parkinson's disease Flashcards
what is the pathophysiology of parkinson’s
impaired clearing of abnormal/damaged intracellular proteins by ubiquitin-proteasomal system, leading to the accumulation of aggresomes –> apoptosis
- degeneration of dopaminergic neurons with lewy body can affect motor movements initiated by motor cortex
what is the criteria for diagnosis of PD?
presence of clinical features and exclusion of alternative diagnosis
early, sx disease without complications
- may not need oral medications if coping well
- physiotherapy & exercise regime - stretching, maintaining posture and balance
- healthy and balanced diet
- knowledge on disease
- social support
MOA and examples of levodopa
- precursor or dopamine, usually combined in preparation with peripheral decarboxylase inhibitors
- madopar: levo & benserazide
- sinemet: levo & carbidopa
ADR of levodopa
short term: N/V, postural HoTN
long term: motor fluctuations & dyskinesia
uses and examples of anticholinergics in PD
- controls tremor, useful in treating sialorrhea
- trihexyphenidyl aka Artane
ADR of anticholinergics
dry mouth, sedation, constipation, urinary retention, delirium, confusion, hallucination
MOA of MAO-Bi and examples
- selective inhibitor of MAO-B, interfering w breakdown of dopamine; may delay nigral brain cell degen (reduce risk of death)
- selegiline aka Jumex
ADR of MAO-B
heartburn, loss of appetite, nausea, constipation, dizziness, anxiety, headache, palpitation, insomnia, confusion, nightmares, visual hallucination
MOA of COMTi and examples
- blocks an enzyme that converts levodopa into inactive form so that more can enter the brain and be converted to dopamine
- entacapone, tolcapone
COMTi must be used with
levodopa
ADR of COMTi
- increased abnormal movements (dyskinesia)
- liver dysfunction with tolcapone
- N/D
- urinary discoloration
- visual hallucination
- daytime drowsiness, sleep disturbances
examples of dopamine agonist
- bromocriptine
- pergolide
- piribedil
- ropinirole
- pramipexole
ADR of dopamine agonist
- similar to levodopa
- fibrosis
- pedal edema
- somnolence (ropinirole and pramipexole)
- arrhythmia
- restrictive valvular heart disease
MOA of amantadine
- enhance release of stored dopamine
- inhibit pre-synaptic uptake of catecholamine
- dopamine receptor agonist
- NMDA receptor antagonist
