Degenerative Disorders Flashcards
What is an excitatory amino acid that could be a mechanism for a CNS degenerative disorder?
Glutamate overstimulating NMDA/AMPA receptors
What is the usual age of onset for Parkinson’s disease?
60 yrs (only 10% will have onset before 60)
What are some clinical manifestations of Parkinson’s disease?
Tremors, rigidity, bradykinesia, postural problems, drooling, slurred speech, and depression
What histologic feature is seen in Parkinsons?
Lewy bodies
What are late symptoms of Parkinson’s?
Depression leading to reclusiveness, immobility, and bowel incontinence
What is the occurrence of Parkinson’s past 80 yrs of age?
50%
Which neurotransmitter is diminished in Parkinson’s?
Dopamine (DA)
What part of the brain degrades in Parkinson’s?
The striatum nigra (due to DA radicals)
What are some possible environmental causes for Parkinson’s?
pesticide exposure, head trauma, DA turning into quinones, Mg or Hg exposure
What drug combination is popular to use with Parkinson’s patients?
L-dopa + cabidopa
meant to increase DA levels
What is L-dopa?
A precursor to DA (large doses must be given to benefit pt)
What is cabidopa?
A drug inhibiting peripheral metabolism of L-dopa
What drug might be beneficial for the Parkinson’s patient to reduce drooling?
Benztropin (one of the side effects is xerostomia)
Which drug can improve the effect of carbidopa and L-dopa on Parkinson’s?
Entacapone
What MAO inhibitor alters the progression of Parkinson’s?
Selegiline
What surgical approach is used to increase DA in the brain?
Deep brain stimulation (most effective in early parkinson’s)
What is the only drug used to medicate for Parkinson’s that doesn’t cause xerostomia?
Selegiline (because it isn’t a working on cholinergic pathways)
What are some side effect of L-dopa?
Bruxism, psychosis, confusion
What is one important dental consideration with Parkinson’s patients?
They have difficulty swallowing so we need to use high-volume suction
What are some general dental considerations for Parkinson’s pts?
Major procedures should be completed in early PD, appts should be short as possible and after PD meds have been taken
Abnormal movements seen in Huntington’s disease are from what?
Too much DA in the striatum nigra projection
What symptoms are experienced in early Huntington’s?
Diminished judgement and depression
What part of the brain is lost in Huntington’s?
The caudate neurons
What causes Huntington’s?
A genetic trait that increases Glutamate activity on NMDA receptors, ultimately burning them out
What are three drugs that are used to treat Huntington’s?
Haloperidol (D2 antagonist), Cytalopram (SSRI), and Baclofen (GABA agonist)
What is haloperidol?
A D2 antagonist meant to decrease the DA stimulation occurring in the brain
What is Cytalopram?
An SSRI used to fight depression by increasing serotonin signaling
What is Baclofen?
A GABA agonist used to reduce the bradykinesia and muscle rigidity
What are three areas of the brain involved in Alzheimer’s?
- hippocampus
- frontal cortex
- nucleus basalis
What autosomal syndrome has an increased incidence in early onset Alzheimer’s?
Down syndrome (trisomy 21)
Name two histologic features in Alzheimer’s?
Senile plaques of β amyloid, and Neurofibrillary tangles of tau protein
What neurotransmitters are involved in Alzheimer’s?
ACh is decreased, (β amyloid and tau protein are compromised)
What drug is given to increase ACh in Alzheimer’s patients?
Donepezil
What happens to the patient in multiple sclerosis?
An immune response destroys myelination of axons
What is the pathophysiology of MS?
possible viral infection causing acute inflammatory episodes, possible genetic component
Name the four classifications of MS.
- benign
- relapsing remission
- relapsing progressive
- chronic progression
Because MS is an inflammatory problem, what could we give the patient?
A steroid for antiinflammation (like Prednisone)
