parkinson

Question 1

what are the major movement symptoms of the parkinson

Answer 1

(1) Bradykinesia: slowness of voluntary movements
(2) Resting Tremor: involuntary, rhythmic movement of a body part
(3) Rigidity: increased resistance during passive mobilization of body parts
(4) Postural Instability: balance impairments impacting posture

Question 2

what are the non-motor symptoms in parkinson

Answer 2

• cognitive impairments and dementia: in 80% of patients after 15-20 years
• depressive disorders: in 50% of patients
• sleep impairments: e.g. insomnia in 90% of patients
• gastrointestinal impairments: e.g. swallowing, constipation

Question 3

what are the Hallmarks of parkinson

Answer 3

occur in the substantia nigra pars compacta:
- decreased dopamine levels
- substantial dopaminergic neuron loss
- cytoplasmic inclusion “Lewy Bodies” present in surviving neurons

Question 4

what is the Augment Dopamine Production medication

Answer 4

Levodopa (L-Dopa)

Question 5

what is Levodopa (L-Dopa)

Answer 5

• precursor to dopamine; has been used for decades
• majority of the dose remains outside of the CNS, where peripheral
  conversion to dopamine induces adverse effects (e.g. nausea, vomiting

Question 6

what are the Two major issues of levodopa

Answer 6

1. Adverse effect with high dose is dyskinesia
2. After long-term use, “wearing-off” may occur
   “on” periods and “off” periods

Question 7

what are the add on approaches to the l-dopa

Answer 7

(i) inhibit peripheral conversion to dopamine
- prevents nausea, vomiting, etc.
(ii) inhibit peripheral metabolism to 3-O-Methyldopa
- increase L-Dopa absorption to the brain
Nissinen, 2010. https://doi.org/10.1016/B978-0-12-381326-8.00001-6

Question 8

explain (i) inhibit peripheral conversion to dopamine

Answer 8

• inhibitors of dopamine decarboxylase (enzyme also metabolizes L-Dopa)
• these agents themselves do not cross the BBB; only work in the periphery
• most commonly combined with L-Dopa within the same pill

Question 9

explain this (ii) inhibit peripheral metabolism to 3-O-Methyldopa

Answer 9

• inhibitors of catechol-O-methyltransferase (COMT)
• this agent does not cross the BBB; only works in the periphery
• can be combined with L-Dopa and a dopamine decarboxylase inhibitor

Question 10

what are the Dopamine Agonists medications for the parkinson

Answer 10

pramipexole and (2) ropinirole
agonists at the D2 family of dopamine receptors
- can be used as an initial treatment, or with L-Dopa in advanced disease
- adverse effects: hallucinations, sleepiness, desire for food, sex, shopping

Question 11

explain the apomorphine

Answer 11

• agonist at both D1 and D2 families of dopamine receptors
• administered subcutaneously
• indicated for acute “off” periods in patients who are already on a
  pharmacological regimen for Parkinson’s disease
• adverse effects: same as for pramipexole and ropinirole
  sudden falling asleep
  nausea
• low demand led to cancellation in 2023