Parkinson's disease Flashcards
what is parkinson’s disease?
- It is a movement disorder
what are the risk factors of parkinson’s disease?
- Genetics
- Gender
- Life experiences
- Smoking
- caffeine
- Enviornmental exposure
what are the motor clinical features of PD?
- Posture
- Hypokinesia
- resting tremor
- Rigidity
what are some nonmotor clinical symptoms of PD?
- Neuropsychiatric
- Sensory
- Sleep disturbances
- Autonomic dysfunction
what are lewy bodies?
- Eosinophilic inclusions caused by alpha syno-synuclein accumulation in neurons particuarly numerous in substantia nigra
L-DOPA is a precursor to DA alleviates some of the symptoms in the early stages of parkinson’s. TRUE OR FALSE?
TRUE
decreased striatal dopamine causes increased inhibitory output from basal ganglia which suppresses movement. TRUE RO FALSE?
TRUE
Dopamine levels are severely reduced in the striatum of PD patients. TREU RO FLASE?
TRUE
why does dopamine not cross the BBB?
- It is too polar
what is the naturally occuring amino acid precursor of dopamine/
- Levodopa
What does DOPA stand for?
- Dihydroxyphenylalanine
Levodopa cannot cross the BBB. TRUE OR FALSE?
FALSE
How is L-Dopa transported into the BBB?
- Via an amino acid transporter system
what happens to L-DOPA when it crosses the BBB?
- It is decarboxylated to dopamine by dopa decarboxylase
L-DOPA being decarboxylated to dopamine in the Brain is an example of a pro-drug. TREU RO FALSE?
TRUE
Levodopa is the least effective drug for the treatment of PD? TRUE OR FALSE?
- TRUE
Where is levodopa metabolised and excreted?
- Liver
- Excreted in the urine
95% of levodopa is decarboxylated to dopamine. TREU RO FALSE?
TRUE
L-Dopa is decarboxylated to dopamine in the peripheral tissue. TRUE OR FALSE?
TRUE
Large doses of L-Dopa are required which leads to increased risks of ADRs of L-dopa and dopamine. TRUE OR FALSE?
TRUE
what is carbidopa?
- It is an inhibitor of amino acid decarboxylase
What are the CNS ADRs and peripheral ADRs?
- CNS
- nausea, depression, anxiety
Peripheral
- cardiovascular side effects
- Motor compications
what are some drug interactions with levodopa?
- Pyridoxine metabolises levodopa
- Phenothiazines antagonises the effects of levodopa
Levodopa is contraindicated in psychotic patients. TRUE OR FALSE?
TRUE
what is motor complications?
- Motor flunctuations
what is dyskinesia?
- The inability to control muscles
- leads to unvoluntary movement of muscles
when does dyskinesia usually occur?
- When drug levels peak
PSD is a progressive and degenerative disease. TRUE OR FALSE?
TRUE
what can you do to reduce side effects or motor complications?
- Give smaller doses
- Give prolonged controlled release of levedopa/carbidopa to reduce fluctuantions
- Brain stimulations
- Adjunct therapies
what do D1 receptor (dopamine agonists) do?
- They increase cAMP leading to excitatory effects (stimulates ca2+)
what do D2 receptors (dopamine agonist) do?
- They decrease levels of cAMP whihc has inhibitory effects (inhibits ca2+)
what are the advantages and diads of dopamine agonist for treatment of PD?
Ads:
- Reduced fluctuantions
- directly stimulates dopamine rceptors
- No competition with AA
- LOnger half life
Disads:
- Not as effective as levodopa
- Higher rate of confusion
what is Ergot deravative?
- It is the first generation dopamine derivative
Ergot derivatives have ben discontinued due to severe side effects. TRUE RO FALSE?
- TRUE
what are the side effects of Ergot derivatives?
- heart Valve disease
Ergot derivatives have longer half lives compared to levedopa. TRUE OR FALSE?
TRUE
what are non ergot derivatives?
- They are selective D2 dopamine agonist (first in-line therapy for newly diognosed patients under 70)
Non ergot derivatives are effective against tremors. TRUE OR FALSE?
TRUE
Rotigotine (non ergot derivative) is given as a transdermal patch. TRUE OR FALSE?
TRUE
what are ADRs of non ergot derivatives?
- Psychosis in elderly and postural hypotension
what is apomorphine?
- A derivative of morphine that has similar stucture to dopamine
Apomorphine is a full agonist of D1 na dD2 receptors. TRUE OR FLASE?
TRUE
when are apomorphines maily used?
- In advanced PD with patients over 70 years
What are teh ADRs of apomorphine?
- Causes respiratory depression if overload
apomorphine must be combined with antiemtic drugs because of it powerful emetic action. TRUE OR FALSE?
TRUE
What does COMT stand for?
- Catechol O-methyl transferase inhibitors
what do COMT do?
- They prevent degradation of dopamine by inhibiting COMT
what are COMT Inhibitors used for?
- Early and flunctauating PD
MAO (B) inhibitors are given as an adjunct therapy with patients with reduced response to Levodopa. TREU OR FALSE?
TRUE
MAO inhibiotors doe not reduce mild on-off phenomena. TREU RO FALSE?
FALSE
what is Amantadine?
is an antiviral agent used to treat prophylaxis of influenza A2
Amantadine has been known to improve PD syptoms, but mechanism is unknown. TRUE OR FALSE?
TRUE
Amantadine can be given alone or as a adjunct therapy. TRUE RO FALSE?
TRUE
What are anticholinergics used for?
- effective in tremor and regidity
- reduces cholinergic activity
what are the CNS side effects of anticholinergics?
- Drowsiness, confusion
- Dry mouth
Withdrawal with anticholinergics should be gradual to prevent acute PD excerbations. TRUE OR FALSE?
TRUE
summarise the drugs fro PD treatments?
- Levodopa
- Dopamine agonists
- Ergot and non ergot derivatives
- Apamophine
- COMT I
- MAO I
- Amantadine
- Anticholinergics
