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53 Cards in this Set
- Front
- Back
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Symptoms of Parkinson's |
-tremors -bradykinesia(slow movement) -rigidity - gait/postural abnormality |
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Charateristics of Parkinson's |
-chronic, progressive -starts middle/late in life -all races/sex |
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PATHO of PARKINSONS
-loss of _______ |
loss of substania nigra pars cells => reduction in dopamine |
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The reduction in dopamine has what 2 effects??? |
-loss of excitatory DA -loss of striatial inhibitory DA
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The loss of DA mediated inhibition of GABA leads to... |
-increased GABA release |
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slow, withering abnormal movement |
athetosis |
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Postural abnorm w/ sustained abnorm movement |
Dystonia |
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what causes athetosis/dystonia |
-brain damage -cortical lesion -drugs i.e antipsych -neuro disorders |
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rhythmic oscillatory movement around joint |
TREMOR |
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Parkinson's is associated with which type of tremor? |
Resting |
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Postural tremor |
Essential |
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associated with ETOH, or brainstem lesion |
Intentional tremor |
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-involuntary muscle jerks |
Chorea |
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violent proximal limb movement |
Ballismus |
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sudden, abnormal coordinated movements |
Tics like in Tourette's |
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What is the cause of Parkinson's? |
-Unknown possible: toxins (environment/endogenous) |
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Clinical manifestations of PArkinsons's |
-Tremors -Rigidity -Bradykinesia (most disabling) - flat affect -depression -drooling -diff walking -
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What is the precursor to DA (dopamine)? |
L-DOPA |
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How does L-DOPA => Dopmine |
via dopa decarboxylase
(DD) |
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does dopamine cross the BBB? |
NO L-DOPA does |
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how many dopamine receptor's are there? |
2: D1 & D2
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-adenyl cyclase stimulation -^ cAMP - high concentration in substantia nigra zona compacts |
D1 |
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-adenyl cyclase INHIBITION - decrease in cAMP - postsynaptic on striatal neurons |
D2 |
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what % of levodopa reaches the brain?? |
1-3% |
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how do we achieve therapeutic brain levels |
- large doses -given along with a dopa decarboxylase inhibitor |
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What is Sinemet? |
Its Levodopa+ Carbidopa
carbidopa lessens levodopa conversion |
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- a COMT inhibitor -in combo with levodopa + carbidopa = stavelo |
Entacapone |
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what happens to Levodopa after 3-4 years of use? |
diminished efficacy |
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what does levodopa do to the disease progression |
Nothing |
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levodopa is most effective against which manifestation??? |
bradykinesis |
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SFX of Levodopa |
-Vomiting -avoid with phenothiazines -dyskinesias
*drug holidaies maybe helpful |
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-Selective MAOI (B) -helps prolong levodopa effects |
Selegiline (Eldepryl) |
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-antiviral - may influence DA release/reuptake/synthesis |
Amantadine |
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these help to improve rigidity/tremors |
Anticholinergics:
Benztropine
Biperiden
Orphenadrine
Trihexyphenidyl |
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what increases tremors? |
-anxiety -fatigue -isoproterenol/epi -thyrotoicosis |
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What drugs ^ tremors? |
-bronchodilators -TCA -lithium |
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What induces tremors? |
Sympathomimetics |
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what blocks tremors? |
propranolol
-suggesting tremors maybe B2 receptor activation |
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Drugs useful in essential tremors |
-BBs -Primidone -Alprazolam |
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intentional tremors may be caused by |
toxic reactions to ETOH and other drugs |
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-dominant, inherited -progressive chorea in dementia
What disease is this? |
Huntington's |
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Chorea is an imbalance of?? |
DA/ACh/GABA
too much DA |
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Pathology of chorea |
DA overactivity |
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what anti-DA drugs reduce chorea?? |
-reserpine -Haldol
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what increases Chorea? |
dopaminergic drugs |
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treatment for Ballismus |
DA blocking drugs
-perphenazine - hadol |
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what agents may help athetosis & dystonia? |
diazepam, antimuscarinics, levodopa, baclofen, phenothiazines, amantadine |
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What is most effective for Tic treatment? |
Haldol |
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what treats drug induced dyskinesias? |
antimuscarinics
benztropine diphenhydramine biperiden diazpam |
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consequence of long term antipsychotic |
tardive dyskinesia |
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why is tardive dyskinesia difficult to treat? |
decreasing dose worsens sx
increasing dose suppresses sx |
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recessive disease
copper metabolism error
^ copper concentration in brain |
Wilson's disease |
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Treatment for Wilson's |
Penicillamine
Trientine
Zinc acetate- ^ copper excretion
Zinc sulfate- decreases copper absorption |
