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29 Cards in this Set
- Front
- Back
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loss of cholinergic neurons in nucleus basalis of Maynert
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Alzheimers
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loss of striatal projection neurons
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Huntingtons Dx
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loss of Dopaminergic neurons in substantia nigra
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Parkinsons Dx
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4 features of Parkinsons Dx
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bradykinesia
muscular rigidity resting tremor impairment of postural balance "pill rolling tremor" |
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what 2 drugs can block dopamine and cause parkinsonian symptoms?
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halperidol
phenothiazines |
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identify the rate limiting step in dopamine synthesis
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Tyrosine -->(tyrosine hydroxylase)--> L-DOPA
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dopamine precursors
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Levidopa
Carbidopa |
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why do we administer Levidopa and carbidopa together?
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to minimize the side effects by inhibiting metabolism of levidopa in the peripheral tissue and GI tract
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Fow long are L-Dopa and Carbidopa effective for?
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first few years
decline in 3-5th year |
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describe on off fluctuation
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on: initial rise in DA--> tremors
off: decline in L-DOPA--> frozen |
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AE of L-dopa and Carbidopa
Peripheral CNS |
Peripheral:
brown saliva anorexia, N,V hypotension mydriasis CNS: hallucinations dyskinesia mood changes |
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CI for L-Dopa and Carbidopa
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M- MAO inhibitor
P- psychotic patients G- glaucoma A- antipsychosis B- B6 C- cardiac problems |
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2 drugs; inhibitors of DA metabolism
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seligiline
rasagiline |
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seligiline
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inhibits MAO-BBBBBBBB!!!
DA --> X --> metabolism --> methamphetamine and ampetamine (insomnia) |
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rasagiline
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more potent than seligiline
no metabolites formed |
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COMT inhibitors
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Encapone
Tolecapone |
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COMT used to convert ______ --> _______.
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L-Dopa ---> O-3methyldopa
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AE of what drug:
Fulminationg hepatic necrosis |
Tolcapone
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Contraindications for tolcaptone
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hx rhabdomyolysis
hyperpyrexia ** crosses BBB** |
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Dopamine receptor agonists
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bromocriptine
apomorphine pramipexole ropinirole rotigotine |
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AE: Pulmonary and retroperitoneal fibrosis
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bromocriptine
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CI for Bromocriptine
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psych illness
hx of MI vascular disease peptic ulcers |
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identify D2 agonists
identify D3 agonists |
D2- Bromocriptine
D3- Apomorphine Pramipexole Ropinorole Rotigotine |
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AE of D3 agonists
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Vivid Dreams and hallucinations
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identify 5 key points about Dopamine Receptor agonists
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1.lasts longer
2.doesnt need dopa decarboxylase to convert L-dopa --> dopamine 3. doesnt compete for BBB transport 4. less AE 5. allieviates symptoms in L-dopa |
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used in acute management of parkinsons
also emetic |
apomorphine
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depends on good renal function
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pramipexole
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inhibits CYP1A2
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ropinirole
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transdermal application
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rotigotine
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