Parkinson Disease Flashcards
What type of disease is Parkinson?
Neurodegenerative
What are the classic symptoms of Parkinson disease? (4)
- rigidity
- resting tremor
- bradykinesia
- postural instability
What is the primary cause of Parkinson?
degeneration of the dopaminergic neurons in the substania nigra
What does decreased dopamine result in with PD patients?
increased ACH
What are the other neurotransmitters affected by PD?
GABA, glutamate, 5-HT
What is the rationale for levodopa therapy?
Attempt to increase dopamine content in the basal ganglia
True or False:
A direct administration of dopamine is ineffective because of the BBB
True
What provides a precursor to dopamine allowing it to cross the BBB?
levodopa (L-dopa)
What is the drug given in conjunction with L-dopa?
carbidopa
What does carbidopa do in the body?
inhibits dopa decarboxylase; prevents premature conversion of L-dopa allowing it to cross the BBB
Does cabidopa cross the BBB?
negative ghost rider
What are the problems L-dopa causes with therapy? (5)
- GI irritation
- hypotension
- behavioral effects
- dyskinesia
- “freezing” of gait
What is end-of-dose akinesia?
A deceased response of L-dopa toward the end of cycle of the drug
What is the on-off phenomenon?
response to L-dopa fluctuates within dose cycle
What is the most serious problem with L-dopa therapy?
diminished response with long term use
When will the benefits possibly be lost?
After 4-5 years of L-dopa therapy
What are dopamine agonists?
Synthetic dopamine that cross the BBB with direct stimulating effects on the dopamine receptors in the brain
True false:
Dopamine agonists have a longer half life
True
True false:
Having a longer half life makes the drug more stable
True
Can Dopamine agonists be used as initial treatment in early PD?
Yeppers
Common problems associated with Dopamine agonists? (4)
- nausea/vomiting
- confusion/hallucinations
- postural hypotension
- increased dyskinesia
What is COMT?
It is an enzyme that breaks down L-dopa in peripheral tissue
What do COMT inhibitors allow for?
Allow for more L-dopa to reach the brain
True False:
COMT inhibitor can be combined with L-dopa and carbidopa in treatment
True
What are the common problems associated with COMT inhibitor therapy? (3)
- GI distress
- Orthostatic hypotension
- Increased dyskinesia
What do anticholinergic agents do?
Decreases acetylcholine influence; may help decrease rigidity and tremor
True False:
Anticholinergic agents are used with limits because of their side effects
True; they have a “package” of side effects
What are the “package” of side effects?
- dry mouth
- constipation
- urinary retention
- Fast/increased HR
What do MAO-B inhibitors do?
Inhibit monamine oxidase type B; Prolongs dopamine effects in the brain
True False:
MAO-B inhibitors are combined with L-dopa to increase and prolong effects of dopamine in the brain
True
What are the major problems of MAO-B inhibitors?
NO major concerns
What is Amantadine (symmetrel)?
It is an antiviral agent that has antiparkinson effects
What was Amantadine (symmetrel) originally developed for?
To treat the flu
What does Amantadine (symmetrel) do?
It blocks NMDA receptors in the brain, decreasing the influence of excititory amino acids (glutamate)
- it decreases the chance of dyskinesias in PD patients
What are the main problems with Amantadine (symmetrel)? (3)
- orthostatic hypotension
- psychotropic effects
- skin discoloration
Is Amantadine (symmetrel) a common drug?
Not really but it is gaining ground
What is the optimal treatment time after taking antiparkinson drugs?
30-60 minutes after ingesting the meds
True False:
It is very important to coordinate rehab sessions with the drugs
Dats da truth
