Parkinsons Flashcards
Non motor effects of parkinsons
cognitive decline, affective disorders, sleep disorders, personality changes, sensory complaints/pain
What are the cardinal signs/symptoms of Parkinson
Bradykinesia, muscular rigidity, resting tremor, postural instability
Pathophysiology of Parkinson’s
Degeneration/loss of dopaminergic neurons in substantia nigra that project to striatum.
Describe activity of cholinergic pathways in basal ganglia in Parkinsons
Loss of dopaminergic input into striatum is accompanied by increased activity of the cholinergic pathways in the basal ganglia
Pathophysiology of Parkinson
Alpha synuclein accumulation, formation of Lewy bodies, increased production of free radicals.
Why L-DOPA, not dopamine for treatment of Parkinsons
Straight Dopamine does not cross BBB. Give L-DOPA, a dopamine precurson, instead
What is Carbidopa?
Inhibitor of dopa decarboxylase in the periphery, so that less L-DOPA metabolized, increasing the amount of L dopa reaching the brain. Administer simultaneously with L Dopa
How do you combat response fluctuations
Go on a “drug holiday”
Adverse effects of L dopa
GI disturbances, cardiovascular problems, behavioral disturbances
L Dopa drug interactions
Pyridoxine, MAO-A inhibitors, antipsychotics, protein rich meals, anti cholinergics
Name three dopamine receptor agonists
Pramipexole, Ropinirole, Apomorphine
L-DOPA degradation blockers
MAO-B inhibitors including Rasagiline, Selegiline
L-Dopa degradation blocker
Catechol O Methyltransferase (COMT) Inhibitors include Entacapone and Tolcapone
Amantadine
Increases dopamine release. Antiviral agent with antiparkinsonism properties. Short duration of action and short lived therapeutic effectiveness.
Adverse effect of amantadine
Livedo reticularis- blotchy reddened pattern, usually on the legs
