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20 Cards in this Set
- Front
- Back
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Parkinsonism |
*bradykinesia * resting tremor rigidity postural instability freezing |
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Parkinsonism - what neurotransmitter problem |
insufficient DA |
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Parkinsons DISEASE (primary) |
* asymmetric signs * L-DOPA responsiveness bradykinesia resting tremor rigidity |
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Levodopa + carbidopa |
increase central dopamine synthesis
- carbidopa cant cross BBB, only block peripheral L-DOPA > DA conversion |
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bromocryptine
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D2 agonist - for early PD - less fluctuations and dyskinesia
side effects: nausea, vomitting, postural hypotension, high dose leads to psychosis |
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carbergoline |
D2 agonist - for early PD - less fluctuations and dyskinesia
side effects: nausea, vomitting, postural hypotension, high dose leads to psychosis |
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rotigotine |
D2 agonist - for early PD - less fluctuations and dyskinesia
side effects: nausea, vomitting, postural hypotension, high dose leads to psychosis |
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D2 agonist x 3 - for early PD - less fluctuations and dyskinesia
side effects: nausea, vomitting, postural hypotension, high dose leads to psychosis |
bromocryptine carbergoline rotigotine |
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MAO-B |
metabolize DA (c.f. MAO-A metabolize NA, 5HT and DA)
pre-synaptic mitochondrial membrane |
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selegiline |
MAO-B inhibitor (slow DA metabolism)
selegiline is metabolized to methamphetamine > psychosis - metamphetamine reduces dopamine clearing and increase dopamine release (like cocaine) (VTA > DA > nucleus accumbens)
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rasagiline |
MAO-B inhibitor (slow DA metabolism)
well-tolerized |
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COMT |
post-synaptic in CNS liver |
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entacapone |
COMT inhibitor (slow DA metabolism) |
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tolcapone |
COMT inhibitor (slow DA metabolism) |
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benzatropine |
anti-cholingergic
- for drug-induced parkinsonism (patients taking neuroleptics: dopamine blockers) - for early DP - improve tremors - anti-cholinergic side-effects |
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amantadine |
increase dopamine release - an antiviral with parkinsonism property |
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Surgical approach |
deep brains stimulation pallidotomy (GPi) subthalamotomy (STN) thalamotomy
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direct and indirect pathway |
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Huningtons disease |
Cholinergic and GABA neurons of indirect pathway are selectively affected
(reduced indirect pathway)
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Ballism |
Lesion in subthalamic nucleus - often due to vascular lesion
(reduced indirect pathway) |
