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HLSC 222- midterm 1 > Parkinsons > Flashcards

Parkinsons Flashcards

1
Q

what is parkinsons PD

A

slowly progressing disorder second to alzyheimers as most common neuron degenerative disease

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2
Q

parkinsons symptoms

A

tremor, rigidity,, postural instability, slowed movements

early- loss of smell, excessive salivation, worsening of handwriting

first appears in middle age and progresses relentlessly

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3
Q

what are motor system changes caused by

A

loss of dopaminergic neurons in substantia nigra of basal ganglia

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4
Q

stratium fxn

A

balance between dopamine and acetylcholine

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5
Q

Dopamine

A

inhibitory transmitter
- inhibits GABA

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6
Q

ACH

A

excitatory
- releases GABA

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7
Q

GABA

A

primary inhibitory neurotransmitter for CNS
- reduces neuronal excitability by inhibiting nerve transmission

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8
Q

Can you draw/ explain movement when normal inhibitory effect of dopamine is balanced by excitatory effect of ACH

A

ACH and DA are in balance

in substantia nigra- releases DA
- acts in striatum to cause a inhibitory effect on GABA

ACH in Striatum causes excitatory response of GABA

Perfect amount of GABA is released and acts on Globus pallidus
–> gives controlled movements

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9
Q

explain how movement is disrupted due to parkinsons

A

Dopamine released from Substantia nigra is disrupted
- inhibitory effect of GABA is decreased causing an INCREASE in GABA. causes Bradykinesis

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10
Q

Bradykinesis

A

slowness of movement
- tremor
- rigidity

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11
Q

Causes of PD

A

Idiopathic

  • genetic vulnerability and environmental toxins
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12
Q

Therapeutic Goal with PD

A

provide relief- do not cure

  • improve patients daily living
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13
Q

what kind of drugs are used to help with PD

A

*1) Dopaminergic agents: act on dopamine receptors

2) Anticholinergic agents: block ACh receptors

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14
Q

Levodopa mechanism of action

A

INCREASES DOPAMINE SYNTHESIS IN STRIATIUM

  • levodopa crosses BBB via active transport
  • enters neuron
  • converted into dopamine

-exits neuron and binds to dopamine receptors on GABA neuron

  • inhibits GABA release –> inhibits disturbed movement
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15
Q

pharmacokinetic of Levodopa (L)

A

oral, rapid absorption from stomach

only 2% enters brain alone, always given with carbidopa and/or entacapone

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16
Q

drug interactions of Levodopa

A

anticholinergic drugs enhance response to levodopa

first-generation Antipsychotic drugs: block dopamine receptors in striatum –> decrease L effects

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17
Q

adverse effects of Levodopa

A

**Dyskinesia (involuntary, erratic movements of face, arm )

Side effects are dose dependent

Nausea/ vomiting: dont administer drug with food
- protein reduces effect

CNS: anxiety, behavioural changes

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18
Q

How do you treat the side effect of dyskinesia from levodopa?

A

1) Amantadine (a-man-ta-dine) - drug

2) Surgery and electrical stimulation

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19
Q

How does treatment of psychosis affect PD?

A

treatments of psychosis intensifies PD symptoms becuase they block striatum dopamine receptors

20
Q

Is Levodopa beneficial?

A

Highly effective but takes months to develop

21
Q
A
22
Q

How do the beneficial effects of Levodopa change over time

A

beneficial effects diminish over time
–> ~ 5 years before function deteriorates to pretreatment levels

Weaning off

Abrupt Loss

23
Q

Weaning off

A

gradual loss of benefits indicated drug levels are at sub therapeutic levels

24
Q

abrupt loss

A

“on-off” loss

can happen when ddrug levels are high
- last from minutes to hours

25
Q

How does Levodop work alone vs with Caribidopa/Entacapone?

A

Alone- highly metabolized (500mg) only (10mg) 2% acts on brain

Carbidopa inhibits Levodopa metabolism- therefore 100mg allows for 10 mg to act on the brain
- less levadopa for the same results

26
Q

What drugs are used to treat Motor Symptoms

A

Dopamine Agonists:
- Pramipexole (pram-a-pex-all)

Catechol-O-Mathyltrasferase (COMPT) Inhibitors
- Entacapone (end-tag-a-pon)

MAO-B Inhibitors
- Selegiline (suh-ledge-a-leen)

Centrally Acting Anticholinergic Drugs
- Benztropine (benz-tro-peen)

27
Q

What is the first line drugs for PD?

A

Dopaimine agonists

28
Q

Mechanism of Action of dopamine agonists

A

cross BBB- directly activate dopamine receptors in striatum

less effective than Levodopa

29
Q

Adverse effects of Dopamine Agonists

A

hallucinations, daytime sleepiness, postural hypotension

reserved for yound patients who tolerate adverse effects better

30
Q

Example of Dopamine Agonists

A

Pramipexole (Pram-a-pex-all)

31
Q

Mechinism of Pramipexole

A

P binds to D2 and D3 dopamine receptors
-binding underlies therapeutic use

32
Q

Therapeutic Use of Pramipexole

A

Used alone in EARLY-STAGE PD
- improve motor performance

Used WITH Levadope in advanced stage
- permits a reduction in Levadopa dosage

33
Q

Adverse Effects of Pramipexole

A

Alone- Gi distruption, weakness, hallucinations

Combined with Levadope- hypotension and dyskinesia

Impulse control disords- gambling, binge eating, hypersexuality

34
Q

Catechol-O-Methyltransferase (COMT) Inhibitor for treatment of PD drug

A

Entacapone (end-tag-a-pon)

35
Q

Mechanism of Entacapone

A

COMT- enzyme degrades dopamine in synamese between neurons

***COMPT INHIBITOR= more dopamine

36
Q

Adverse Effects for Entacapone

A

most adverse effects is increasing levodopa levels = dyskinesia

37
Q

drug interactions of entacapone

A

increased levels of other drugs metabolized by COMT

38
Q

MAO-B Inhibitors for PD drug name

A

Selegiline (suh-ledge-a-leen

39
Q

Mechanism for Selegiline

A

causes irreversible MAO-B inhibition

MAO-B- enzyme inactivates dopamine in striatum

INHIBITION OF MAO-B = increased DA in stratum

40
Q

Selegiline adverse effects

A

High doses can inhibit MAO-A and cause hypertensive crisis

41
Q

Selegiline Drug Interactions

A

interacts with ++ drugs
- check before using

intesnsify levodopa
- dyskinesias, hallucinations, confusion

Opioid drugs will increase opioid adverse effect

Dont combine with SSRI- fatal serotonin syndrome

42
Q

Centrally Acting Anticholinergic Drug for PD

A

Benztropine (benz-tro-peen)

Second -line therapy

43
Q

Mechanism of Benztropine

A

blocks muscarinic receptors in striatum
- increases ACh
- therefore improves balance between D and ACh

44
Q

Therapeutic Use of benztropine

A
  • reduce tremor and regidity
45
Q

Adverse Effects Benztropine

A

blocks muscarinic receptors in periphery

46
Q

Commonly used drugs for NON-MOTOR Symptoms in PD patients

A

Autonomic Symptoms

Erectile dysfunction: viagra

Orthostatic hypotension: increased intake of salt and water

Urinary Incontinence: oxybutynin

Constipation: increase intake of fluids and fiber

HLSC 222- midterm 1 (10 decks)

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