Neuro: Drugs For Parkinson's And Spastic Diseases

Front 1

What effect does dopamine has on the three different systems (i.e. mesocortical, tuberoinfundibular, and nigrostriatal)?

Back 1

- Mesocortical: executive function, low DA results in schizophrenia.

- tuberoinfundibular: controls release of prolactin.

- nigrostriatal: intergrate sensory with movement, feeling and emotion, initiate movements.

Front 2

What does the imbalance of ACh and DA cause?

Back 2

High level of nonspecific motor output and decrease in voluntary motor output.

Front 3

What are the two reasons why you only see symptoms with Parkinson's when there is over 80% terminal depletion?

Back 3

1. Receptor supersensitivity: loss of neuron results in better coupling of DA to receptors and increasing in the number of DA receptors, thus mask the deficit.

2. Increase in firing rate of the remaining neurons: negative feedback loop from SNc to SNr to disinhibit inhibition.

Front 4

What are some classes of drugs that treat Parkinson's? (6)

Back 4

1. Anticholinergics: Benztropine, Trihexaphenidyl, Diphenhydramine.
2. Direct DA: L-Dopa, Carbidopa.
3. Direct DA receptor agonist: Bromocriptine, Ropinirole, Piramipexole.
4. MAO-B inhibitor: Selegiline, Rosagiline.
5. COMT inhibitor: Tolcapone.
6. Amantadine

Front 5

When is anticholinergics usually used in treating Parkinson's?

Back 5

When disorder is associated with schizophrenics, or DA is contraindicated (low angle glaucoma, prostatic hypertrophy).

Front 6

Which drug when injected, can treat acute DA blocker induced dystonia such as torticholis and ocular gyric crisis?

Back 6

Diphenhydramine

Front 7

What is the key consideration of L-Dopa dosage in treating Parkinson's?

Back 7

Must start out low and must be titrated to the individual patient.

Front 8

What is the rate limiting enzyme in DA synthesis in the body?

Back 8

Tyrosine hydroylase

Front 9

What are some side effects of L-Dopa?

Back 9

- initial nausea, vomit
- hypotension
- cardiac arrythmia
- sensory disturbance
- affective disturbance: schizophrenia, paranoia
- increased sexual activity
- dystonia: facial tics, grimace, rocking motions

Front 10

What is the function of Carbidopa?

Back 10

inhibit peripheral conversion from L-DOPA to DA.

Front 11

What are some drug interactions with L-DOPA/Carbidopa?

Back 11

- B6(pyridoxine): increase the activity of AAAD in the periphery.
- antipsychotics: DA blockers
- nonspecific MAO inhibitors: hypertensive crisis.
- mutual enhancement effects between L-DOPA and anticholinergics.

Front 12

Why should pyridoxine not be used with L-dopa/Carbidopa?

Back 12

Pyridoxine(B6) increases the conversion from L-DOPA to DA in the periphery, thus limiting the amount of L-DOPA into the CNS.

Front 13

Why is nonspecific MAO inhibitor not used with L-dopa/Carbidopa?

Back 13

Will cause hypertensive crisis.

Front 14

What is Amantadine used for?

Back 14

- prophylactic for A2 influenza
- addon drug for Parkinsons': weakly block NMDA glutamate receptors.

Front 15

What are some dopamine receptor agonists? and which specific receptor do they act on?

Back 15

- Bromocriptine: D2 agonist
- Ropinirole: D3 agoinst
- Pramipexole: D3 ad D4 agonist

Front 16

Which of the following will cause sedation?
A. Bromocriptine
B. Ropinirole
C. Pramipexole

Back 16

C. Pramipexole is also an alpha2 agonist which lowers NE release, thus leads to sedation.

Front 17

Which of the following will cause less dystonia side effects?
A. Bromocriptine
B. Ropinirole
C. Pramipexole

Back 17

B. Ropinirole has less binding affinity to D2 and very little affinity to D1, thus do not cause dystonia (an effect of D1 and D2 agonist).

Front 18

MAO-A inhibitor treats ____ whereas MAO-B inhibitor treats ____.

Back 18

MAO-A inhibitor treats depression whereas MAO-B inhibitor treats Parkinson's.

MAO-A: degrades NE and Serotonine.
MAO-B: degrade DA only.

Front 19

What are the two MAO-B inhibitors, and what are their differences?

Back 19

- selegiline (deprenyl): reversible, metabolized to amphetamine which leads to NE and DA release, causing insomnia and jitteriness especially in elderly.
- rosagiline: irreversible, not metabolized to amphetamine.

Front 20

Which of the following also treats restless leg syndrome?
A. Bromocriptine
B. Ropinirole
C. Pramipexole

Back 20

B. Less dystonia.

Front 21

Which class of drug can be used as adjunctive to increase the "on" time without causing dystonia?

Back 21

Direct DA receptor agonists, especially Ropinirole.

Front 22

Name one COMT inhibitor.

Back 22

Tolcapone: must avoid nonspecific MAO inhibitors, will potentiate L-DOPA side effects such as nausea, anorexia, diarrhea, hallucinations(rare).

Front 23

D2 dopamine receptors are ____ linked to adenylate cyclase whereas D1 dopamine receptors are ____ linked to adenylate cyclase. (positively/negatively)

Back 23

D2 dopamine receptors are negatively linked to adenylate cyclase whereas D1 dopamine receptors are positively linked to adenylate cyclase.

Front 24

What can be used when L-DOPA can no longer be subdivided into more frequent daily doses ("on-off" phenomenon)?

Back 24

- direct agonists
- MAO-B inhibitors or COMT inhibitors
- anticholinergics

Front 25

What are some potential treatments for Parkinson's underway?

Back 25

- transplanted fetal tissue into CNS
- Pallidotomy: only reduces L-DOPA induced dyskinesia.
- Deep brain stimulation
- A2A receptor antagonist(caffeine): decrease GABA neuron firing.
- Coenzyme Q-10: improves mitochondrial electron chain processing for energy production, leading to more firing.

Front 26

Why are coffee drinkers less likely to develop Parkinson's?

Back 26

Coffee blocks A2A receptors which modulates GABA neuronal firing.

Front 27

Which antispastic drugs can be used to treat sprains or strains?

Back 27

Cyclobenzaprine
Metaxolone

Front 28

What side effects do cyclobenzaprine and metaxolone have?

Back 28

Anticholinergic side effects: ataxia, dry mouth, pupil dilation, double vision, urinary retention.

Front 29

Name one GABA-A and GABA-B agonist. What are their mechanisms of action?

Back 29

GABA-A agonist: Benzodiazapine

GABA-B agonist: Baclofen
- increase K+ conduction at nerve terminals which then leads to decrease in Ca2+ influx after AP, thus there is less neurotransmitter released to cause muscle contraction.

Front 30

Name two classes od drugs that can be used to treat spinal cord injury and multiple sclerosis.

Back 30

1. GABA-B agonist: Baclofen
2. Alpha2 agonist: Tizanidine

Front 31

Which drug can be used to treat ALS?

Back 31

Baclofen: GABA-B agonist

Front 32

Which drug can be used to treat muscle spasm related to stroke?

Back 32

Tizanidine

Front 33

What side effects does Baclofen has?

Back 33

Sedation, weakness, lassitude, confusion.

Overdose: withdrawal syndrome of anxiety and hallucinations.

Front 34

What side effects does Tizanidine has?

Back 34

Sedation, dry mouth, dizziness.

Front 35

Which antispastic drug has wide uses including muscle trauma?

Back 35

Benzodiazapine (GABA-A agonist) when used in higher dose than antianxiety.

Front 36

Which drug has direct muscle aciton?
A. Cyclobenzaprine
B. Benzodiazapine
C. Baclofen
D. Tizanidine
E. Dantrolene

Back 36

E: decreases Ca2+ from sarcoplamsmic reticulum.

Side effects: muscle weakness, fatigue, dizziness, hepatotoxicity.

Front 37

Which drug can be used to treat muscle spasm related to stroke?

Back 37

Tizanidine

Front 38

What side effects does Baclofen has?

Back 38

Sedation, weakness, lassitude, confusion.

Overdose: withdrawal syndrome of anxiety and hallucinations.

Front 39

What side effects does Tizanidine has?

Back 39

Sedation, dry mouth, dizziness.

Front 40

Which antispastic drug has wide uses including muscle trauma?

Back 40

Benzodiazapine (GABA-A agonist) when used in higher dose than antianxiety.

Front 41

Which drug has direct muscle aciton?
A. Cyclobenzaprine
B. Benzodiazapine
C. Baclofen
D. Tizanidine
E. Dantrolene

Back 41

E: decreases Ca2+ from sarcoplamsmic reticulum.

Side effects: muscle weakness, fatigue, dizziness, hepatotoxicity.

Front 42

Which of the following drug has potential hepatoxicity?
A. Cyclobenzaprine
B. Benzodiazapine
C. Baclofen
D. Tizanidine
E. Dantrolene

Back 42

E.

Front 43

Which of the following is an alpha2 agonist at the bouton?
A. Cyclobenzaprine
B. Benzodiazapine
C. Baclofen
D. Tizanidine
E. Dantrolene

Back 43

D.

Front 44

Which of the following antispastic drug can also treat mnalignant hyperthermia and neuroplegic malignant syndrome?
A. Cyclobenzaprine
B. Benzodiazapine
C. Baclofen
D. Tizanidine
E. Dantrolene

Back 44

E.

Front 45

Which class of drugs can not be used in combinaiton with MAO-B inhibitors?

Back 45

Merpiridine and antidepressants: wil cause serotonine(hyperactivity) syndrome.

Front 46

What drugs can cause medication induced Parkinsonism?

Back 46

1. antipyschotics(DA antagonist)
2. MPTP(opiod containminants): neurotoxin to substantia niagra.

Front 47

Which drug can be used to treat MPTP induced Parkinsonism?

Back 47

MAO-B inhobitors: selegiline or rasagiline.