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Kirstys Flashcards > Parkinsons 2 > Flashcards

Parkinsons 2 Flashcards

1
Q

What does the loss of dopamine cause?

A

Alters the output of the basal ganglia circulitry resulting in changed motor control

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2
Q

How is dopamine degraded?

A

DA –(MAO)–> DOPAC –(COMT)–HVA

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3
Q

How is dopamine synthesised?

A

Tyrosine –(tyrosine hydroxylase)–> DOPA –(Dopa decarboxylase)-> Dopamine

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4
Q

What is ADME for L-DOPA?

A
  1. Absorbed well by duodenum and jejenum by neuronal AA transporters
  2. In GI/liver metabolised greatly by DDC to dopamine and degraded by MAO
  3. In systemic circulation DDC converts and COMT degrades
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5
Q

What is the blood brain barrier made up of?

What transporters are used to access BBB

A
  • Smooth muscle cells, pericytes, endothelial cells

Large AA LAt1 transporter or SLC7A5 transporters used to enter BBB

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6
Q

What effects does L-DOPA have?

A
  • Smooth, faster more controlled movements
  • Tremor alleviated to lesser degree
  • Improvement in initating and stopping movement
  • speach
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7
Q

SIde effects of LDOPA

A
  • Nausea
  • Vomitting
  • Postural hypotension
  • Dyskinesia
  • Pyshiatric disturbances
  • Coloured urine
  • GI bleeding
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8
Q

How can side effects of L-dopa be reduced?

Examples

A

L-DOPA + Peripheral DOPA decarboxylase inhibitors (DDCI)

Carbidopa

Benserazide

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9
Q

ADME for DDCI and LDOPA

A
  1. Absorbed by AA transporters in jejudenum and duodenum
  2. Less Ldopa converted by DDC in liver/GI
  3. Less Ldopa converted to DDC in systemic/ blood
  4. More LDopa in brain
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10
Q

Why should Ldopa not be taken with a large meals?

A

Competition between AA from food and Ldopa for AA transporter in liver

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11
Q

What dose should be given for DDCI and LDopa?

A

depends on indivdual and extend of disease progression

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12
Q

What first line treatments are available for people with parkinsons?

A
  1. L-Dopa and peripheral DDCI
  2. Oral or transdermla dopamine agonist
  3. MAO-B inhibitors
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13
Q

What second line treatments are available for people with parkinsons?

A
  1. B-adrenergic antagonist : PD with postural tremor
  2. amantadine
  3. Anticholinergics: for young people with severe tremors
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14
Q

What drug interactions occur with L-dopa?

A
  • Anaesthetics: risk of arrhythmias
  • Anti-depressants: hypertensive crisis
  • Axiolytics/ hypnotics: antagonism with diazepam
  • Antipsychotics: antagonism
  • Vit B6: Antagonism except when given with DCI
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15
Q

What are side effects of dopamine agonists?

A
  • Excessive day time sleepiness
  • peripheral odema
  • hallucinations and confusion
  • Nausea and vomitting - use doperidone
  • dopamine dysregulation syndrome
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16
Q

Who should ergot dopamine agonists not be used in?

What tests are required?

A

People with heart problems or people with serosal fibrosis

ECG, Blood tests, Radiological

17
Q

What do antimuscularanics do in the treatment of parkinsons?

A
  • Less effective than L-dopa
  • Reduce tremor but no effect on slowness of movement
  • Treatment of drug-induced parkinsons symptoms (antipyshotics)
18
Q

What are side effects of antimusclarinics?

A
  • Peripheral: dry mouth, blurred vision, constipation, urine retention
  • Centeral - confusions, hallucinations, excitment, euphoria
19
Q

What are the long term problems of people with PD?

A
  • progessive decline in efficscy of drug treatment - desensitisation to dopamine
  • Fluctuations in motor performance - involuntary movements. on/ off effect
20
Q

What are the long term treatments of parkinsons disease?

A
  • Manipulation of drug therpay
  • More invasive drug treatments: apomorphine infusion/ intraduodenal levodopa
  • neurosurgery and deep brain stimulation
21
Q

What should be used in the treatment of motor complications in patients with advanced PD?

A
  • Oral or transdermal agonists, non-ergot agonists preferred to ergot
  • MAO-B inhibitors
  • COMT inhibitors - reduces ‘fff’ time
22
Q

What do MAO-B inhibitors do?

examples

A

reduces dopamine breakdown

selegiline

23
Q

What are side effects of selegiline

A

hallucinations, insomnia, avoid sudden withdrawl

24
Q

When are comt inhibitors used? what are the side effects?

A

In later disease progessive and used with L-dopa

dyskinesia, aneamia, urine disorder

25
Q

What other drugs are used and what do they do?

A
  • Amantadine: causes dopamine release and inhbits reuptake
  • apomorphine - injection only. potent D1/2 agonist. Treats off period

Kirstys Flashcards (116 decks)

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