parkinsons drugs

Question 1

parkinsons

Answer 1

1) dopaminergic neuron degeneration
2) paralysis agitans, shaking palsy
3) decreased number of neurons in the substantia nigra

Question 2

alzheimers

Answer 2

1) neurons in brain degenerate

Question 3

parkinsons etiology

Answer 3

1) SNCA gene regulates synaptic vesicles in presynaptic terminals
2) mutations will cause misfolding, leading to death of dopaminergic neurons in substantia nigra
3)AD or AR

Question 4

parkinsonism

Answer 4

symptoms which may occur due to anti-dopaminergic drugs (anti-psychotics)

Question 5

motor pathways

Answer 5

1) pyramidal tract (A) controls voluntary movements
2) extrapyamidal tract (B)
- posture, balance, tonus, smooths fine voluntary movements

Question 6

dopamine transporter scan

Answer 6

1) DAT
2) activity can be detected
- red is fast, green is slow

Question 7

diagnosis

Answer 7

1) premotor
- reduced smell, speech
- impulsive behavior
- changes of thinking
- sleep disturbance
- constipation
2) motor
- resting tremor
- postural rigidity
- postural instability

Question 8

nigrostriatal pathway in norma and PD

Answer 8

1) dopaminergic neurons inhibit GABAergic neurons
- whereas cholinergic and glutaminergic neurons produce excitatory effects
2) in PD< abnormally high output by GABAergic efferents
- increased inhibition of thalamus and reduced excitatory input to motor cortex

Question 9

pharmacotherapy of PD

Answer 9

1) redress DA levels
- supply precursor for DA (levodopa)
- stimulate DA receptors
2) reduce cholinergic activity in striatum

Question 10

levodopa

Answer 10

1) precursor of DA
- useful in 2/3 of PD for 2-3 years
2) carbadopa makes L-dopa more stable in blood

Question 11

l-dopa side effects

Answer 11

1) overdose cause schizophrenia like symptoms
2) uncontrolled movements (on-off effects)
3) anorexia, nausea, vomiting
5) tachycardia, postural hypotension

Question 12

carbidopa

Answer 12

1) adjunct with L-dopa
2) allows 4-5 fold lower dose of L-dopa, reduce side effects

Question 13

COMT inhibitors

Answer 13

1) COMT inactivates dopamine
2) tolcapone and entacapone will inhibit COMT
3) used in combo with l-dopa

Question 14

dopamine receptor agonists

Answer 14

1) activate the dopamine receptors in striatum directly
2) apomorphine, bromocriptine, amantadine

Question 15

MAO-B inhibitors

Answer 15

1) rasagiline, salagiline
2) inhibit deactivation of dopamine

Question 16

summary of adverse reactions

Answer 16

1) know the reactions

Question 17

experimental therapy

Answer 17

1) deep brain stimulation
-globus pallidus and subthalamic nucleus
- like a pacemaker
2) implantation of dopaminergic neurons
3) gene therapy

Question 18

drugs to remember

Answer 18

1) know them