Parkinson's disease

Question 1

Parkinsons disease symptoms

Answer 1

• Chronic progressive motor disorder
  
  • tremor at rest
  • rigidity- difficult to initiate movement
  • adv “frozen state”
• secondary signs
  
  • slurred speech, stooped posture, shuffling gait, pill rolling motion, depressed, apathetic

Question 2

Etiology of parkinsons

Answer 2

• unknown
• viral theories
• crebral hypoxia (atherosclerosis)
• extrapyramidal side effects from antipsychotic agents

Question 3

physiologic cause

Answer 3

• Dysfunction of basal ganglia of brain (control EPS)
• redox of number of dopamine terminals in substantia nigra
• imbalance of neurotransmitters dopamine and acetylcholine

Question 4

Treatment choices

Answer 4

• antihistamines
• anticholinergics
• dopa
• dopa/ carbidopa
• dopamine receptor stimulants

Question 5

anticholinergics

Answer 5

• therapeutic use
  
  • min symptoms, adjunct therapy
  • drug induced parkinson’s (EPS)
• Mechanism of action
  
  • Blocks acetylcholine receptors
• side effects
  
  • dry mouth, blurred vision, constipation, urinary retention

NOTES

adjunct therapy is in addition with another therapy

Question 6

antihistamines

Answer 6

• Therapeutic use
  
  • elderly male
  • drug induced parkinsons (EPS)
• mechanism of action
  
  • anticholinergic properties

Question 7

Dopa Pharmacokinetics

Answer 7

• Dopa can cross blood brain barrier
• dopamine cannot cross bbb
• 95% of DOPA dose is metabolized to dopamine prior to crossing BBB
  
  • uses grams
• vit B6 induces decarboxylase enzyme
  
  • less than 5% of DOPA is then use (BAD)
• CarbiDOPA blocks decarboxylase enzyme
  
  • binds to decarboxylase so more DOPA can be cross

Question 8

Dopa Effects

Answer 8

• Therapeutic
  
  • relieves rigidity, decreases tremor, enhances mood
  • no effect ondrug induced parkinsons
• side effects/ adverse reaction
  
  • orthostatic hypotension, arrhythmogenic, nausea/vomiting, psych disturbances, on/off (frozen state is delayed with carbidopa)
  • limit dose decreases side effects

Question 9

DOPA contraindications

Answer 9

• Narrow angle glaucoma (inc pressure in the eye which cuases blindness)
• acute psychosis
• melanoma (skin cancer, dopa stimulate melanoma)

Question 10

amantadine

Answer 10

• stimulates dopa receptor
• antiviral properties
  
  • influenza type a
  • not useful against type b
• side effects
  
  • insomnia, depression, orthostatic hypotension

NOTE:

use when the flu shot cannot be taken