Parkinsons Disease Flashcards
What are the major differences of the CNS that distinguish it from the peripheral ANS?
- CNS’ circuitry is more complex.
- The CNS contains inhibitory neurons exclusively.
- The CNS has much more types of neurotransmitters.
Which type of channels are the receptors at most synapses in the CNS coupled to?
Most of the receptors in the CNS are coupled to ion channels, enabling transient and rapid action.
What are the two types of action potentials in the CNS?
- EPSP.
- IPSP.
What are the two types of neurotransmitters in the CNS?
- Excitatory neurotransmitters (cause depolarization).
- Inhibitory neurotransmitters (cause hyperpolarization).
Describe how the postsynaptic membrane is depolarized in the CNS.
- Excitatory neurotransmitter binds to its receptor, which is coupled to an ion channel.
- Ion channel opens, and Na+ ions flux in, resulting in the depolarization of the postsynaptic membrane, exciting it.
This process is called EPSP.
Describe how the postsynaptic membrane is hyperpolarized in the CNS.
- Inhibitory neurotransmitter binds to its receptor, which is coupled to an ion channel.
- Ion channel opens, and Cl- ions flux in, K+ ions flux out, resulting in the hyperpolarization of the postsynaptic membrane, inhibiting it.
This process is called IPSP.
What are the two major excitatory neurotransmitters of the CNS?
- Glutamate.
- Acetylcholine.
What are the two major inhibitory neurotransmitters of the CNS?
- Glycine.
- GABA.
Do excitatory and inhibitory neurotransmitters bind to the same receptor?
No, each neurotransmitter binds to its own specific receptor.
Define neurodegenerative diseases.
Diseases characterized by the loss of structure and function of neurons, including their death.
How do most CNS drugs work?
By altering some step in the neurotransmission process.
What are the three most common neurodegenerative diseases?
- Parkinson’s disease.
- Alzheimer’s disease (most prevalent).
- Multiple sclerosis.
Define Parkinsons disease.
A progressive neurological disorder of muscle movement.
Which age group is most likely to develop Parkinson disease?
Most cases involve people over the age of 65.
What are the cardinal symptoms of Parkinson disease?
- Tremors.
- Muscular rigidity.
- Bradykinesia.
- Postural and gait abnormalities.
What causes Parkinson disease?
The actual cause of Parkinson disease is unknown, but it is correlated with the destruction of the dopaminergic neurons in the substantia nigra.
What does the basal ganglia consist of?
The corpus striatum and the substantia nigra.
Which type of neurons degenerate in Parkinson disease patients?
Dopaminergic neurons in the substantia nigra.
Which site of the brain experiences a reduction of dopamine action that result in the symptoms of Parkinson disease?
The corpus striatum.
Which type of neurons predominate the corpus striatum?
Cholinergic neurons.
How is the neostriatum connected to the substantia nigra?
By neurons that secrete GABA at their termini in the substantia nigra.
What is secondary parkinsonism?
Parkinsonian symptoms induced by factors other than actual neuronal degeneration, e.g., drugs.
Which drugs cause secondary parkinsonism? Why?
- Phenothiazines (e.g., prochlorperazine).
- Haloperidol.
These drugs block dopamine receptors in the brain.
What is the strategy of treatment of Parkinson disease?
- Restoring dopamine in the basal ganglia:
- Dopamine replacement therapy: levodopa.
- Dopamine agonists: pergolide, apomorphine, etc. - Antagonizing excitatory cholinergic neurons (antimuscarinic agents).
The ultimate goal is to reestablish the correct dopamine/acetylcholine balance.
Do anti-Parkinson disease drugs cure?
No. They only offer temporary relief from the symptoms of the disorder, but they do not arrest or reverse the neuronal degeneration caused by the disease.
What is Levodopa?
A metabolic precursor of dopamine (i.e., pro-drug) that, unlike dopamine itself, can cross the blood-brain barrier and so it is used as dopamine replacement therapy for patients with Parkinson disease.
How does levodopa work?
Levodopa restores dopaminergic neurotransmission in the corpus striatum by enhancing the synthesis of dopamine in the surviving neurons of the substantia nigra, making it useful in treating early stages of Parkinson disease.
Does levodopa cure Parkinson disease?
No, the relief provided by levodopa is only symptomatic and lasts only while the drug is present in the body.
Why shouldn’t we administer levodopa alone without carbidopa?
When we administer levodopa on its own, about 97% of it gets metabolized into dopamine peripherally, making the amount that actually reaches the brain insufficient to exert a therapeutic effect.
Why don’t we use dopamine itself to manage Parkinson disease directly?
Because dopamine itself doesn’t cross the blood-brain barrier. Levodopa, dopamine’s precursor, is actively transported into the CNS and is converted into dopamine in the brain.
What is Carbidopa?
A peripheral dopa decarboxylase inhibitor.
What is dopa decarboxylase?
An enzyme that converts levodopa into dopamine that exists peripherally and centrally.