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Pharm Unit 3 > CNS II- Neurodegenerative Disorders/ Parkinson's Disease > Flashcards

CNS II- Neurodegenerative Disorders/ Parkinson's Disease Flashcards

1
Q

What is neurodegeneration?

A

Progressive loss of neuronal function, typified by neuronal cell death (apoptosis or necrosis) and protein aggregates (inclusion bodies)

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2
Q

What are the 4 main neurodegenerative disorders to know?

A
  1. Alzheimer’s (most common)
  2. Parkinson’s
  3. Huntington’s
  4. Amyotrophic Lateral Sclerosis (ALS)
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3
Q

What kind of inclusion bodies are associated with Parkinson’s disease?

A

Lewy bodies

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4
Q

What are the major symptoms of Parkinson’s disease?

A

Major Symptoms of Parkinson’s disease:

  • Resting tremor (abates during voluntary movement)
  • Bradykinesia, akinesia (slowness, lack of movement)
  • Muscular rigidity
  • Postural instability (disturbances of gait, falling {PD+})
  • Dementia

“TRAP”–> tremor, rigidity, akinesia, postural

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5
Q

Which neurons are destroyed in Parkison’s disease?

A

The dopaminergic neurons that project to the neostriatum from the substantia nigra pars compacta are selectively and progressively destroyed.

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6
Q

What forms the extrapyramidal motor system (EPS)?

A

The neostriatum (basal ganglia)

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7
Q

What happens when the EPS is damaged?

A
  • Depression in the ability to initiate voluntary movements

- Causes involuntary movements (ie/ resting tremor, huntington’s)

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8
Q

What are the risk factors for developing Parkinson’s?

A
  • Genetic (10-15% familial)
  • Age
    - illness (CNS infection, perhaps viral)
  • Environment toxins (herbicides, rotenone, MPTP)
  • Oxidative stress
    - mitochondrial dysfunction
    - nitric oxide production
    - loss of reduced glutathione
  • Glutamate excitotoxicity
  • Protein misfolding and impaired degradation
    - Mutations, e.g. Parkin, polygenetic origins
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9
Q

What is the net result of the direct DA pathway?

A

Produces excitatory input to the motor cortex

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10
Q

What is the net result of the indirect DA pathway?

A

Produces inhibitory input to the motor cortex. HOWEVER–> D2 inhibits the indirect pathway, which ultimately produces excitatory input to motor cortex

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11
Q

What is the major goal of pharmacological treatment in PD?

A

Major goal of pharmacological treatment of PD is to improve DA neurotransmission from the SNpc to the neostriatum.

This is accomplished by attempting to elevate DA levels in the SNpc

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12
Q

Why don’t we use dopamine to treat PD?

A

Because it does not cross the BBB

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13
Q

What are the dopamine precursors?

A

Levodopa
Carbidopa- inhibits peripheral conversion of L-DOPA to dopamine (inhibits AAD)
Levodopa/Carbidopa (#1 initial therapy for PD)

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14
Q

What are the dopamine receptor agonists?

A 
Pergolide (PERMAX) (taken off the market--> side effect of cardiac valve regurgitation)	 
Bromocriptine (PARLODEL) 
Ropinirole (REQUIP)	 
Pramipexole (MIRAPEX) 
Rotigotine (NEUPRO) (recalled in 2008)
Apomorphine (APOKYN)
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15
Q

What are the COMT inhibitors?

A

Entacapone (COMTAN)
Tolcapone (TASMAR)
Levodopa\carbidopa\entacapone (STALEVO)

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16
Q

What are the MAO-B inhibitors?

A

Selegiline (ELDEPRYL, ZELAPAR)

Rasagiline (AZILECT)

17
Q

Name the anticholinergic drugs associated with treating PD

A 
Trihexyphenidyl (ARTANE)
Benztropine (COGENTIN)
Procyclidine (KEMADRIN)
Ethopropazine (PARSITAN)
Biperiden (AKINETON)
18
Q

What is the primary reason we give Amantadine?

A

It reduces dyskinesias associated with long-term levodopa therapy.

It’s an influenza A antiviral drug- it has dopaminergic, anticholinergic, and anti-NMDA activities, but it’s effective mechanism of action is unknown still.

19
Q

What is the only surgical treatment that has been approved?

A

Deep brain stimulation–> it is the last line of therapy

20
Q

What is the main drug used as a rescue therapy for “off” symptoms? (“off”-no relief of motor symptoms)

A

Amorphine; fast onset–> use “as needed”

21
Q

What is the net effect of the gain of function mutation in Huntington’s disease?

A

The net effect is the opposite of that in Parkinson’s disease–> decreased GABAergic inhibitory drive from the SNpr and medial globus pallidus onto the ventroanterior and ventrolateral thalamic nuclei (VA/VL).

The end result is increased excitatory input to the motor cortex.

22
Q

Is there any treatment to halt disease progression in Huntingon’s?

A

No- current treatments are targeted to controlling symptoms of depression, anxiety, irritability, paranoia, psychosis

23
Q

What is the only approved therapy for ALS?

A

Riluzole, but it only improves median duration of survival by 60 days

24
Q

What symptoms of Parkinsons are the anticholinergics used to treat and what are their side effects?

A

symptoms-tremor and drooling
side effects-Confusion, impaired memory, hallucinations, typical anticholinergic sx (dry mouth)
Not for use in demented

25
Q

What are some of the side effects of L-DOPA and carvidopa?

A
  • hallucinations
  • dyskinesias
  • on-off phenomenon
  • neuroleptic malignant syndrome (NMS)
  • psychosis possible with chronic use
  • nausea
  • hypotension
  • dizziness
26
Q

Which of the Dopamine agonists must be titrated slowly because of hypotension? What are some other side effects of these drugs?

A
  • the ergot alkaloids; bromocriptine and pergolide
  • pleural effusions, cough, SOB, pulmonary fibrosis
  • cardiac valve regurgitation w/ pergolide
27
Q

Which of the Dopamine agonists can cause compulsive behavior? daytime sleep attacks?

A
  • pramipexole- compulsive behavior

- ropinorole- sleep attacks

28
Q

What are the common side effects of the non-ergot D2 agonists? Ropinirole, Pramipexole, Rotigotine

A

psychosis, nausea, edema

less effective with the motor symptoms of parkinsons

29
Q

Which type of parkinsons drug has side effects of diarrhea, increase in dyskinesias, and urine discoloration?

A 
COMT inhibitors (Entacapone, Tolcapone)
**only last 2 hours**
30
Q

Which of the parkinsons drugs has a side effect of fatal hepatotoxicity?

A

Tolcapone only used if entacapone fails

31
Q

What stage of parkinsons are the MAO-B inhibitors (selegiline and rasagiline) used to treat and what are their side effects?

A

treat-mild early parkinsons

side effects-hypotension, GI distress, dyskinesia, and psychosis

32
Q

What other medications can the MAO-B inhibitors (selegiline and rasagiline) not be combined with?

A
  • decongestants
  • dextromethorphan
  • St. John’s wort
  • analgesics
  • methadone
  • tramadol
  • propoxyphene
  • caution with SSRIs, MAO-A inhibitors
33
Q

What is riluzole used to treat and what is its mechanism of action? side effects?

A

-glutamate receptor antagonist
-used to treat ALS
side effects-hepatotoxicity (rare), nausea and diarrhea

34
Q

What is Baclofen used to treat and what is its mechanism of action?

A
  • GABAb receptor agonist-causes loss of spinal motor nerve inputs from the cortex
  • Treats-spasticity
35
Q

What is Tizanidine used to treat and what is its mechanism of action?

A
  • alpha-2 receptor agonist

- Treats- spasticity

Pharm Unit 3 (14 decks)

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