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28 Cards in this Set

  • Front
  • Back
What transmitters are released via volume transmission?
Dopamine and catecholamines, Vt is associated with the raising of extracellular levels
By what mechanism are Glutamate and Gaba released?
Within the synapse (classical neurotransmission)
What is the source of dopaminergic input to the basal ganglia?
Nirgal-striatal pathway. Cell bodis in the substantia nigra project through the medial forebrain bundle (MFB) to the basal ganglia
What is the basal ganglia comprised of?
1. The striatum which consists of the caudate and the putamen
2. The internal/external Globus Pallidus
What neural pathway is responsible for motor movements?
Pyramidal/corticospinal tract
What is the extrapyramidal system?
Pathway including basal ganglia, recticular formation, vestibular nuclei and red nucleis responsible for starting and stopping movement and maintenance of tone and posture
What are pathways important in modification/correction of motor movement?
1. Extrapyramidal system
2. Cerebellar output- coordinates msls of skilled movement
What compensatory mechanisms occur in Parkinsons?
1. Increased synthesis of DA
2. Increased synaptic release of DA
3. Upregulation of DA receptors when lesion is > then 90%
What is Sinemet?
Treatment for Parkinsons. L-Dopa and carbidopa (peripheral aromatic amino acid decarboxylase Inhibitor that cannot cross BBB)
Discuss side effects of L-dopa.
1. anorexia, nausea and vomitting
2. Also some tacchycardia, hypertension
What are some dietary considerations neccessary for utilization of L-dopa?
1. Foods high in protein may interfere with L-Dopa absorption
2. Take 30 min before eating
What are problems associated with L-dopa/sinemet use?
1. Short half-life
2. Cab cause hypertensive crisis if given to patient on MAO or MAO-I
3. On-off phenomenon after 5 years
4. Peak dose dyskinesia
Discuss the use of Bromocriptine and Pergolide.
Ergot derivatives and Dopamine agonists typically used in conjunction with L-Dopa to decrease dosage and concomitatnt bouts of dyskinesia. Bromo-D2/D1 ag/antagonist and Pergolide is a DI and D2 agonist.
What is the advantage to using Bromocriptine and Pergolide to L-dopa?
No dependence on dying neurons, bypass presynaptic part to directly excite D2...etc. Disadvantage is that there is no regulation of release.
Discuss the action and cliniclal utility of Ropinirole and Paramipexole.
Newer D3>D2 dopamine agonists useful as monodrug therapy.
used to reduce off time when used with L-dopa
Discuss the utility of apomorphine.
An emetic inhalant....cannot be taken orally
2. Rapid onste and short duration for emergency use in "off" pahse situations.
Discuss the clinical utility of COMT-Inhibitors.
Used to block metabolism of L-dopa in the periphery by Catechol-O-Methyl Transferase after Aromatic Amino Acid Decarboxylase is blocked by Carbidopa in Sinemet. Allows decrease in dosage and side efx
Name two COMT-Inhibitors? the market and enacapone which turns urine bright orange.
Characterize the utilization and classification of Amantidine.
Amantidine is an antivral agens which enhances DA releause and inhibits its uptake...useful as a first line therapy
For what type of patient are anticholinergics typically used?
Young patients...they have too many side efx
What is the recommendation for treatment of Parkinsons?
1. Initiate with amantadine, ropinirole or pramipexole
2. Low does L-dopa
3. Combine with COMT or DA agonists
What is the treatment for tremor?
1. Beta-blockers- propanolol, indorol
2. Anticonvulsants- gabapentin, topiramate
3. Benzodiazepines- Alprazolam
Characterize Huntingtons DZ.
Imbalance between Ach, GABA, and dopamine secondary to destruction of Gabaergic/cholinergic neurons in the striatum resulting in slightly increased to normal dopamine...chorea and dementia
SSRI for depression- fluoxetine
How is Wilsons Dz treated?
Pencillamine- copper chelating agent or ZInc acetate- interferes with copper absorption
True/False. Chorea responds to anticholinergics.
False. But other hyperkinetic disorders do.
Give an example of a dopamine depleting drug.
Reserprine or tetrabenazine
What is the characteristic treatment for TIC?
Haloperidol, DA receptor blocker (neuroleptic) can cause tardive dyskinesia
For what dz are their good pharmalogical treatments? Poor?
1. Wilson
2. Parkisnons
3. Focal dystonia

1. Huntington
2. Tremor