Parkinson's Disease Flashcards

1
Q

Levodopa

A
  • Levodopa is used as a shuttle to transport precursor to dopamine across the BBB.
  • The precursors are converted to dopamine, which is stored in the surviving nigrostratial nerve terminals.
  • It is administered with carbidopa or benzerazide to block peripheral conversion of levodopa to dopamine.
  • Adverse effects include nausea, vomiting, postural hypotension, involuntary movements, restlessness and cardiac arrhythmias.
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2
Q

Carbidopa

A
  • Administered with levodopa to block peripheral conversion of levodopa to dopamine.
  • Metabolism of L-Dopa in GI tract and peripheral tissues is decreased, therefor increasing L-Dopa levels in CNS.
  • Carbidopa is highly emetogenic as it stimulates the CTZ.
  • Side effects include nausea, abdo pain, constipation, orthostatic hypotension, dizziness, sedation, confusion, and hallucination.
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3
Q

Benzerazide

A
  • Blocks peripheral conversion of levodopa to dopamine. Combined with levodopa.
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4
Q

Pramipexole or Bromocriptine

A
  • Dopamine agonist.
  • Used to delay the onset of L-Dopa therapy and prolong the effective treatment period in patients with deteriorating response.
  • Also can be given to those who cannot tolerate L-Dopa.
  • Crosses the BBB.
  • Potential side effects include somnolence, dyskinesia, nausea, vomiting, orthostatic hypotension, nightmares, hallucination, confusion and dizziness.
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5
Q

What is the difference between pramipexole and bromocriptine?

A
  • Bromocriptine is an ergot, so it also targets serotonin receptors.
  • Pramipexole is a non-ergot so it does not target serotonin receptors.
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6
Q

Entacapone

A
  • COMT inhibitor.
  • Inhibits degradation of dopamine.
  • Increases the duration of effect of levodopa dose. Can increase peak levels of levodopa, and should be taken with carbidopa/levodopa.
  • Can reduce the required dosage of levodopa/carbidopa.
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7
Q

Selegiline

A
  • Selective MAOI (MAO-B).
  • Reduces degradation of synaptic dopamine and prolonged dopaminergic activity.
  • When used as a mono therapy delays the need for L-Dopa by an average of nine months.
  • Possible side effects includes nausea, dizziness, abdominal pain, confusion, and exacerbation of L-dopa side effects.
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8
Q

Benztropine

A
  • Anticholinergic.
  • Used in patients to reduce the side effects of antipsychotic medications. Antipsychotic medications can lead to pseudo-parkinsonism and dystonia.
  • Also a second line drug for the treatment of Parkinson’s. Improves tremor but not rigidity or bradykinesia.
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9
Q

Amantadine

A
  • Inhibits dopamine reuptake and blocks ACh and glutamate receptors.
  • Currently being used to reduce involuntary spasmodic twitching movements. Was used as an anti-viral, now used as an antiparkinsonian drug.
  • Effect on Parkinson’s not understood.
  • Amantadine is cautioned in renal failure patients and has a narrow TI.
  • Side effects include nausea, dizziness, confusion, hallucinations, nightmares, dry mouth, peripheral oedema and livedo reticularis.
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10
Q

What is Parkinson’s disease?

A
  • Parkinson’s is a degenerative brain disorder affecting movement, and it is characterized by EPSE symptoms.
  • The cause is a deficiency of dopamine, but how this happens is unknown. It is a progressive and incurable disease, and severely affects quality of life.
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11
Q

What are the major symptoms of Parkinson’s Disease?

A
TRAP
- Tremor
- Rigidity
- Akinesia and bradykinesia
- Postural instability
and gait instability (shuffling feet).
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12
Q

What are the non-motor related conditions associated with PD?

A
  • Depression and Anxiety
  • Cognitive disorders such as dementia
  • Sleep abnormalities
  • Autonomic dysfunction e.g. constipation
  • Sensory e.g. olfactory dysfunction
  • Fatigue and weight loss
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