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32 Cards in this Set
- Front
- Back
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what is parkinson's disease-PD
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is a chronic, progressive, degenerative disorder affecting the dopamine-producing neurons in the brain.
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what are related CNS diseases to PD
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myasthenia gravis, dementia, and Alzheimer’s disease.
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what is the cause of PD
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Imbalance in two neurotransmitters – dopamine (DA) and acetylcholine (ACh) in the area of the brain called the basal ganglia.
Imbalance caused by failure of the nerve terminals in the substantia nigra to produce the essential neurotransmitter dopamine. Dopamine inhibits, ACh excites the neurotransmitter Symptoms appear when 80% of the dopamine store in the substantia nigra has been depeleted |
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PD affects who
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at least 1 million americans, most between 45-65, occurs in more males than females
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test used to DX PD
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MRI,CT,PET, and IV injection with deoyglucose adn radioactive fluorine
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what are the symptoms of PD
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bradykinesia-slow movement\
Rigidity- resistant to passive movement tremor- thumb against the forefiner postural- falling, unstable gait and may stop walking |
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what is dyskinesia
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difficulty performing voluntary movements.
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what is chorea
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irregular, spasmodic, involuntary movements of the limbs and facial muscles
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what is dystonia
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abnormal muscle tone
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what is the TX of PD
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full explaination, PT, OT, and speech thearpy, drug thearpy is aimed at levels of dopamine
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what is huntingdon's chorea
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Involuntary writhing, ballistic, or dance like movements
Gradually worsens – emotional and behavioral disturbances/dementia Inherited gene Rx – Haldol |
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what is monomine oxidase inhibitor thearpy
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First used to treat depression
Major side effect interact with tyramine-containing foods such as cheese, red wine, beer, and yogurt. “Cheese effect” Results in severe hypertension Do NOT use Demerol with these agents – causes serotonin syndrome. Causes fatal hypertensive episodes. Most common selegiline (Eldepryl) |
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what parts of the body do MAOIs effect
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liver, kindney, stomach, intestinal wall, and brain
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what is the primary role of MAOIs
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is the breakdown of catecholamines such as dopamine
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when is the drug selegiline used
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when the pt's response to levodopa is fluctuating. it is a prophylactic drug to delay pt's reduced response to levodopa, these can delay serious debilitating PD for 9-18 years
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what are the side effects of selegiline
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mild and constant nausea, lightheadedness, dizziness, abdominal pain, insomnia, confusion, and dry mouth
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what is Dopaminergic therapy
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Provide exogenous replacement of the lost dopamine or enhance the function of the few neurons that are still producing dopamine. Act indirectly or directly on the neurons.
Ultimate goal is to create a balance level of dopamine in the brain, reversing akinesias |
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what is akinesias
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are symptoms such as masklike facial expression and impaired postural reflexes. Impaired postural reflexes render the patient unable to care for themselves.
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what are the actions of dopaminergic therapy
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Corner-stone of treatment is levodopa and combination product of levodopa-carbidopa provide exogenous sources of dopamine.
Levodopa is the biologic precursor of dopamine required by the brain for dopamine synthesis. These drugs are referred to as presynamptic drugs or replacement drugs. Exogenously administered dopamine cannot pass through the blood-brain barrier, whereas levodopa can. |
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what must dopamine be administered this way
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it can't go through the blood brain barrier, but levodopa can and then it is broken down into dopamine
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symmetrel-amantadine
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Originally used for prophylaxis and treatment of viral disorders.
Realized that by causing the release of dopamine and catecholamies from their storage sites in the ends of the nerve cells that are still intact. Triggers release of dopamine indirectly. It also blocks the reuptake of dopamine into the nerve endings which allows more dopamine to accumulate Adults po – 100-400 mg/day divided q 12 hr |
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parlofel and permax
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Dopaminergic agonists that directly stimulate the dopamine receptors.
Permax is 20 times more potent than Parlodel and has a half life that is 3 times longer. pergolide stimulates dopamine receptors on the substantia nigra of the brain |
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COMT inhibitors
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breaks down dopamine molecules,Tasmar and Comtan
Inhibits COMT and break down of levodopa May be used as adjunctive treatment with other PD drugs |
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what is tasmar
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is a drug that acts on both the central and peripheral nervous systems
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what is comtan
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it is a drug that can't pass the blood brain barrier so can only act peripherally
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what is the positive effect of both of these drugs
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they prolong the duration of levodopa benefit
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the drug levodopa-carbidopa
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doesn't cross the blood brain barrier but can prevent breakdown of levodopa to dopamineSinemet, Sinemet CR – cornerstone in treatment of PD
Limits on and off phenomena which is when pt have strong S/S of PD and none at all Contraindicated with narrow-angle glaucoma, melanoma, and MAOIs Sinemet: 10/100 – 1 tab 3-8 x day 25/100 – 1 tab 3-6 x day 25/250 – 1 tab tid – qid Sinemet CR – do not crush 1 tab bid; up to 1-8 tabs at 4-8 hour intervals |
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what is anticholinergic thearpy
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Block effects of ACh
Belladonna alkaloids, atropine, and scopolamine Side Effects – dry mouth, urinary retention, blurred vision. Developed new and better anticholinergic and antihistamines with better side effect profiles useful in tx muscle tremors and rigidity |
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ACh effects what symptoms of PD
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is muscle tremors, muscle rigidity, pill-rolling movements at rest and bobbing of head.
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what is SLUDGE
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salivation, lacrimation, urination, diarrhea, increased GI motility, and emesis.
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cogentin
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used as adjunct treatment for extrapyramidal symptoms. Dosage po is 0.5-6 mg/day
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artane
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used as adjunct. Dosage po 6-10 mg/day
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