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A-CNS Pharma > AntiParkinsonism ! > Flashcards

AntiParkinsonism ! Flashcards

1
Q

بسم الله الرحمن الرحيم وبه نستعين

exxplain pathophysiology of parkinsoinsm disease

A

Basal ganaglia is responsible for:
inhibition of muscle tone
Intation and modulation of Movements
This Needs balacne of Ach and Dopanmine
And dopamine is syntheisd within it in the subsatnia Nigra and reache s corpus striatum throuh dopaminergic NigroStriatal Fibers
In parkinsonism NigroStiratal are degenrated so no dopaimine in the straitum Casuing Dominiance of Cholinergic Systems :
1-Dyskinesa
2-Tremors
3-RIgidity

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2
Q

Classify antiparkonisan drugs !

A

1-increasing dopaminergic activity :
CMN DO[PA
DOPA agonists : Ergot and non
Ergot bromocrotpine
Non: Pareximole
LevoDopa carbidopa
COMT inhibtior Entacapone
MAOB inhibitor sergelline raselligne
NMDA-R-Inhibiotr? Amantidine

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3
Q

Sinemet = …+… why?

A

Levodopa + carbidopa
levodopa crossing BB
Caribdoa inhibiting the peripheral decaroxylase to incerses portion of levodopa to CNS

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4
Q

The most efficent drug for improving feature of parkinsonism

A

Ldopa but better to be reserved when symptoms become Turbelosome

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5
Q

Mention Adverse effects of L dopa

A

1-Central : Hallucination +psychosis
Dyskinesia choreoathetosis
2-Peripheral : CI in PU dut vomiting and Nauses
CVS : Postural hypotenison+Arryhthmia
3-Fluctations in responce
On - Off effect: sudden change from mboility to dyskinsea
End of dose akinesia : truning into dyskinestic before next dose

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6
Q

What is the best anti nasuse and antiemetic in parkinsoism ?

A

Domperidone Blcoking D2 peripherally in CTZ ALSO
Not interferred with Central D2 in basal ganglia so not interfere with antiparkinsoinan effect of l dopa

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6
Q

What is the best anti nasuse and antiemetic in parkinsoism ?

A

Domperidone Blcoking D2 peripherally in CTZ ALSO
Not interferred with Central D2 in basal ganglia so not interfere with antiparkinsoinan effect of l dopa

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7
Q

L dopa casue psycosis ?

A

Yes due to incrasing dopaime in mesolimbic tract

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8
Q

Atypical anipsychotics used in ?

A

l dopa induced psychosis
selecvitve for D2 of Mesolimbic

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9
Q

Dyskinesa casues in l dopa/treat

A

-Dut to extereme high level of dopamine in basal ganglia
-Fulucations in dopamine level in blood so in Basal ganglia
-Fluctations casue pulsatile stimulation NMDA Rs realsing glutamte in basal gagnlia
_______________
lowering sinemet dose and giving XR dose to prevent fluctations

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10
Q

Anti dyskineas action !

A

Amantatdine
NMDA R BLOCKERS
Anti parkisonian :
+dopaminergic
anti cholinergic

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11
Q

Motro flucutations is for?

A

Short t1/2
fLUCTUATING L DOPA LEVEL
:
1-peripheral due to
Gastric paresis
antagoism of protein
short t1/2
________________
2-centrla
pulsatattile deilvert to straitla DA receptros
Impaited storage
Alteration of DA receptor

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12
Q

HOow to treat motor fluctuations?

A

Decrasing interval between doses of sinemet
SINemet sr
Sinemet+ sillgelline
sinemet +entacapone exntednign

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13
Q

Interactions with l dopa ?

A

1-Vitb6 = pariphela dopa decarobxylase
2-MAO I increasing dopamine periophelalyy and HTN cirsis occur2
3-Antipsychotic halopridol blocking D2 in nigroStriatal

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14
Q

pHARMACO kinetic of levodopa ?

A

Ansorbed rapidly from small intestine
Short hald life 1-2h
protein interfers with its absorptions @ so must be taken 30 mintues before meal or after 1.5 h of meal

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15
Q

Nutrition care in PD ?

A

1-avoid Vit b6
2-lessen Protein
taken 30 minutes before diet
Fibers +fluids for constipations effect of PARKISNONISNM

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16
Q

Ergot problem ?

A

Vasospam
Fibrosis Pulmonary and Pericardial

17
Q

young + mild first line antiparkinson ?

A

Dopamina agonists
less effective but! less dyskinesia
less flutcuations due to rapid absorption and long t1/2

18
Q

Less dyskinesia in D2 AGONISTS WHY ?

A

less dyskinesia
less flutcuations due to rapid absorption and long t1/2

19
Q

Functions of DA agonists?

A

Stop Fluctations occuring with Sinemet
Referactory to DA we give Siemet

20
Q

Charatreicsitc adveres effect oPramipexole :

A

Pramipexole :
Impulse control disorder
Impulse control disorder
Impulse control disorder

21
Q

Mention Adverese effects of dopamine agonists ?

A

Day time sleepleness
Like ldopa in /
Haluucination dyskinesia
Nause vomitting- Postural hypotension
Impusle contorl disorder
Vasospam
Pulmonart and pericardial fibrosis

22
Q

Rescue therapy or drug for Sever off periods of akinesia in parkinsoinsm ?

A

Apomorphine

23
Q

Rapid and more effective than l dopa and need antiemetic and it is potetne DA ?

A

apoMorphiiine

24
Q

Amantidine

A

Antidyskinsisa why?
blckin NMDA-R
Dopamierc
anticholinergic
in mild cases

25
Q

Amantadine side effects mention ?

A

HALTI
Hallucinations
Ankllllllle Edema
LividoReticularis
Tolerance rapied
Insomnia

25
Q

Amantadine side effects mention ?

A

HALTI
Hallucinations
Ankllllllle Edema
LividoReticularis
Tolerance rapied
Insomnia

26
Q

MAOB I Explian

A

sellgiline rasergiline
Neuroprotective
Extedning duration of dopamine work
Prevents accumulation of toxic degerative metabolites
in mild cases
Used with siemet to extedning its action preventing fluctuations

27
Q

MAOB I adverse effects mention

A

HI
Hallucination -isnmoina
cheese reaction to tyramine dut to imhibitng MAOA MAOB in high doses

28
Q

Selegilline and Raegiline compare

A

selegilline : Insmonia but rase no ampetamine like insomnia
Resgelline Once daily less side effects neruoprotectv MAOBI

29
Q

cOMT II role in therapy
?

A

Prevent break down of l dopa into 3OMD
increasing l dopa to CNS
dECREASING Antagonism at its receptor to cns
Extending action of dopamine l dopa and decrasing Fluctuation Decrasing waring off and on -off

30
Q

Other drug can be added to siemet ?q

A

Entacapone COMT I

31
Q

orange urine occue int ?

A

eNTACOPNE

32
Q

Entacapone adverses ?

A

as L dopa as dopa antagonists
Hallucination
dyskinesa
nasue postural hypotenison
Orange urin

33
Q

Indicatiosn of Anticholinergics?

A

Parknison disease mono in mild and with DA in tremors and droppling sialoherrea
Drug induced Parkinsonism as ?
Halopridol why?

34
Q

Why antichilinergic in Antipyschotic taking patients ?

A

Beacuse L dopa cannot attach to blocker receptor by antipsycho
Becasue If dopamine rised will aggravate anipsycotic

35
Q

Adveerse of anticholinergic ?

A

Halucination\

memory loss
Urine Retenrion BPH

paresis causing l dopa fluctations

36
Q

tREMORS can also traeted by ?

A

Inderal
propranolo blocking b receptors
monitor HR BP

37
Q

SIALORRHEA

A

Botox
Sublingual atropine

38
Q

guidlline ofor parkinsonism

A

If Drug induced = remove offednidng+ non pharma
If idipathic non phaerma +phaema
ANTICHOLINERGICS + COM I
+
1-cARBIDOPA - LEVODOPA if complications give
vomiting domepridone
P HTN midofdrine
Motor : Wearing off : extenders +DA agonists + sinemet if complications go complications path
Pshyc: depression TCA SSRI
Hallucinton clozpaine quuetapine
______________________
2-DA agonists <65 young
Dopamine agonist + carvidopa livdoppa

39
Q

الحمدلله رب العالمين

A

A-CNS Pharma (11 decks)

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