AntiParkinsonism !

Question 1

بسم الله الرحمن الرحيم وبه نستعين

exxplain pathophysiology of parkinsoinsm disease

Answer 1

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

Question 2

Classify antiparkonisan drugs !

Answer 2

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

Question 3

Sinemet = …+… why?

Answer 3

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

Question 4

The most efficent drug for improving feature of parkinsonism

Answer 4

Ldopa but better to be reserved when symptoms become Turbelosome

Question 5

Mention Adverse effects of L dopa

Answer 5

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

Question 6

What is the best anti nasuse and antiemetic in parkinsoism ?

Answer 6

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

Question 6

What is the best anti nasuse and antiemetic in parkinsoism ?

Answer 6

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

Question 7

L dopa casue psycosis ?

Answer 7

Yes due to incrasing dopaime in mesolimbic tract

Question 8

Atypical anipsychotics used in ?

Answer 8

l dopa induced psychosis
selecvitve for D2 of Mesolimbic

Question 9

Dyskinesa casues in l dopa/treat

Answer 9

-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

Question 10

Anti dyskineas action !

Answer 10

Amantatdine
NMDA R BLOCKERS
Anti parkisonian :
+dopaminergic
anti cholinergic

Question 11

Motro flucutations is for?

Answer 11

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

Question 12

HOow to treat motor fluctuations?

Answer 12

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

Question 13

Interactions with l dopa ?

Answer 13

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

Question 14

pHARMACO kinetic of levodopa ?

Answer 14

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

Question 15

Nutrition care in PD ?

Answer 15

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

Question 16

Ergot problem ?

Answer 16

Vasospam
Fibrosis Pulmonary and Pericardial

Question 17

young + mild first line antiparkinson ?

Answer 17

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

Question 18

Less dyskinesia in D2 AGONISTS WHY ?

Answer 18

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

Question 19

Functions of DA agonists?

Answer 19

Stop Fluctations occuring with Sinemet
Referactory to DA we give Siemet

Question 20

Charatreicsitc adveres effect oPramipexole :

Answer 20

Pramipexole :
Impulse control disorder
Impulse control disorder
Impulse control disorder

Question 21

Mention Adverese effects of dopamine agonists ?

Answer 21

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

Question 22

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

Answer 22

Apomorphine

Question 23

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

Answer 23

apoMorphiiine

Question 24

Amantidine

Answer 24

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

Question 25

Amantadine side effects mention ?

Answer 25

HALTI Hallucinations Ankllllllle Edema LividoReticularis Tolerance rapied Insomnia

Question 25

Amantadine side effects mention ?

Answer 25

HALTI Hallucinations Ankllllllle Edema LividoReticularis Tolerance rapied Insomnia

Question 26

MAOB I Explian

Answer 26

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

Question 27

MAOB I adverse effects mention

Answer 27

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

Question 28

Selegilline and Raegiline compare

Answer 28

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

Question 29

cOMT II role in therapy ?

Answer 29

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

Question 30

Other drug can be added to siemet ?q

Answer 30

Entacapone COMT I

Question 31

orange urine occue int ?

Answer 31

eNTACOPNE

Question 32

Entacapone adverses ?

Answer 32

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

Question 33

Indicatiosn of Anticholinergics?

Answer 33

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

Question 34

Why antichilinergic in Antipyschotic taking patients ?

Answer 34

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

Question 35

Adveerse of anticholinergic ?

Answer 35

Halucination\ memory loss Urine Retenrion BPH paresis causing l dopa fluctations

Question 36

tREMORS can also traeted by ?

Answer 36

Inderal propranolo blocking b receptors monitor HR BP

Question 37

SIALORRHEA

Answer 37

Botox Sublingual atropine

Question 38

guidlline ofor parkinsonism

Answer 38

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

Question 39

الحمدلله رب العالمين