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123 Cards in this Set

  • Front
  • Back
pd
slowly progressive degenerative neurological dz
shaky palsy
pd characterized by
tremor
rigidity
bradykinesia
postural instability
distinctive mortor disability
bradykinesia
sluggish neuromuscular responsiveness
pd pathogenesis
neurodegenerative dz assoc
depigmentation of substantia nigra and loss of dopaminergic input tp the basal gangia (extrapyrimidal sys)
basal ganglia
resp for initiating, sequencing and modulating motor activity
dopamine
produced by neurons that project from substantia nigra to neostriatum and globus pallidus
neostriatum
include caudate and putamen
dopamine acts
inhibitory neurotransmitter
lewy bodies
occur in basal ganglia, braun stem, spinal cord and sympathetic ganglia
loss of dopamine-producing neurons in substantia nigra
imbalance between dopamine and acetylcholine
acetylcholine
excitatiry neurotransmitter
neurotransmitters involve in pathophysiology of pd
norepi
serotonin
gaba
primary (idiopathic) pd
classic od or paralysis agitans
hypotheses of neuronal loss in primary pd
absorption of highly potent neurotoxins

exposure to the free radicals
highly potent neurotoxins
carbon monoxide
manganese
solvents
n-methyl-4-phenyl-1,2,3,6-tetrahydropyridine (MPTP)
MPTP
product of improper synthesis of a synthetic heroin-like compd
MAO
dopamine is catabolized by
products of catabolism
hydrogen peroxide
prodxn of free radicals

both toxic to cells
protects cells from damage
enzymes
free radical scavengers
free radical scavengers
vit e and c
destruction of free radicals
caused by either a dec in protective mechanisms or inc in prodxn of dopamine
secondary parkinsonism
caused by drugs incl dopamine antagonist
dopamine antagonist
phenothiazines (chlorpromazine , perphenazine)
butyrophenone (haldol)
reserpine
poisoning by chemicals or toxins
carbon monoxide poisoning
heavy metal poisoning -manganese and mercury
MPTP
infectious causes
encephalitis -viral
syphilis
other causes
arteriosclerosis
degenerative dz of cns -prog supranuclear palsy
metabolis disorder - wilsons dz
pd s/s
tremor
limb rigidity
akinesia or bradykinesia
gait and postural difficulties
changes in menta status
unified parkinsons dz rating scale (updrs)
pill rolling tremor
thumb and forefinger involve
akinesia
difficulty in initiating movements
bradykinesia
slowness in performing common voluntary movements
precursor of dopamine
carb/lev
direct acting dopamine agonist
bromocriptine
pergolide
indirect acting dopamine agonist
amantadine - dec uptake
selegiline - dec metabolism
drug therapy for treating assc symptoms
tricyclic antidepressants
b blkers
antihistamines
tricyclic antidepressants
depression
b blocker
propranolol - high lipophilicity
benzodiazepines
primidone - action tremor
antihistamines
diphenhydramine- mild tremor
dyskinesia/ dystonia
oral facial movmts, grimacing or jerky and writhing movmt of trunk and extremities
3 types of dyskinesia
peak dose
biphasic
off period
peak dose dyskinesia trmt
sustain release prep
dec l dopa dose
add comt inhibitor
add amantadine
perform surgery
biphasic dyskinesia trmt
sustain release prep
dec l dopa
inc dopaminergic dise
symptoms present- comt inhibitor
amantadine
off perior dystonia trmt
dec l dopa dose
inc dopaminergic dose
drug holiday
long term levodopa use results in downregulation of dopamine receptors

allows striatal nigra dopamine rec to be resensitized
2ndary eff of pd incl
cardiovascular eff
gi eff
genitourinary eff
cns eff
cardiovascular eff
orthostatic hypotension
arrhy
gi eff
constipation
hypersalivation
genitourinary eff
inc urinary frequency
impotence
cns eff
hallucinations
depression
psychosis
pd late disabilities
levodopa related disabilities
non-levodopa rel disabilities
levodopa related disabilities
motor fluctuation
dyskinesia
neuropsychiatric toxicity
reduced response
non lec related disabilities
cognitive impairement
instability - falls
gait disturbance, dysphagia speech disturbance
management therapies
motor fluctuation
oxybutynin
urinary urgency
apomorphine
urinary retention
constipation
fiber
peg
tenesmus
clonazepam
apomorphine
hypersalivation
antihistamine
anticholinergic
dysphagia
liquid levodopa
sweating crises
b blkers
anticholinergic agts
daytime sleepiness
selegiline
nightmares
amitriptyline
clonazepam
panic attacks and depression
liq levodopa
amitriptyline
orthostatic hypotension
domperidone
desmopressin
dysphonia
reduce levodopa dosage
speech therapy
pain
amitriptyline
fluvoxamine
anticholinergic agents
used for mild smptoms predominantly tremors
anticholinergic moa
blocks the excitatory neurotranmitter cholinergic influence in the basal ganglia
anticholinergic interaxn
antihistamines
antidepressants
phenothiazines
inc dig levels
haloperidol -schizo inc rxn
levodopa/carbidopa
most effective drug for managing pd
levodopa
converted to dopamine by enzyme dopa decarboxylase
dopa decarboxylase
elevates cns levels of dopamine
levodopa sustain release
designed to release the drug over 4-6 hrs thereby inhibiting variation in plasma conc and dec motor fluctutation "off" time or to omprove overall dose response in pt with adv dz
lev/carb interaxn
antacids
hydantoin
methionine
metoclopramide
false + in coombs test
inc uric acid test
mao inhib
furazolidine
tricyclic antid
food- protein restricted diet
direct acting dopamine agonist - ergot deriv
bromocriptine
pergolide
direct acting dopamine agonist - non ergolines
pramipexole
ropinirole
direct acting dopamine agonist
reduce motor fluctuations
not metabolized by oxidative pathway
do not produce free radical metabolites
direct antioxidative eff
bromocriptine moa
resp for directly stimulating postsynaptic dopamine rec
adjunct to lev therapy
bromocriptine adv eff
1st dose phenomenon
cardiac dysrhythmias
bromocriptine interaxn
antihypertensive drugs
doparmine antagonist
pergolide moa
semisynthetic ergosine deriv
directly stimulating postsynaptic dopamine rec in the nigrostriatal system
pergolide 1000x more potent than
bromocriptine
pergolide inhibits
secretion of prolactin
pergolide use
adjunctive trmt to lev/carb
pergolide adv eff
vent arrhy
card dysrhy
cns eff
gi eff
transient elevationsof aspartate aminotransferase
alanine aminotransferase
alkaline phosphate
pleural thickening
pergolide interaxn
caution with highly protein bound drug
antipsychotic agts (phenothiazines, haldol, metoclopramide)
indirect acting dopamine agonists
selegiline
amantadine
lack of mao in intestinal tract
causes absorption of tyramines => hypertensive crisis
mao a
predominantly found in intestinal tract
mao b
brain
selegiline moa
selective inhibitor of mao b

prevents breakdown of dopamine selectively in the brain
selegiline use
adjunct with lev/carb when pt experience wearing off phenomenon
selegiline adv eff
hypertensive crisis
tyramine containing foods
tyramine containing foods
aged cheese
beer
wine smoke meat
selegeline interaxn
meperidine
fluoxetine - 5 wks must elapse then dc fluoxetine and start selegiline otherwise death
amantadine axn
antiviral agent

inc dopamine levels at postsynaptic rec sites by dec presynaptic reuptake and enhancing dopamine synthesis and release
amantadine adv eff
dermatological eff - livedo reticularis- diffuse rose-color mottling of the skin
amantadine interaxn
anticholinergic drugs
hctz + triamterene
non ergot dopamine agonist
indicated for both early and advanced stages of pd
pramipexole
ropinirole moa
bind to dopamine rec and activate the d2 rec but have little or no affinity to d1 rec
non ergot dopamine agonist
adv eff
pleuropulmonary fibrosis
retoroperitoneal fibrosis
coronary vasocontriction
erythromelalgia
raynauds phenomenon
ropinirole
metabolized by the liver cyp1a2 and 1st pass eff
COMT inhibitors
tolcapone
entacapone
tolcapone moa
selective and reversible inhibitor of comt and used as adjunct to lev/carb therapy
inhibits both centrally and peripherally
comt
main enzyme resp fpr peripheral anc central metabolism of catecholamines incl levodopa
addition of comt
results in the doubling of the elimination t 1/2 of levodopa and inc oral bioavailability of lev
rapid withrdrawal or abrupt reduction of comt dose
hyperpyrexia
confusion symptoms
comt adv eff
liver toxicity
monitor AST AND ALT
2 enzymes involve in the metabolism of catecholamines
MAO
COMT
Tolcapone + non selective MAO =
inhibition of the pathway resp for normal catecholamine metabolism
drugs metabolized by comt system
methyldopa
dobutamine
apomorphine
CYP2C9
Tolcapone has an affinity with

similar to warfarin
entacapone moa
selective and reversible inhibitor of comt and permits additional lev to reach the brain

does not have any anti-parkinson eff of its own
entacapone
acts only peripherally by inhibiting comt
entacapone
improves the duration of "on" time and dec the duration of "off" time
biliary excretion
entacapone
drugs known to interfere with biliary excretion
probenecid
erythromycin
ampicillin
entacapone side eff
dyskinesia
brownish orange urine
entacapone interaxn
drugs that interact with cyp450
globus pallidus internys pallidotomy
a pallidotomy entails the surgical resection of parts of the globus pallidus

improves contralateral dyskinesia
deep brain stimulation
high frequency stimulation that induces functional inhibition of target regions of the brain by implnating an electrode into a target site and connecting the lead to a suncutaneously placed pacemaker
adv of deep brain stimulation
no desctructive lesion is formed
fetal nigral transplantation
implantation of embryonic dopaminergic cells into the denervated striatum to replace degenerated neuronal cells
adv of fetal nigral transplantation
implanted cells all survive and innervation of the striatum is accomplished in an organotypic manner
does not necessitate making a destructive lesion