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Pharmocolgy > Neuro Pharmological > Flashcards

Neuro Pharmological Flashcards

1
Q

What is IPD ?

main cause?

A

neurodegenerative disorder
progessive course
low dopamine in substania nigra-

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2
Q

what are the clinical features (Motor) of parkinson’s ?

A 
one sided at the start
motor symptoms -
Tremor - at rest pill rolling 
bradykinesia 
Postural instability 
rigidity - lead pipe
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3
Q

what are Non-motor manifestations of PD?

A 
Mood changes 
pain
cognitive change 
urinary symptoms 
sleep disorder 
sweating 
drooling
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4
Q

what are common prognostic problems of PD?

A 
Dyskinesia 
falls
cognitive decline 
somnolence 
swallowing difficulty 
speech problems
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5
Q

what other causes other then idiopathic for Parkinson’s ?

A

Drug induce - Metoclopramide

vascular (stroke)

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6
Q

what histological features are seen in IPD ?

A

Lewy bodies

loss of pigment of Sn

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7
Q

what is problem with treating parkinson’s when it manifests?

A

by then 50% of dopamingeric neurones are lost and we are trying to persevere them

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8
Q

explain the basal ganglia circuit malfunction in Parkinson’s

A

loss of dopamingeric neurones in Sn = reduced inhibition on neostriatum = increased ACh to motors cortex and spinal cord

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9
Q

what is the synthesis chain of dopamine?

A

L-Tyrosine –> L-Dopa –> Dopamine –> NA –> A

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10
Q

what 2 enzymes breakdwon Dopamine?

A

MAO -Monoamine oxidase

COMT - Catechol-O-Methyl transferase

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11
Q

what possible scan is done for PD? what does it measure?

A

DAT

measures presynaptic uptake of dopamine

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12
Q

Why don’t you use Dopamine for Parkinsons?

A

does not cross BB

L-DOPA crosses via active transport

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13
Q

why is L-Dopa only good in early Parkinson’s ?

A

a substantial amount of dopmingeric cells in Sn are still present to convert L-Dopa to dopamine . fewer cells = less reliable effect

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14
Q

what is the Absorption of L-Dopa like ?

A

Active transport , competed with amino acids (dont eat high protein meals)
90% inactivated at intestinal wall

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15
Q

what is the Metabolism of L-Dopa?

A

T1/2 = 2 hrs so many doses
9% converted to dopamine in periphreal tissues
less than 1% enters CNS - competing with amino acids

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16
Q

what is L-Dopa given with ? why and name the 2 drugs combined ?

A

Dopa decarboxylase inhibitor
reduced dopamine production at peripheral tissues = reduce dose of L-Dopa and side effects

Co-Beneldopa
Co-careldopa

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17
Q

what is formulations of L-Dopa?

A

tablets
controlled release preps
dispersible madator

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18
Q

what drugs should you not use with L-Dopa ?

A

D2 antagonist: Domperidone, Metoclopramide

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19
Q

what are Low-Side effects of L-Dopa?

A

Nausea / vomiting
hypotension
Psychosis
tachycardia

20
Q

what are long term side effects of L-Dopa ?

A

Loss of efficacy
involuntary movements
motor complication- dyskinesias , dystonia and freezing

21
Q

what drugs have adverse interactions with L-Dopa ? why?

A

Pyridoxine (Vit D) - Increase periphrel breakdown of L-Dopa
MAOs = risk of hypertension
Antipsychotics = Metoclopramide , Chlopromazine

22
Q

Name some D agonists used in parkinson’s

A

Apomorphine - SC
Ropinirole-
Rotigotine- Patch

23
Q

When is apomorphine indicated ?

A

sever motor fluctuations

24
Q

what D agonists used for ?

A

first line in PD

or added one therapy

25
Q

what advantages of Ropinirole ?

A 
Direct acting
• Less dyskinesias/
motor complications
• Possible
neuroprotection
26
Q

what disadvantages of Ropinirole ?

A 
Less efficacy than
L-DOPA
• Impulse control
disorders
• More psychiatric s/e
• Dose limiting
• Expensive
27
Q

what is Impuilse control disorder ? what behavioural issues does it lead to ?

A

Dopamine dysregualtion syndrome
Pathological gambling , shopping , Punding
hypersexuality , desire to increase dosage

28
Q

what are ADRs of Ropinirole ?

A

sedation , hallucinations , confusions , nausea and hypotension

29
Q

Name 2 MAOI type B drugs

A

Rasagiline, Selegiline

30
Q

Name a COMT inhibitor

A

Entacapone

31
Q

what is Entacapone’s MOA?

A

Inhibits COMT in the periphery (but not, or at most marginally, in the brain[10]) and the metabolism of levodopa, thus increasing plasma levels of levodopa

32
Q

Why do you give L-Dopa with Entacapone ? indications ?

A

Entacapone cant cross BB

wearing off symptoms

33
Q

What symptoms of PD treated by Anti-ACh ? Name 1 , name 1 side effects

A

Orphenadrine, Procyclidine,

tremor

No effect on
bradykinesia
• Side effects
• Confusion
• Drowsiness
• Usual anticholinergic s/e
34
Q

what are surgery criteria for parkinsons ?

A
  • Dopamine responsive
  • Significant side effects with L-DOPA
  • No psychiatric illness
35
Q

what causes Myasthenia Gravis?

A

IgG blocks of neuromuscular junctions leading to less ACh binding to post synaptic receptors

36
Q

what is key symptoms in Myasthenia Gravis?

A

Fluating and fatiguable weakness of skeletal muscles

37
Q

what are common presentations of Myasthenia Gravis?

A

Extraocular muscles – commonest , Ptosis and diplopia )
– Bulbar involvement – dysphagia, dysphonia, dysarthria, slurring of speech
– Limb weakness – proximal symmetric
– Respiratory muscle involvement
may be combined

38
Q

what common drugs exacerbate Mg ?

A 
Aminoglycosides
• Beta-blockers, CCBs, quinidine,
procainamide
• Chloroquine, penicillamine
• Succinylcholine
• Magnesium
• ACE inhibitors
39
Q

what do you give in myasthenic crisis ? what must you be careful of ?

A

• IV immunoglobulin or plasmapheresis
ABC approach
over treatment lead to cholinergic crisis

40
Q

what symptoms seen in myasthenic crisis ?

A

resp distress
dilation of pupils
increased pulse , BP
Dysphagia and weakness

41
Q

what is treatment options for MG?

A 
Acetylcholinesterase inhibitors
• Corticosteroids
– Decrease immune response
• Steroid sparing
– Azathioprine
• IV immunoglobulin
Plasmapheresis
– Removes AChR antibodies
42
Q

how to Acetylcholinesterase inhibitors help in MG?

What are disadvantages

A

– Enhance neuromuscular transmission in Skeletal and smooth muscle

Excess dose can cause depolarising block – cholinergic crisis
Muscarinic side effects

43
Q

Name 1 Acetylcholinesterase inhibitors

A

Pyridostigmine -

44
Q

what must you be aware of when giving Pyridostigmine - ?

A

peak onser of action 60-120 mins

give before meal times so patients with MG can eat properly

45
Q

what are side effects of cholingerics ?

A 
miosis and the SSLUDGE syndrome:
» Salivation,
» Sweating,
» Lacrimation
» Urinary incontinence
» Diarrhea,
» GI upset and hypermotility
» Emesis)

Pharmocolgy (22 decks)

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