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Pharmocolgy > P19: Treatment of Parkinsonism > Flashcards

P19: Treatment of Parkinsonism Flashcards

1
Q

What are the 3 main brain areas that co-ordinate motor function?

A
  • Motor cortex
  • Basal ganglia
  • Cerebellum
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2
Q

What does the cerebellum regulate?

A

Posture and movement and speech

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3
Q

What does the cerebellum influence?

A

Muscle tone and eye movements

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4
Q

Which part of the brain is responsible for motor learning? (riding bike)

A

Cerebellum

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5
Q

What is the basal ganglia?

A

A group ofnucleiof varied origin in thebrainsof vertebrates that act as a cohesive functional unit

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6
Q

What is the function of the basal ganglia

A
  • Integrate desire and fine movement (i.e. initiate and stop movement)
  • Smooth fine motor behaviour
  • Suppress unwanted movements
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7
Q

What are the 3 interacting pathways that regulate cortical activity through the thalamus?

A
  • Direct pathway
  • Indirect pathway
  • Hyperdirect pathway
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8
Q

What is the direct basal ganglia pathway?

A

Relieves the inhibitory drive of the internal globus pallidus upon thalamocortical pathways

Permits amplification of cortical signals, eventually leading to motor activation

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9
Q

What is the indirect basal ganglia pathway?

A
  • Inhibits thalamocortical pathways that target areas that would interfere with desired motor behaviour
  • Restricts movement to wanted muscles only
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10
Q

What is the hyperdirect basal ganglia pathway?

A

Rapid stimulation of the subthalamic nucleus by the motor cortex; proposed to prevent premature movements

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11
Q

How does dopamine regulate the basal ganglia?

A

Via the nigrostriatal dopaminergic pathway, dopamine is released which prevents motor activity

Stimulates direct pathway
Inhibits indirect pathway

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12
Q

What is Chorea?

A
  • Hyperkinetic disorder
  • Involuntary, sudden, frequent and purposeless jerks of the extremities, head, & trunk, with facial grimaces (Huntington’s)
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13
Q

What is Athetosis?

Athetosissssssssssss

A
  • Hyperkinetic disorder

- Slow, writhing, continuous, worm-like motions of distal extremities

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14
Q

What is Ballism?

Bald ultras are what?

A
  • Hyperkinetic disorder

- Violent, flinging, continuous movements of the limbs

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15
Q

What is Dystonia?

Dyst rhymes with a word beginning with T

A
  • Hyperkinetic disorder

- Involuntary twisting, slow, contorting movement

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16
Q

What is Akinesia?

A
  • Hypokinetic disorder

- Impairment in motor initiation, rigidity

17
Q

What is Bradykinesia?

Tom Brady throws a football at maximum….?

A
  • Hypokinetic disorder

- Reduction in the amplitude and velocity of movement

18
Q

What are symptoms of Parkinson’s disease?

A
  • Resting tremor
  • Bradykinesia
  • Rigidity
  • Postural instability
  • Problems with speech & swallowing
  • Micrographia
  • Dementia in later stages
19
Q

How is Parkinson’s disease caused?

A

Caused by degeneration of nigrostriatal dopamine neurones and consequent
dysregulation of the basal ganglia

20
Q

What is the general method of action for most Parkinson drugs?

A
  • Replace the lost dopamine

- Principal targets are dopamine synthetic pathways, dopamine catabolism and dopamine receptors

21
Q

What is Levodopa?

A
  • Drug to improve bradykinesia and rigidity in Parkinsons
  • Immediate precursor of dopamine, converted into dopamine by endogenous L-DOPA decarboxylase in remaining cells (Boost Dopamine)
22
Q

How effective is Levodopa (L-DOPA) ?

A

Therapeutic effect wanes with time (8-10 years of clinical usefulness)
No effect on neurodegeneration, eventually nerve terminals become too sparse for effectiveness

23
Q

What are some of the unwanted effects of Levodopa?

A
  • Dyskinesia
  • On-off effects
  • Nausea + vomiting (carbidopa given to treat)
  • Hypotension
  • Clouds thought
  • Schizophrenic-like syndrome
24
Q

Name some MAO-B inhibitors

A

selegiline

rasagiline

25
Q

How do MAO-B inhibitors work?

A

Stop dopamine from being broken down

26
Q

How do Anticholinergic Drugs help treat Parkinson’s?

A

Indirectly stops GABA release so dopamine isn’t broken down

27
Q

What is Amantadine?

A

Is a weak antagonist at glutamate NMDA receptors, increases dopamine release, blocks dopamine reuptake and has anti-muscarinic actions

28
Q

What are the different structures found in the basal ganglia

A
  • Striatum - Caudate, putamen nuclei
  • Globus pallidus (interior and exterior)
  • Subthalamic nucleus
  • Substantia nigra - pars reticulata, pars compacta
29
Q

What is a hyperkinetic disorder

A

Excessive involuntary movements

30
Q

Whats the most common basal ganglia disorder

A

Parkinson’s

31
Q

What is given alongside Levodopa and why

A

Peripheral DOPA decarboxylase inhibitors to prevent nausea e.g. carbidopa or benserazide

32
Q

What effect do MAO-B inhibitors have on PD and how are they superior to MAO-A inhibitors

A

Improves motor function in early and advanced PD

Lacks the peripheral cheese reaction of MAO-A inhibitors

33
Q

How does amantadine interact with L-DOPA

A

improves the on-off effects of L-DOPA and limits L-DOPA induced dyskinesias

34
Q

What +ve and -ve effects does amantadine have

A
  • Weak therapy for PD that improves tremor and rigidity
  • May act to protect dopamine neurones from degeneration
  • sudden withdrawal causes dramatic worsening of PD

Pharmocolgy (22 decks)

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