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Pharmacology Y2 > Movement Disorders > Flashcards

Movement Disorders Flashcards

1
Q

What is the cause of Parkinson’s?

A

Degeneration of dopaminergic axons in the substantial nigra

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2
Q

What factors could contribute to early onset Parkinson’s?

A

Head trauma
Environmental factors
Virus

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3
Q

Name the 2 receptors that dopamine can bind to

A

D1
D2

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4
Q

Which motor pathway is the D1 receptor part of?

A

The direct (excitatory) pathway

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5
Q

What pathway is the D2 receptor part of?

A

The indirect (inhibitory) pathway

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6
Q

What is the action of dopamine on the direct pathway?

A

It activates the striatal neurones

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7
Q

What is the action of dopamine on the indirect pathway?

A

It inhibits the striatal neurones

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8
Q

Overall what does dopamine do motor activity?

A

Increases it, as it results in excitation in the cerebral cortex

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9
Q

What is akinesia?

A

Loss of voluntary movement

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10
Q

Why does muscle rigidity occur in parkinson’s?

A

Due to locking up of the basal ganglia

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11
Q

Which part of the indirect pathway does dopamine inhibit?

A

Inhibits the disinhibition from the striatal neurones to the globus pallidus, causing less overall inhibition to the excitatory neurones from the thalamus to the cerebral cortex

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12
Q

List 8 signs of Parkinson’s

A

Soft monotonic speech
Swallowing problems
Masked face
Shuffling gait
Stooped posture
Depression
Anxiety
Sleep problems

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13
Q

Name 5 pathways in the brain that dopamine is part of

A

Nigrostriatal pathway
Mesolimbic pathway
Mesocortical pathway
Median eminence to anterior pituitary
Chemoreceptor trigger zone

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14
Q

Which dopamine pathway in the brain is affected in Parkinson’s?

A

Nigrostriatal pathway

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15
Q

Describe the function of dopamine that leads to tremor in Parkinson’s

A

Loss of dopamine stops the inhibition of ACh neurones, leading to tremors as these now function

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16
Q

Describe the function of dopamine that leads to rigidity in Parkinson’s

A

Loss of dopamine inhibits the direct pathway and excited the indirect pathway leading to rigidity

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17
Q

Why can muscarinic antagonists be used in treatment of Parkinson’s?

A

Because they have a function to inhibit the ACh neurones (this is usually the role of dopamine)

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18
Q

Why does a precursor of dopamine have to be given to patients instead of pure dopamine?

A

Dopamine itself cannot pass the blood brain barrier, however the precursor can

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19
Q

List 5 side effects of L DOPA as a treatment for Parkinsons

A

Dyskinesia (uncontrolled movement)
Psychotic
Decrease in prolactin release
On and off effects due to all neurones in substantial nigra eventually degenerating
Increased dopamine in other dopaminergic pathways

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20
Q

What is the effect of dopamine in the ventral tegmental area and nucleus accumbens?

A

Increases the reward pathway in the brain, can result in gambling habits

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21
Q

Why are noradrenergic pathways also increased by dopamine?

A

Dopamine is a precursor for noradrenaline, so will excite these pathways aswell

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22
Q

List 2 peripheral side effects of dopamine

A

Hypotension
Nausea

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23
Q

How does dopamine cause hypotension?

A

Removes noradrenaline from the nerve terminal, inhibiting sympathetic tone

24
Q

How does dopamine cause nausea?

A

It activates the dopamine receptors on the CTZ (chemoreceptor trigger zone)

24
Q

How does dopamine cause nausea?

A

It activates the dopamine receptors on the CTZ (chemoreceptor trigger zone)

25
Q

How can dopamine be prevented from being converted to noradrenaline?

A

Inhibit the enzymes in the pathway that convert dopamine to noradrenaline

26
Q

Name 3 enzymes in the dopamine to noradrenaline pathway that can be inhibited

A

DOPA decarboxylase
Monoamine oxidase B
Catechol-O-methyl transferase

27
Q

Name 2 drugs that block DOPA carboxylase enzyme

A

Carbidopa
Benserazide

28
Q

Name 2 drugs that block DOPA carboxylase enzyme

A

Carbidopa
Benserazide

29
Q

Name a drug that blocks the monoamine oxidase B enzyme

A

Selegline

30
Q

Name an enzyme that blocks the Catechol-O-methyl transferase enzyme

A

Entacapone

31
Q

Does carbidopa and benserazide work on L DOPA in the brain or in the periphery?

A

Works in the periphery, so can be given at the same time as L DOPA being given and will not reduce its effectiveness

32
Q

Does selegline work on L DOPA in the brain or periphery?

A

Works in the brain, protects the dopamine that has already been formed

33
Q

What drug can be used to reduce the nauseous effects of L DOPA on the patient?

A

Domperidone

34
Q

Which receptor does domperidone target?

A

D2 receptor

35
Q

What kind of drug is domperidone?

A

D2 receptor antagonist

36
Q

Why is the effect of giving L DOPA only effective for 2-10 years?

A

Because eventually too many neurones degenerate, so there are none left to take up the L DOPA

37
Q

What are adjuncts?

A

Drugs that are added to something else as a supplementary element, but is not an essential part

38
Q

Name 3 examples of muscarinic antagonists

A

Benzhexol
Benztropine
Atropine

39
Q

Why are muscarinic antagonists not commonly used in Parkinsons?

A

Inhibiting cholinergic can be negative effects as it has other important functions in the brain

40
Q

What type of drug can be used if L DOPA stops functioning?

A

Dopamine receptor agonists

41
Q

Name 3 D2 receptor agonists

A

Ropinirole
Bromocriptine
Pergolide

42
Q

Name a D1 and D2 antagonist

A

Apomorphine

43
Q

Why is domperidone always given with D2 receptor agonists?

A

Because it causes a lot of nausea

44
Q

Name an anti viral drug that can be used in the treatment of Parkinsons

A

Amantadine

45
Q

What is the function of amantadine?

A

NMDA antagonist, blocks glutamate

46
Q

Why are glutamate antagonists effective at reducing Parkinsons symptoms?

A

Excess glutamate is toxic to nerve cells, reduces the effect of this
Also reduces the amount of ACh used in pathways so more dopamine is used

47
Q

What is a non drug related way to treat Parkinsons?

A

Deep brain stimulation

48
Q

Describe the process of deep brain stimulation

A

Electrodes placed into the brain on the thalamic area, and electrical stimulation is given

49
Q

Which pathway is being unregulated through deep brain stimulation?

A

GABAergic pathways (increases inhibition)

50
Q

Why are transplants not permanent solutions to Parkinson’s?

A

The existing neurones will still continue to die alongside the healthy graft

51
Q

Is Huntington’s chorea a hypokinetic or hyperkinetic disorder?

A

Hyperkinetic

52
Q

Why is Huntingtons chorea hyperkinetic?

A

Loss of inhibition of the GABAergic neurones and no inhibition of the dopaminergic neurones

53
Q

What drugs are used to treat Huntingtons chorea?

A

D2 receptor antagonists (Tetrabenazine)

54
Q

Name dopamine antagonist used to treat tics and tourettes

A

Haloperidol

55
Q

What is tourettes syndrome?

A

Uncontrolled motor output to speech centres

56
Q

Where in the brain is the chemoreceptor trigger zone located?

A

Medulla

Pharmacology Y2 (9 decks)

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