Parkinson Disease

Question 1

What type of disease is Parkinson?

Answer 1

Neurodegenerative

Question 2

What are the classic symptoms of Parkinson disease? (4)

Answer 2

• rigidity
• resting tremor
• bradykinesia
• postural instability

Question 3

What is the primary cause of Parkinson?

Answer 3

degeneration of the dopaminergic neurons in the substania nigra

Question 4

What does decreased dopamine result in with PD patients?

Answer 4

increased ACH

Question 5

What are the other neurotransmitters affected by PD?

Answer 5

GABA, glutamate, 5-HT

Question 6

What is the rationale for levodopa therapy?

Answer 6

Attempt to increase dopamine content in the basal ganglia

Question 7

True or False:

A direct administration of dopamine is ineffective because of the BBB

Answer 7

True

Question 8

What provides a precursor to dopamine allowing it to cross the BBB?

Answer 8

levodopa (L-dopa)

Question 9

What is the drug given in conjunction with L-dopa?

Answer 9

carbidopa

Question 10

What does carbidopa do in the body?

Answer 10

inhibits dopa decarboxylase; prevents premature conversion of L-dopa allowing it to cross the BBB

Question 11

Does cabidopa cross the BBB?

Answer 11

negative ghost rider

Question 12

What are the problems L-dopa causes with therapy? (5)

Answer 12

• GI irritation
• hypotension
• behavioral effects
• dyskinesia
• “freezing” of gait

Question 13

What is end-of-dose akinesia?

Answer 13

A deceased response of L-dopa toward the end of cycle of the drug

Question 14

What is the on-off phenomenon?

Answer 14

response to L-dopa fluctuates within dose cycle

Question 15

What is the most serious problem with L-dopa therapy?

Answer 15

diminished response with long term use

Question 16

When will the benefits possibly be lost?

Answer 16

After 4-5 years of L-dopa therapy

Question 17

What are dopamine agonists?

Answer 17

Synthetic dopamine that cross the BBB with direct stimulating effects on the dopamine receptors in the brain

Question 18

True false:

Dopamine agonists have a longer half life

Answer 18

True

Question 19

True false:

Having a longer half life makes the drug more stable

Answer 19

True

Question 20

Can Dopamine agonists be used as initial treatment in early PD?

Answer 20

Yeppers

Question 21

Common problems associated with Dopamine agonists? (4)

Answer 21

• nausea/vomiting
• confusion/hallucinations
• postural hypotension
• increased dyskinesia

Question 22

What is COMT?

Answer 22

It is an enzyme that breaks down L-dopa in peripheral tissue

Question 23

What do COMT inhibitors allow for?

Answer 23

Allow for more L-dopa to reach the brain

Question 24

True False:

COMT inhibitor can be combined with L-dopa and carbidopa in treatment

Answer 24

True

Question 25

What are the common problems associated with COMT inhibitor therapy? (3)

Answer 25

- GI distress - Orthostatic hypotension - Increased dyskinesia

Question 26

What do anticholinergic agents do?

Answer 26

Decreases acetylcholine influence; may help decrease rigidity and tremor

Question 27

True False: | Anticholinergic agents are used with limits because of their side effects

Answer 27

True; they have a "package" of side effects

Question 28

What are the "package" of side effects?

Answer 28

- dry mouth - constipation - urinary retention - Fast/increased HR

Question 29

What do MAO-B inhibitors do?

Answer 29

Inhibit monamine oxidase type B; Prolongs dopamine effects in the brain

Question 30

True False: | MAO-B inhibitors are combined with L-dopa to increase and prolong effects of dopamine in the brain

Answer 30

True

Question 31

What are the major problems of MAO-B inhibitors?

Answer 31

NO major concerns

Question 32

What is Amantadine (symmetrel)?

Answer 32

It is an antiviral agent that has antiparkinson effects

Question 33

What was Amantadine (symmetrel) originally developed for?

Answer 33

To treat the flu

Question 34

What does Amantadine (symmetrel) do?

Answer 34

It blocks NMDA receptors in the brain, decreasing the influence of excititory amino acids (glutamate) - it decreases the chance of dyskinesias in PD patients

Question 35

What are the main problems with Amantadine (symmetrel)? (3)

Answer 35

- orthostatic hypotension - psychotropic effects - skin discoloration

Question 36

Is Amantadine (symmetrel) a common drug?

Answer 36

Not really but it is gaining ground

Question 37

What is the optimal treatment time after taking antiparkinson drugs?

Answer 37

30-60 minutes after ingesting the meds

Question 38

True False: | It is very important to coordinate rehab sessions with the drugs

Answer 38

Dats da truth