quinones that turn into Reactive Oxygen Species (ROS)
What genetics can cause Parkinson’s disease?
- Alpha Synuclein (a trafficking protein that doesn’t work anymore)
- Larkin
When you take away the dopamine what effects go up?
-Cholingergic effects
What do you do for treatment of Parkinsons?
- Increase Dopamine side
- Decrease Cholinergic side
Levodopa (L-DOPA) is what?
-A precursor to Dopamine
What does Azilect do?
-Inhibit dopamine breakdown
What does Entacapone do?
-Improve the effect of carbidopa-levodopa
T/F L-DOPA gets metabolized before it gets to the brain
True
Can Dopamine cross the BBB?
-No
What does carbidopa do?
-Inhibit the metabolism of L-DOPA in the periphery
What two drugs can you use with Carbidopa-Levodopa?
- Azilect
- Entacapone
What is Entacapone an inhibitor of?
-COMT
Can giving L-DOPA increase the degeneration that causes Parkinsons?
-Yes in theory it could but not really hard evidence
What is an anticholinergic drug that is commonly used in Parkinson’s pts?
- Trihexylphenidyl
- Benztropine
MAO-B inhibitors used for parkinson’s disease include what?
- Rasagline (Azilect)
- Selegiline (Eldepryl)
COMT inhibitors used for parkinson’s disease include what?
- Tolcapone
- Entacapone
What are the dopamine agonists used for Parkinson’s disease?
- Pramipexole
- Ropinirole
- Rotigotine
- Apomorphine
- Cromocriptine
What is the early onset drug used for Parkinson’s disease?
-Pramipexole
What are surgical approaches for Parkinson’s?
- Put an electrode into the brain
- Can diminish tremors in younger pts
What drugs given to treat parkinsons disease can cause xerostomia, gingivitis, and glossitis?
-Ropinirole
What are three drugs given to treat Parkinsons disease that can cause glossitis?
- Carbidopa with Levodopa
- Carbidopa with Levodopa and Entacapone
- Ropinirole
What drug can cause dark saliva in the treatment of Parkinsons disease?
-L-DOPA
What oral hygiene strategies can you use for xerostomia in parkinsons disease?
- Frequent sips of water may assist with this problem in addition to avoiding dehydration
- Avoid alcohol and smokine
What oral hygiene strategies can you use to treat sialorrhea in parkinson’s disease?
-Use anticholinergic medications to address this problem
If a person is using levodopa what oral hygiene strategy should they do?
-Rinse the mouth to prevent discoloration of the teeth
What is selegiline?
-MAO inhibitor
What is entacapone?
-COMT inhibitor
What is Pramipexole?
-D2 agonist
