neurodegenerative Flashcards
Loss of intrinsic GABAergic neurons of the of the Vladimir Putin(caudate putamen)
Huntington’s disease
Excessive cortical activity, chorea, hyperkinesia
Huntington’s disease
chorea-a neurological disorder characterized by jerky involuntary movements affecting especially the shoulders, hips, and face.
what are lewy bodies?
abnormal intracellular proteins clump or aggregate
a synuclein ubiquitin
Parkinson’s
Progressive degeneration of y-aminobutyric acid (GABA) neurons in the basal ganglia and cortex
Huntington disease
And anti viral agent used to treat mild to moderate Parkinson disease, Anti cholinergic properties
Amantadine/Symmetrel
loss of intrinsic cortical neurons beginning in the entorhinal cortex that spreads to the whole cortex resulting in a loss of memory and logical thinking
Alzheimer’s disease
Potent dopamine D1 and D2 receptor agonist
Apomorphine(apokyn)
name two anticholinesterase used to treat Alzheimer’s
donepezil(Aricept)
galantamine (razadyne)
With this disease there is a marked decrease in cholinergic neuron activity as a result these patients are very sensitive to central nervous system effects of muscarinic antagonist
Alzheimer’s patients
Parkinson’s disease is an issue with the neurotransmitter______ and decreased activation of the _______pathway which results and an increased activation of the_______ pathway. Parkinson’s is a ____kinetic disorder.
Parkinson’s disease there’s an issue with the neurotransmitter dopamine and decreased activation of the direct pathway which results in an increased activation of the indirect pathway. Parkinson’s is a hypokinetic disorder.
these drugs are used to treat huntington’s by decreasing dopamine neurotransmission, depletion of dopamine and nerve terminals by inhibition of VMAT
tetra-benazine/ xenazine
deu-tetra-benazine/ austedo
side effect of being metabolised to methamphetamine or L amphetamine which may account for the side effect of anxiety and insomnia
Selegine/eldepryl-selective irreversible MAOB inhibitor
GABA and decreased indirect pathway, which disease?
Huntington’s
Parkinson’s disease also results in some neurodegenerative signs related to autonomic degeneration
4
orthostatic hypotension
Significant autonomic dysfunction-hemodynamic instability
Bowel and bladder and mobility
Incontinence
Major side effects similar to carbidopa-levodopa/Sinemet-orthostatic hypotension, nausea vomiting Constipation, psychotic reactions, cardiac dysrhythmias, dyskinesias
Apomorphine(apokyn)
What is the longer duration patch form of Ropinirole/requip
Rigatoni
Rotigone/neupro
Parkinson’s disease can also include some non motor cognitive and emotional symptoms such as?
fatigue loss of interest in religion Alexithymia-Loss of one's ability to recognize one's own emotions as well as the emotions of others dementia Depression of mood Anxiety
a key relay station in the initiation and control of coordinated patterns of movement
the basal ganglia/basal nuclei
these drugs treat Huntington’s disease by blockade of postsynaptic dopamine
Antipsychotic drugs haloperidol and chlorpromazine
b-amyloid, tau protein which disorder
Alzheimer’s
Loss of dopamine neurons of the substantia nigra that innervate the basal nuclei (basal ganglia)
Parkinson’s disease
side effects include may exacerbate carbidopa-levodopa/Sinemet induced dyskinesias, confusing and hallucinations
Selegine/eldepryl-selective irreversible MAOB inhibitor
why are typical antipsychotics not administered to Parkinson disease patients
blocking D2
typical antipsychotics are D2 antagonist
What causes the Parkinson psychosis hallucinations and delusions
D2
A muscarinic receptor antagonist used to reduce cholinergic dominance in Parkinson’s
Benztropine(Cogentin)
Parkinson’s adjunct therapy that peripherally inhibits COMT-Blocks conversion of L-DOPA to 3-O-methyldopa increasing L-DOPA availability
Entacapone/comtan
Acts on dopamine one and two, a rescue medication, short acting, approved for subq doses?
this drug must be taken with what?
How must the IV infusion be administered?
Apomorphine(apokyn) D1&2 agonist
Antiemetic
long term in-dwelling venous catheter
name a positive allosteric modulator of nicotinic acetylcholine receptors used to treat Alzheimer’s
galantamine (razadyne)
anticholinesterase
What’s some anesthetic implications for Parkinson’s disease
Short half life of L-DOPA, frequent doses-may have to administer and long surgeries
avoid dopamine antagonists
avoid dopamine receptor blockade for PONV prophylaxis
What causes the adverse side effects of dopamine?
Dopamine is metabolised in norepinephrine and epinephrine in the CNS and in the periphery. side effects are what you would expect from high catecholamine levels
Inhibits the metabolism of L-DOPA in the periphery by action on AADC(aromatic amino acid decarboxylase)
Carbidopa/sinemet
dopamine and decreased direct pathway, which disease?
Parkinson’s
Noncompetitive glutamate NMDA receptor antagonists used to treat Alzheimer’s
Memantine/namzaric
The treatment strategy of which disease is to decrease dopamine neurotransmission?
what mechanism of the disease causes this to be a solution?
Huntington disease
because there is a destruction of the GABA neurons in the basal ganglia and cortex/indirect pathway, the dopamine mediated direct pathway is overactive.
an inverse agonist at serotonin 5 HT-2A receptors-
pimavanserin(nuplazid)
pimps might work out of vans too
the one that’s similar to LSD
far out man
hippies live in vans like Brennan
Dead and dying nerve cells contain neurofibrillary tangles which are made up of twisted strands of tau protein
Alzheimer’s
Tau protein stabilize microtubules, Microtubules provide platforms for intracellular transport
Toxic b amyloid oligomers Impair basic neuronal processes and activate immune system causing inflammation
What might interact with carbidopa-levodopa/sinemet reducing its efficacy?
Pyridoxine(vitamin B6)
accelerate systemic metabolism of levodopa by enhancing the effectiveness of decarboxylase thereby decreasing availability of the amino acid to the brain
Name of dopamine receptor agonist primarily at D2, adjunct Parkinson therapy
Ropinirole/requip
To prevent a life threatening hypertensive crisis and hyperpyrexia, non selective Mao inhibitors should be discontinued how many days before carbidopa-levodopa/Sinemet is administered
14 days
Parkinson’s is a profound loss of dopaminergic neurons where?
substantia nigra
a synuclein ubiquitin which disorder
Parkinson’s disease
Used for management of drug induced parkinsonism and schizophrenic patients treated with antipsychotics(potent D2 receptor antagonist), Preferred treatment of neuroleptic induced extrapyramidal syndrome
Benztropine(Cogentin)
Used for management of drug induced parkinsonism and schizophrenic patients treated with antipsychotics(potent D2 receptor antagonist), Preferred treatment of neuroleptic induced extrapyramidal syndrome
the basal ganglia consist of three structures
Caudate nucleus
Putamen
Globus pallidus
Describe some of the characteristic motor symptoms of Parkinson’s disease
resting tremor(most obvious early symptom)
rigidity and stiffness
stooped posture
shuffling gait
poor righting reflex-balance
Bradykinesia-slowness of movement, difficulty walking
Difficulty speaking and swallowing
Difficulty writing (tiny, crowded handwriting)
mask like face
in advanced stages of Parkinson’s disease patients become virtually immobile
What are two common characteristics of neurodegenerative disorders?
accumulation abnormal protein
progressive and irreversible loss of neurons in the brain
Within the basal nuclei Which pathway facilitates movement and which pathway inhibits movement?
Direct pathway facilitates movement
Indirect pathway inhibits movement
what part of the brain does Alzheimer’s begin in?
entorhinal cortex
Adverse side effects include cardiac arrhythmias and transit tachycardia, nausea and vomiting, and orthostatic hypotension. what is the nausea and vomiting caused by?
L-Dopa
dopamine D receptors on the chemo trigger zone
carbidopa-levodopa/sinemet is contraindicated in combination with which drugs? two different classes
dopamine receptor antagonist-typical antipsychotic drug
chlorpromazine, Thorazine
haloperidol, Haldol
flupenthixol, fluanxol
Non selective irreversible Mao inhibitors
Phenelizine/nardil
Ipronizad(marsilid, iprazid, ipronid
Huntington protein which disorder
Huntington’s disease
This disease has a loss of dopaminergic input/inhibition, which leads to acetylcholine mediated excitation of inhibitory GABA neurons.
GABA has done let loose like it’s spring break in Myrtle Beach 1995.
Parkinson disease
dopamine precursor that crosses the blood brain barrier by active transport to stimulate dopamine synthesis
levodopa(l-dopa)
What treatment strategy/drug would block dopamine degradation in the brain?
Selegine/eldepryl-selective irreversible MAOB inhibitor
Administration of this drug has the benefits of a lower dose of L-DOPA being administered, more L-DOPA reaches the brain, reduction in peripheral side effects, resulting in less peripheral conversion of L-DOPA to dopamine and norepinephrine
carbidopa-levodopa/sinemet
The disease process progresses to include lateral temporal and parietal lobes and when severe associated with loss of neurons throughout the cortex including frontal and occipital lobe, severe cortical atropy in later stages
Alzheimer’s
Usually develops in the mid 30s to 40s, early symptoms include mental decline, problems with mood and cognition, general lack of coordination and an unsteady gait. as the disease advances coordinated movements become difficult, uncoordinated involuntary jerking or twitching movements known as chorea, further mental decline into dementia
Huntington’s disease
Reduced cortical stimulation hypokinetic disorder
Parkinson’s
