Neurodegenerative Disorders

Question 1

When neurons die can they be replaced?

Answer 1

No when neurons die they cannot be replaced

Question 2

Name two neurodegenerative disease that causes death of neurons

Answer 2

-Alzheimer’s disease
-Parkinson’s disease

Question 3

Which neurodegenerative diseases are responsible for protein folding

Answer 3

-Alzheimer’s disease
-Parkinson’s disease

Question 4

Which protein is folded in Parkinson’s disease

Answer 4

a(Alpha )synuclein (mutations)

Question 5

Which protein is misfolded in Alzheimer’s disease

Answer 5

-Beta-amyloid protiens(AB)
-Tau proteins

Question 6

Describe mechanism of protein misfolding and how it causes pathology

Answer 6

-first genetic mutation leads to misfolding of proteins which can form and insoluble aggregate which gets deposited intracellular and extra cellular
-leading to neurotoxicity which is demonstrated by excitotoxicity ,oxidative stress and apoptosis and necrosis

Question 7

What are the chief symptoms of Parkinson’s disease

Answer 7

-Bradykinesia
-muscle rigidity and when movement starts it cannot stop as well as initiate
-Tremor at rest
-cognitive impairment

Question 8

What is the pathogenesis of Parkinson’s disease

Answer 8

Gradual loss of dopamine when the striatal dopamine content has fallen 20-40 % of normal

Question 9

Parkinson’s disease is associated with what conditions

Answer 9

-dementia
-depression
-autonomic dysfunction

Question 10

What are the mechanisms of action of Parkinson’s drug treatment

Answer 10

-you reduce the release of acetylcholine in striatum by increasing dopaminergic effects
-you block the NMDA receptors to inhibit release of acetylcholine
-Lastly you reduce acetylcholine by Muscarinic receptor antagonism

Question 11

So in essence the drugs for Parkinson’s is classified into

Answer 11

*Dopaminomimetics
-NDMA receptor antagonist
-central Muscarinic cholinergic antagonists

Question 12

List drugs for treatment of Parkinson’s disease

Answer 12

-levodopa with combination of carbidopa and as well as entacapone

Question 13

Parkinson’s drugs mention 2 drugs that are dopamine agonists

Answer 13

-Bromocriptine
-Ropinirole

Question 14

Pkd drugs- mention 2 Monamine oxidase B(MAO-B) inhibitors

Answer 14

-Selegiline
-resagiline

Question 15

Cathechol-o-methyl transferase inhibitors

Answer 15

Entacapone

Question 16

NMDA receptor blockers is ?

Answer 16

Amantadine

Question 17

Muscarinic Acetylcholine receptor antagonists

Answer 17

Orphenadrine
Procyclidine

Question 18

Pharmacokinetics of levodopa

Answer 18

*95% of levodopa is converted into dopamine in the intestine and can cause side effects only 5% gets into the brain

Question 19

Side effects of levodopa

Answer 19

-Dyskinesia (involuntary movement)
-Hypotension
-schizophrenic like syndrome like hallucinations,night mares ,insomnia
-nausea and anorexia

Question 20

Short notes on bromocriptide and why it was stopped

Answer 20

Bromocriptine, and cabergoline are dopamine agonists that are stopped due to side effects of fibrotic reactions in lungs , retroperitoneum and pericardium

Question 21

Side effects of dopamine angonists ropinirole include

Answer 21

-over eating
-gambling and excessive sexual behavior
-hallucinations and somnolence

Question 22

Good sides of dopamine agonists

Answer 22

-can improve mood
-have neurological protective activity
-D2/3 selective and better tolerated and do not show the fluctuations in efficacy

Question 23

Unwanted side effects of muscarinic antagonists

Answer 23

-dry mouth
-constipation
-urinary retention
-Mydiarisis
-Tachycardia

Question 24

Treatment of Parkinson’s disease and management which drug is contraindicated and what age?

Answer 24

-Patients age 65 we should not give muscarinic antagonist

Question 25

Patient with age 50-70 with moderate motor disorders which drugs can we start with

Answer 25

Agonist of dopamine plus inhibitor of MOA)B amantadine, or muscarinic antagonists for patients less than 65

Question 26

Age of patient 50-70 years with expressed motor and Cognitive Impairment which drugs should we administer

Answer 26

-start with levodopa
-if not improved add agonists of dopamine or inhibitor of MAO B or amantadine

Question 27

Describe pathogenesis Alzheimer’s disease

Answer 27

Brain shrinkage and loss of focal cholinergic neurons in basal forebrain and hippocampus

Question 28

Give 2 microscopic features of Alzheimer’s disease

Answer 28

-Amyloid plaques extra cellular deposits of Beta amyloid
-Intraneuronal neurofibrillary tangles (tau protein)

Question 29

Give 3 drugs for treatment of Alzheimer’s disease

Answer 29

1-choline alfascerate(precursor of acetylcholine)400 mg
2-Cholinesterase inhibitors: Rivastigmine
Donepezil
Galantamine
3 antiexitotoxic agent: Memantine