Parkinson's Flashcards
Three classifications of parkinson’s disease?
1) idiopathic
2) iatrogenic
3) post-traumatic
In PD, dopamine neurons die off, causing less dopamine release in the ___
striatum
In the striatum, there’s an association between ___ and ___-producing neurons
dopamine, ach
When dopaine > Ach what occurs?
Parkinsonism
When Ach>dopamine what occurs?
Choreiform movements
Presently available drugs are thought to alleviate symptoms by restoring the functional balance between ___ and ___ systems in the striatum
dopaminergic and cholinergic
What three drugs enhance dopaminergic activity?
1) L-Dopa
2) Selegiline
3) Entacapone
_____ inhibits the metabolism of dopamine by MAO-B
Selegiline
____ inhibits COMT and slows the metabolism of dopamine near the synaptic cleft
Entacapone
____ is a dopamine pre-cursor that is converted to dopamine
L-Dopa
What three drugs are dopamine agonists and stimulate post-synaptic dopamine receptors?
1) Bromocryptine
2) Pergolide
3) Pramipexole
What three drugs reduce cholinergic activity and are centrally acting muscarinic antagonists?
1) Benztropine
2) Trihexiphenidyl
3) Diphenhydramine
Why is L-dopa typically not used to treat symptoms alone?
L-dopa converts to dopamine in periphery, which can cause cardiovascular effects
What is L-dopa commonly used with?
Carbidopa
Carbiodopa acts in the peripheral to inhibit L-dopa from becoming ___
dopamine
How long does it take to see therapeutic effects of L-dopa?
3-4 weeks
True or False:
L-Dopa becomes more effective as Parkinson’s Disease Progressive
False
L-Dopa becomes LESS effective as disease progresses
Why is nausea and vomiting a common side effect of L-Dopa?
Stimulates chemoreceptor trigger zone (CRTZ)
What are three ways that L-Dopa can affect the heart?
-Postural hypotension
-Arrhythmias
-Tachy
What is the most effective drug for managing the psychiatric side effects of L-Dopa?
Clozapine
Why are there psychiatric side effects with use of L-Dopa?
Acts on mesolimbic and mesocortical pathways
True or False:
L-Dopa can cause extrapyramidal motor symptoms/choreiform movements
True
True or False:
L-dopa can increase prolactin levels
False
L-Dopa can decrease prolactin levels
The ___ ___ ____ phenomenon appears to be related to decline in blood levels of L-Dopa near the end of the dosage interval
End of Dose phenomenon
The ____ phenomenon can occur at any time in the dosage interval and appears to be related to disease progression
on-off phenomenon
How can you minimize the end of dose phenomenon?
1) Use SR
2) Add dopaminergic agonist/COMT inhibitor to cocktail
Contra-indications for L-dopa?
Glaucoma
Active peptic ulcer disease
Melanoma
Psychosis
Cardiac stuff
____ inhibits DOPA decarboxylase in the periphery but does not enter the brain
Carbidopa
____ is a non-specific dopamine receptor agonist that can decrease severity of on off phenomenon
bromocryptine
What two drugs are newer dopaminergic agonists that may preferentially target D2/D3 receptors?
1) Ropinirole
2) Pramipexole
____stimulates release of dopamine from nerve ends, but may also inhibit reuptake
Amantadine
Selegiline selectively inhibits ___ and prevents breakdown of dopamine in CNS
MAO-B
_____inhibits metabolism of dopamine and L-Dopa by COMT
Entacapone
