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aa Neuro 3 > Parkinson’s Disease > Flashcards

Parkinson’s Disease Flashcards

1
Q

WHAT IS THE PROBLEM IN PARKINSON’S DISEASE?

A

DEAD DOPAMINE NEURONS

Loss of dopamine synthesis

Loss of regulated release

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2
Q

PARKINSON’S DISEASE

Disease of the elderly, average onset age:

A

60, about 1% of people over age 60 have it

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3
Q

PARKINSON’S DISEASE

Genetic causes of Parkinson’s discovered in past 10 years show selective vulnerability of:

A

dopamine neurons

-Younger patients more likely to have genetic cause

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4
Q

PARKINSON’S DISEASE

People who drink ________, work with pesticides or metals like iron and copper have higher risk of Parkinson’s

A

well water

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5
Q

Tea and coffee drinkers have __________ risk of Parkinson’s

A

up five-times lower

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6
Q

________ have lower risk of Parkinson’s

A

Smokers

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7
Q

PARKINSON’S DISEASE

People who drink well water, work with pesticides or metals like _________ have higher risk of Parkinson’s

A

iron and copper

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8
Q

L-Dopa

A

rx- direct precursor of dopamine
Carbidopa reduces dose of L-Dopa needed

(much L-Dopa destroyed in gut w/o carbi)

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9
Q

Carbidopa

A

rx- Inhibits peripheral metabolism of L-Dopa

CAN”T cross BBB

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10
Q

If _____ makes you better, you have Parkinsons

A

L-Dopa

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11
Q

DRUG TREATMENT OF PARKINSON’S DISEASE

A

L-dopa – direct precursor of dopamine
Dopamine agonists
Dopamine “extenders”–carbidopa, MAO inhibitors and COMT inhibitors
Anticholinergic drugs
Amantadine - A glutamate antagonist
Drugs that may prevent progression

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12
Q

The most important drug for Parkinson’s

A

L-DOPA

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13
Q

L-DOPA

A

L-dopa is combined with carbidopa to block peripheral metabolism

Side effects – nausea, hypotension, depression, psychosis (up to 15%)

Long term complication – drug induced dyskinesias

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14
Q

Healthy brain makes about _____ of dopamine

A

1 g

L-Dopa dose
Typical dose 125 mg q2h 8 times/day

Taking more than 1 g of L-Dopa can cause side effects

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15
Q

Comtan

A

Keeps dopa around

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16
Q

Ripineral

A

Direct dopa agonist

Smoothes out peaks and troughs of L-Dopa w/ a short half life

17
Q

L-Dopa half life

A

1 hour

18
Q

The tremor in parkinson’s is

A

A rest tremor

19
Q

Walking with parkinsons

A

Shuffling gait chasing the center of gravity

20
Q

Cognitive ability of Parkinson’s

A

normal

21
Q

Substantia Nigra name

A

has black pigment

Not born with pigment, it grows over time. PArk pts have no pigment

22
Q

Diagnostic feature of parkinsons

A

Lewy Bodies

23
Q

SN location

A

Base of skull

feeds axons to caudate and putamen (these stay normal)

Dopa deletion is worse in the Putamen

24
Q

Main output of BG

A

GPI/SNr

25
Q

Inhibitory Neurons

A

These dont see dopamine in PK, and they say “no movement allowed”

26
Q

Amantadine

A

Glu Antagonist

27
Q

Tyr–> L-Dopa–> Dopamine

A

enzyme not available in PK to do this synthesis

28
Q

Dopamine Receptor Agonists

A

Most D2-dopamine receptor agonists
Developed for longer half lives
Often started at time of diagnosis to delay need for L-DOPA

Ropinirole (Requip)
Pramipexole (Mirapex)
Apomorphine – short acting

29
Q

Dopamine Receptor Agonists ADR

A

TOXICITY: Nausea, hallucinations, Sudden onset of sleep* – car accidents

Pergolide – cardiac valve thickening – FDA withdrew drug

EVENTUALLY, NEARLY EVERYONE ON A DOPAMINE AGONIST NEEDS L-DOPA

30
Q

Anticholinergics

A

Invention of antihistamines led to their use in Parkinson’s before dopamine and L-DOPA discovered
Have some limited value in treating some patients with tremor
Side effects: confusion, drowsiness, constipation, and urinary retention limit use in elderly Parkinson patients

31
Q

Amantadine

A

Beneficial effects discovered when Parkinson patients took amantadine for influenza symptoms – Dose 300 mg/day

Mechanism uncertain

- facilitate release of endogenous dopamine
- glutamate antagonist
32
Q

Cost of Drugs

A

VERY steep

33
Q

Drugs that may prevent progression of Parkinson’s

A

Co-enzyme Q-10 at dose of 1200 mg/day or greater has passed early double blind study

Creatine in doses of 10-20 gm/day may be beneficial

Caffeine and Adenosine A2a antagonists are being tested

Minocycline and Vitamin E have failed testing

34
Q

Surgical Therapy for Parkinson’s Disease

A

Deep brain stimulation—reversible thalamotomy or pallidotomy
Thalamus
Internal pallidum
Subthalamic nucleus

Fetal dopamine cell transplantation

*When drugs arnt doing the trick

aa Neuro 3 (24 decks)

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