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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

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
How does Levodop work alone vs with Caribidopa/Entacapone?
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
What drugs are used to treat Motor Symptoms
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
What is the first line drugs for PD?
Dopaimine agonists
28
Mechanism of Action of dopamine agonists
cross BBB- directly activate dopamine receptors in striatum less effective than Levodopa
29
Adverse effects of Dopamine Agonists
hallucinations, daytime sleepiness, postural hypotension reserved for yound patients who tolerate adverse effects better
30
Example of Dopamine Agonists
Pramipexole (Pram-a-pex-all)
31
Mechinism of Pramipexole
P binds to D2 and D3 dopamine receptors -binding underlies therapeutic use
32
Therapeutic Use of Pramipexole
Used alone in EARLY-STAGE PD - improve motor performance Used WITH Levadope in advanced stage - permits a reduction in Levadopa dosage
33
Adverse Effects of Pramipexole
Alone- Gi distruption, weakness, hallucinations Combined with Levadope- hypotension and dyskinesia Impulse control disords- gambling, binge eating, hypersexuality
34
Catechol-O-Methyltransferase (COMT) Inhibitor for treatment of PD drug
Entacapone (end-tag-a-pon)
35
Mechanism of Entacapone
COMT- enzyme degrades dopamine in synamese between neurons ***COMPT INHIBITOR= more dopamine
36
Adverse Effects for Entacapone
most adverse effects is increasing levodopa levels = dyskinesia
37
drug interactions of entacapone
increased levels of other drugs metabolized by COMT
38
MAO-B Inhibitors for PD drug name
Selegiline (suh-ledge-a-leen
39
Mechanism for Selegiline
causes irreversible MAO-B inhibition MAO-B- enzyme inactivates dopamine in striatum INHIBITION OF MAO-B = increased DA in stratum
40
Selegiline adverse effects
High doses can inhibit MAO-A and cause hypertensive crisis
41
Selegiline Drug Interactions
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
Centrally Acting Anticholinergic Drug for PD
Benztropine (benz-tro-peen) Second -line therapy
43
Mechanism of Benztropine
blocks muscarinic receptors in striatum - increases ACh - therefore improves balance between D and ACh
44
Therapeutic Use of benztropine
- reduce tremor and regidity
45
Adverse Effects Benztropine
blocks muscarinic receptors in periphery
46
Commonly used drugs for NON-MOTOR Symptoms in PD patients
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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