Reading...
Play button
Play button
Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
56 Cards in this Set
- Front
- Back
|
What is parkinsons?
|
this is degeneration of dopamine pathways from substantia nigra along the nigrostriatal pathway
|
|
|
How much brain is lost before symptoms occur?
|
about 70% of the striatal DA is lost
|
|
|
What are the primary symptoms of parkinsons?
|
stiffness, tremor
bradykinesia difficult balance difficult walking |
|
|
What is the pathophysiology of parkinsons disease?
|
degeneration of DA neurons in pars compacta of substantia nigra. This leads to overactivity in the *indirect pathway*. leading to increased glutamate to subthalamic nucleus (an inhibitory guy)-> more GABA to thalamus itself
|
|
|
How do DA neurons affect the striatum output?
|
DA inhibits GABA output from stiratum
|
|
|
how do AcH neurons affect Striatum output?
|
Ach increases the GABA output from striatum
|
|
|
How does L-Dopa work?
|
this is the precursor to DA, it is used to increase DA levels in the brain (to inhibit GABA output from striatum)
|
|
|
How much L-Dopa is given?
|
this requires a large dose of L dopa, because it is metabolized in thegut by COMT
|
|
|
What does Dopa/Carbidopa (Sinemet) do?
|
Carbidopa is a dopa decarboxylase inhibitor that doesnt enter the brain- so this allows more L dopa to enter the brain
|
|
|
Does sinemet alter the course of parkinsons disease?
|
no it does not, it only reduces symptoms for a couple years before it loses effect
|
|
|
What is Sinemet best at treating in parkinsons?
|
bradykinesia
|
|
|
What are the GI effects of Sinemet?
|
these will be nausea and vomiting, but side effects are low compared to L dopa alone
|
|
|
What are the Cardiovascular side effects of Sinemet?
|
possible arrythmias
hypertension |
|
|
What are the movement side effects of Sinemet?
|
you get dyskinesias over time
|
|
|
What are the behavior side effects of Sinemet?
|
depression
psychosis- treated with atypical antipsychotics |
|
|
What is the On-Off phenomenon of L-Dopa?
|
this is alternating periods of akinesia (off) followed by improved mobility with dyskineas (on periods)
|
|
|
How is L-Dopa discontinued?
|
this is done gradually
may cause akenesia or neuroleptic malignant syndrome |
|
|
What is the memonic for neuroleptic malignant syndrome?
|
F- fever
E- encephalopathy V- vitals unstable E- elevated CPK enzyme R- rigid muscles |
|
|
How do MAOI's affect L-Dopa?
|
these can produce hypertensive crisis together
|
|
|
How does Vitamin B6 (pyridoxine) affect L dopa?
|
this increases the peripheral metabolism of L dopa
|
|
|
What are the Contraindications of L-Dopa?
|
Psychosis*
closed-angle glaucoma cardiac disease peptic ulcer malignant melanoma |
|
|
What type of drug is Selegiline (Deprenyl)?
|
this as an MAOI against MAO-B
|
|
|
Where is MAO-B located?
|
in the striatum
|
|
|
How does Selegiline (Deprenyl) work?
|
this reduces metabolism of DA by inhibiting MAO-B in the striatum
|
|
|
How does Selegiline (deprenyl) affect free radicals?
|
this decreases them, because MAO-B creates them when breaking down DA
|
|
|
What do you NOT combine with Selegiline (deprenyl)?
|
Meperidine (demerol)
|
|
|
What does Tolcapone (Tasmar) do?
|
this is a COMT inhibitor
|
|
|
What is the prototype for dopamine receptor agonists?
|
Bromocriptine
|
|
|
How does Bromocriptine (parlodel) effect change over time?
|
its effectiveness does not change over the course of parkinsons
|
|
|
How does Bromocriptine (parlodel) affect prolactin levels?
|
this decreases the release of prolactin
|
|
|
What are the GI effects of Bromocriptine (parlodel)?
|
anorexia, nausea, vomiting
|
|
|
What are the cardiovascular effects of Bromocriptine (parlodel)?
|
postural hypotension
cardic arryhtmias |
|
|
can Bromocriptine (parlodel) cause dyskinesia?
|
yes it can
|
|
|
What drug causes Erythromelaglia?
|
Bromocriptine (parlodel).
this is red, tender, swollen feet due to vasospasm |
|
|
What kind of drug is Pramipexole (mirapex)
|
this is a dopamine receptor agonist like Bromocriptine (parlodel)
|
|
|
What does Pramipexole (Mirapex) treat?
|
this treats parkinsons disease
|
|
|
What does Ropinirole (requip) treat?
|
this treats parkinsons disease
|
|
|
What does Apomorphine (Apokyn) treat?
|
this treats off-period akinesia in parkinsons treatments
|
|
|
How is Apomorphine (apokyn) given?
|
this is a subcue injection
|
|
|
What is amantadine (symmetrel) used to treat?
|
this is an antiviral drug thats being used to treat parkinsons! neat!
|
|
|
What are the side effects of Amantadine (symmetrel)?
|
toxic psychosis
convulsions spotting of skin edema |
|
|
What kind of drug is Benztorpine (Cogentin)
|
this is an anticholinergic drug
|
|
|
What kind of drug is Biperiden (akineton)
|
this is an anticholinergic drug
|
|
|
How does Benztropine (Cogentin) affect parkinsons symptoms?
|
this relieves rigidity, tremor, and drooling
does NOT help bradykinesia |
|
|
What two drugs treating huntingtons disease?
|
Tetrabenazine, and reserpine
|
|
|
What is the best drug for Tourettes syndrome?
|
Haloperidol
|
|
|
What are the risk factors for Alzheimers?
|
Being old
family history being a woman low education |
|
|
What is the hallmark destruction of the brain in Alzheimers disease?
|
degeneration of cholinergic neurons in the nucleus basalis of Meynert, which projects to the cerebral cortex and hippocampus
|
|
|
What NT does Alzheimers effect?**
|
ACh is reduced by up to 90%
|
|
|
What type of drugs treat alzheimers?
|
cholinesterase inhibitors
|
|
|
What kind of drug is Tacrine (Cognex)
|
this is a cholinestease inhibitor used in alzheimers
|
|
|
What kind of drug is Rivastigmine (exelon)
|
this is a cholinesterase inhibitor
|
|
|
What is the major adverse effect of Tacrine (Cognex)
|
this causes liver toxicity in up to HALF of people
|
|
|
How does memantine (Ebixa) work?
|
this is an antagonist of NMDA receptors
blocks sustained activation of NMDA receptors by glutamate |
|
|
What does memantine (ebixa) treat?
|
this treats severe Alzheimers disease
|
|
|
What are the side effects of Mamantine (Ebixa)
|
this enhances the side effects of L-dopa
agitation urinary incontinence/ infection insomnia diarrhea |
