Parkinson's Disease🧠Flashcards
Disorder of movements that occur mainly in the elderly?
Parkinson’s disease
What are the main symptoms of Parkinson’s disease??
1/bradykinesia >low dopamine
2/muscle rigidity >high acetylcholine
3/tremor at test >high acetylcholine
4/postural instability.
How the muscle rigidity being detected?
During the passive movement that is done by the physician and seeing that three a resistance of the body to the passive movement
The tremor symptom in Parkinson’s disease is started in the legs 🦵:
True or False?
False it is started in hands and forming the PILL ROLLING TREMOR
There is a constant degree of cognitive impairment:
T or F?
False, it is variable degree
What are the pathogenesis of PD?
1/idiopathic
2/molecular aspects
3/genetic factors
What are the diseases that associated with PD?
Dementia
Depression
Autonomic dysfunction
Because not the basal ganglia is affected in the brain ,but also other parts
Which of the CNS diseases have a characteristic of being SHUFFLING GAIT? PD DEPRESSION EPILEPSY SCHIZOPHRENIA
PD
A neurotoxins MPTP is selective in destroying the nigrostriatal dopamiinergic neuron with the other dopaminergic neurons being affected,too,:
T or False
False affected only the nigrostriatal pathway without the other pathway for unknown reason.
MOTP neurotoxins is a toxic metabolite which causes the oxidative distress in the nigrostriatal and lowering the dopamine level and causes the PD by being converted to MPP+ by which enzyme?
MAO-A
MAO-B
COMT
MAO-B WHICH IS THE ENZYME RESPONSIBLE THE DOPAMINE
What is the mechanism that the MOTP done in the brain to cause PD?
The MPTP being converted to a toxic metabolite which MPP+ by MAO-B and being transported by dopamine transport system to the nigrostriatal pathway where it is selectively inhibit the mitochondrial oxidation reactions and causes oxidative distress in this pathway which will lower the amount of D .
MPTP IS A CONTAMINATE IN PREPARATION AND USED AS COCAINE SUBSTITUTE:
T OR F?
False used as HEROIN.
The formation of PD being idiopathic or unknown when exposure to one of these:
Neurotoxins Oxidative reactions Cerebral ischemia(stroke) Viral encephalitis Head injury dug-induced which block the dopamine receptor antiemetic and antipsychotic such as chlorpromazine and reserpine
S the genetic factors are common instances of familial early-onset of PD :
T OR F?
False! Rare instances.
It is a synaptic protein that present in the synapse and involved in the vehicle recycling of the dopamine and present in large amounts in normal brain:
What is it?
Alpha-synuclein.
When the alpha-synuclein being misfolded or aggregates will the function of being vesicular storage of dopamine:
T orF?
True
The aggregations of the alpha-synuclein in the PD has which form?
Lewis bodies
The neurodegenrative disorders like PD are associated with the development of intracellular protein aggregate and misfolding:
True or False?
True
Which of the neurodegenrative disorders is in basal ganglia and characterized by the loss of fibers in the nigrostriatal pathway: PD DEPRESSION ANXIETY EPILEPSY
PD
Has no cure but the symptoms can be treated by providing the balance between DOPAMINE and ACETYLCHOLINE is describing which of the neurodegenrative disorders?
Parkinson’s disease
If the progressive of the the PD symptoms loss that will increase the severity of the disease:
T orF?
True
What is the most symptom that related to dopamine deficiency:
Tremor
Rigidity
Bradykinesia
Bradykinesia
Because the tremor and rigidity is a disturbance also in other transmitters which are GABA,5HT,NA,Ach and dopamine,too.
Which part of the brain regulate the flow of information from the cerebral cortex to the motor neurons in the spinal cord.?
BASAL GANGLIA
Norepinephrine is the brain’s motivational chemical
T orF?
False , dopamine us the motivational chemical of the brain.
The on-off syndrome is a common side effects of which drug?
Levodopa.
What are long term adverse effects of LEVODOPA?
1/wearing-off phenomenon
2/on-off phenomenon
3/dyskinesia
What is this long averse effect: That return the Parkinson’s disease symptoms before taking the next dose of levodopa? Wearing-off phenomenon On-off phenomenon Dyskinesia
Wearing-off phenomenon.
How to solve the wearing -off phenomenon??
1increase the frequency of the levodopa dose so the symptoms are not able to appear for a while.
2/adding dopamine agonists to increase the dopamine level
3/MAO-B INHIBITORS
4/COMT INHIBITORS
We inhibit theses enzymes to increase the half life of levodopa and then can be converted to dopamine by dopa decarboxylase.
The return of Parkinson’s disease symptoms without the respect to the dosing interval describes which on of the long term adverse effects of levodopa?
(a) Wearing-off phenomenon.
(b) On-off phenomenon
(c) Dyskinesias
On off phenomena
What is the treatment used opportunity the on-off phenomenon?
1/levodopa holiday to resensetize the dopamine receptor
2/apomorphine
3/selengiline
4/reasgiline
5/ropinirole
6/entacapone which will inhibit the DDC enzyme in the peripheral nervous system so all the dopamine will be in the CNS.
Levodopa-induced the involuntary movements during the peaks of the drug including dystopia and chorea:
Describe which of the long-term adverse effects of the levodopa?
(a) Wearing-off phenomenon.
(b) On-off phenomenon
(c) Dyskinesias
Dyskinesias
What are the treatments used to treat Dyskinesias?
1/decreasing the dose of levodopa so doesn’t reach the peak of having involuntary movements such chorea(dancing) and dystonia
2/adding the AMANTADINE to the levodopa which work as antidyskinetic drug.
The quick movements of the hands and feet’s which similar to the dancing movements is dystonia:
True or False?
False!it is called chorea which means dancing while dystonia means contraction of the muscles
What are the types of dopamine receptor agonist?
1/ergot derivatives Bromocriptine Pergolide 2/non-ergot derivative Pramipexole Ropinirole Apomorphine
These drugs have longer duration of action than levodopa and more effective in patients with PD that have fluctuations and variations in response to levodopa.: What is the class of these drugs? Dopamine receptor agonist Dopamine receptor antagonist MAO-B INHIBITORS COMT INHIBITIRS
Dopamine Receptors Agonists
If the patient that has PD and he has the levodopa as initial therapy will have less risk of developing dyskinesia and motor fluctuations comparing to dopamine receptors agonist!
True or False?
False , because the Dopamine Receptors Agonists produce less risk of having the dyskinesia and motor fluctuations if taking as initial therapy instead of levodopa.
The side effects that comes of the dopamine receptor agonist limit the use of the it:
True or false?
True.
Which of the following drug that gave to a patient and observed having hallucination and confusion also worsen the orthostatic hypotension and enhancing fibrosis: Bromocriptine Pramipexole Ropinirole Levodopa
Bromocriptine which is belong to ergot derivatives of the dopamine receptor agonists.
A patient came to the hospital with cardiac fibrosis and when the physician done the ECG do not see any thing and it was regular and normal which of the following drug is taken by this patient? Pergolide Pramipexole Ropinirole Levodopa
Pergolide because it is ergot derivatives.
What are the adverse effects that comes with BROMOCRIPTINE?
1/hallucinations’confusion and worsen the orthostatic hypotension.
2/retro peritoneal fibrosis
3/cardiac fibrosis
4/pleuropulmonary fibrosis
The usurper of bromocriptine is declined because of the newer agents which non-ergot dopamine receptor agonists:
True or False?
True
Which of these drugs Fido not show fluctuations when associated with levodopa: Bromocriptine Pergolide Cabergoline Pramipexole
Pramipexole which is non-ergot derivatives
This drug cases compulsive behaviors such the excessive eating and gambling and somnolence : Ropinirole Pramipexole Bromocriptine Levodopa Both A and B
Both A and B
Ergot derivatives have selectivity to D2/D3 :
True or False
False the non-ergot derivatives
Which is the drug that is contraindicated with patients have active peptic ulcer,psychotic illness and myocardial infarction?
Pramipexole
Which of the non-ergot derivative have high affinity to D2 receptor:
Pramipexole
Ropinirole
Apomorphine
Ropinirole
Used as no therapy drug and can be used with levodopa to smooth out the response fluctuations!
Ropinirole
Ropinirole is metabolized by which subtype of the CYP450: CYP2C9 CYP3A4 CYP3A5 CYP1A2
CYP1A2
A patent came to the hospital with bacterial infection and the physician gave him the fluoroquinlone (antibiotic)
And he diagnosed with a PD and was taking a drug but the drug inhibited it’s metabolism and became toxicity:
Which of the following drugs is that drug?
Pramipexole
Ropinirole
Levodopa
Bromocriptine
Ropinirole because ropinirole and the antibiotic which work to inhibit the metabolism of the ropinirole by this enzyme which then need to have dosage adjustment or the ropinirole toxicity will be increased.
The warfarin and caffeine is metabolized by CYP1A2 so they will reduce the clearance of which drug? Pramipexole Ropinirole Levodopa Apomorphine Bromocriptine
Ropinirole where they all metabolized by the same enzyme and will reduce the clearance of the ropinirole
Which of the following is the short-acting dopamine receptor agonist: Pramipexole Ropinirole Apomorphine Bromocriptine
Apomorphine
Which of the following drugs used as an intermittent treatment of “off” episodes associated with advanced Parkinson disease: Apomorphine Bromocriptine Pramipexole Ropinirole
Apomorphine but it is using as a last epresort opinion the other drugs failed
The apomorphine is contradicted with a drug that causes profound hypotension! What is the drug? 5HT3 5HT4 5HT2 5HT1
5HT3 WHICH ONDASERTON.
used as subcutaneous injection in a pen self-injector; Which of the following drug: Pramipexole Apomorphine Ropinirole
Apomorphine because it is short acting drug and when given orally it has poor bioavailability and face the first pass metabolism.
A patient came to the hospital with dry mouth,urinary retention and deficits in memory and concentration what is the drug he is using and causes these adverse effects to him?
Anti-muscairnic
Which of the following drugs can improve the tremor and rigidity of parkinsonism but have little effect on bradykinesia? Dopamine receptor agonist Levodopa Anti-muscairnic COMT INHIBITORS MAO-B INHIBITORS
Anti-muscairnic agents
The NMDA if it is getting blocked that increase the releasing if dopamine:
True or False?
True
