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56 Cards in this Set

  • Front
  • Back
What is parkinsons?
this is degeneration of dopamine pathways from substantia nigra along the nigrostriatal pathway
How much brain is lost before symptoms occur?
about 70% of the striatal DA is lost
What are the primary symptoms of parkinsons?
stiffness, tremor
difficult balance
difficult walking
What is the pathophysiology of parkinsons disease?
degeneration of DA neurons in pars compacta of substantia nigra. This leads to overactivity in the *indirect pathway*. leading to increased glutamate to subthalamic nucleus (an inhibitory guy)-> more GABA to thalamus itself
How do DA neurons affect the striatum output?
DA inhibits GABA output from stiratum
how do AcH neurons affect Striatum output?
Ach increases the GABA output from striatum
How does L-Dopa work?
this is the precursor to DA, it is used to increase DA levels in the brain (to inhibit GABA output from striatum)
How much L-Dopa is given?
this requires a large dose of L dopa, because it is metabolized in thegut by COMT
What does Dopa/Carbidopa (Sinemet) do?
Carbidopa is a dopa decarboxylase inhibitor that doesnt enter the brain- so this allows more L dopa to enter the brain
Does sinemet alter the course of parkinsons disease?
no it does not, it only reduces symptoms for a couple years before it loses effect
What is Sinemet best at treating in parkinsons?
What are the GI effects of Sinemet?
these will be nausea and vomiting, but side effects are low compared to L dopa alone
What are the Cardiovascular side effects of Sinemet?
possible arrythmias

What are the movement side effects of Sinemet?
you get dyskinesias over time
What are the behavior side effects of Sinemet?
psychosis- treated with atypical antipsychotics
What is the On-Off phenomenon of L-Dopa?
this is alternating periods of akinesia (off) followed by improved mobility with dyskineas (on periods)
How is L-Dopa discontinued?
this is done gradually

may cause akenesia or neuroleptic malignant syndrome
What is the memonic for neuroleptic malignant syndrome?
F- fever
E- encephalopathy
V- vitals unstable
E- elevated CPK enzyme
R- rigid muscles
How do MAOI's affect L-Dopa?
these can produce hypertensive crisis together
How does Vitamin B6 (pyridoxine) affect L dopa?
this increases the peripheral metabolism of L dopa
What are the Contraindications of L-Dopa?
closed-angle glaucoma
cardiac disease
peptic ulcer
malignant melanoma
What type of drug is Selegiline (Deprenyl)?
this as an MAOI against MAO-B
Where is MAO-B located?
in the striatum
How does Selegiline (Deprenyl) work?
this reduces metabolism of DA by inhibiting MAO-B in the striatum
How does Selegiline (deprenyl) affect free radicals?
this decreases them, because MAO-B creates them when breaking down DA
What do you NOT combine with Selegiline (deprenyl)?
Meperidine (demerol)
What does Tolcapone (Tasmar) do?
this is a COMT inhibitor
What is the prototype for dopamine receptor agonists?
How does Bromocriptine (parlodel) effect change over time?
its effectiveness does not change over the course of parkinsons
How does Bromocriptine (parlodel) affect prolactin levels?
this decreases the release of prolactin
What are the GI effects of Bromocriptine (parlodel)?
anorexia, nausea, vomiting
What are the cardiovascular effects of Bromocriptine (parlodel)?
postural hypotension

cardic arryhtmias
can Bromocriptine (parlodel) cause dyskinesia?
yes it can
What drug causes Erythromelaglia?
Bromocriptine (parlodel).

this is red, tender, swollen feet due to vasospasm
What kind of drug is Pramipexole (mirapex)
this is a dopamine receptor agonist like Bromocriptine (parlodel)
What does Pramipexole (Mirapex) treat?
this treats parkinsons disease
What does Ropinirole (requip) treat?
this treats parkinsons disease
What does Apomorphine (Apokyn) treat?
this treats off-period akinesia in parkinsons treatments
How is Apomorphine (apokyn) given?
this is a subcue injection
What is amantadine (symmetrel) used to treat?
this is an antiviral drug thats being used to treat parkinsons! neat!
What are the side effects of Amantadine (symmetrel)?
toxic psychosis
spotting of skin
What kind of drug is Benztorpine (Cogentin)
this is an anticholinergic drug
What kind of drug is Biperiden (akineton)
this is an anticholinergic drug
How does Benztropine (Cogentin) affect parkinsons symptoms?
this relieves rigidity, tremor, and drooling

does NOT help bradykinesia
What two drugs treating huntingtons disease?
Tetrabenazine, and reserpine
What is the best drug for Tourettes syndrome?
What are the risk factors for Alzheimers?
Being old
family history
being a woman
low education
What is the hallmark destruction of the brain in Alzheimers disease?
degeneration of cholinergic neurons in the nucleus basalis of Meynert, which projects to the cerebral cortex and hippocampus
What NT does Alzheimers effect?**
ACh is reduced by up to 90%
What type of drugs treat alzheimers?
cholinesterase inhibitors
What kind of drug is Tacrine (Cognex)
this is a cholinestease inhibitor used in alzheimers
What kind of drug is Rivastigmine (exelon)
this is a cholinesterase inhibitor
What is the major adverse effect of Tacrine (Cognex)
this causes liver toxicity in up to HALF of people
How does memantine (Ebixa) work?
this is an antagonist of NMDA receptors

blocks sustained activation of NMDA receptors by glutamate
What does memantine (ebixa) treat?
this treats severe Alzheimers disease
What are the side effects of Mamantine (Ebixa)
this enhances the side effects of L-dopa

urinary incontinence/ infection