Pharmacological management of Huntington’s disease Name drugs for that used to treat HD that use following mechanisms: Vesicular amine transporter inhibitor [1] Antidopaminergic (antipsychotic) drugs [2]

Vesicular amine transporter inhibitor: tetrabenazine Antidopaminergic (antipsychotic) drugs: haloperidol, olanzapine

BBEOYS2 Flashcards by patrick ellis

Which drug used to treat Huntingdons Disease works by the mechanism of action depicted by A? [1]

Tetrabenazine

acts primarily as a reversible high-affinity inhibitor of mono-amine uptake into granular vesicles of presynaptic neurons by binding selectively to VMAT-2

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Which treatment used in PD is good at managing tremors

Haloperidol
Ritotigone
L-DOPA
Orphenadrine

Which treatment used in PD is good at managing tremors

Haloperidol
Ritotigone
L-DOPA
Orphenadrine: anticholinergic

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[] is defined as that part of the PFC in which saccades can be elicited

Superior colliculi
Inferior colliculi
Frontal eye fields
Supplementary eye field

[] is defined as that part of the PFC in which saccades can be elicited

Superior colliculi
Inferior colliculi
Frontal eye fields
Supplementary eye field

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The tectospinal tract orginates at the
Superior colliculi
Inferior colliculi
Frontal eye fields
Supplementary eye field

The tectospinal tract orginates at the
Superior colliculi
Inferior colliculi
Frontal eye fields
Supplementary eye field

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Damage to which of the following would cause someone to not be able to inhibit a response to a stimulus

A
B
C

Damage to which of the following would cause someone to not be able to inhibit a response to a stimulus

A: dorsolateral pre-frontal cortex
B
C

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Carbidopa and benserazide inhibit which enzymes

Monoamine oxidase
COMT
Decarboxylase
Amylase

Carbidopa and benserazide inhibit which enzymes

Monoamine oxidase
COMT
Decarboxylase: stop conversion of L-DOPA - dopamine
Amylase

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If you were sitting in a quiet room and all of a sudden heard a noise to your right, you would subconsciously turn your head in that direction and orient your eyes towards the direction of the sound, attempting to find the source. Which spinal tract would be responsible for this? [1]

Tectospinal tract

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Which spinal tract provides drive to the respiration via the phrenic nerve?

Rubrospinal
Lateral vestibulospinal
Recticulospinal
Cortciospinal
Coticobulbar

Which spinal tract provides drive to the respiration via the phrenic nerve?

Recticulospinal

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Pharmacological management of Parkinson’s disease

Name two drugs that can combined with L-DOPA (aka levodopa) that means it doesn’t get metabolised to dopamine outside the BBB [2]

What is their MOA? [1]

L-DOPA (levodopa) & carbidopa or benserazide

carbidopa, benserazide are decaboxylase inhibitors: allows L-DOPA to pass BBB where it can then be converted to dopamine

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Pharmacological management of Parkinson’s disease

Name 3 dopminergic agonists and describe their MOA

Dopamine agonists:
* ropinirole
* pramipexole
* rotigotine (in BB PBL; transdermal patch)

Dopamine agonists act directly on the dopamine receptors and mimic dopamine’s effect

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Which of the following dopamine agonists can be used as a transdermal patch?

bromocriptine,
pramipexole
ropinirole
rotigotine
Apomorphine

Which of the following dopamine agonists can be used as a transdermal patch?

bromocriptine,
pramipexole
ropinirole
rotigotine
Apomorphine

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Which of the following dopamine agonists can be used as an infusion for major motor fluctuations?

bromocriptine,
pramipexole
ropinirole
rotigotine
Apomorphine

Which of the following dopamine agonists can be used as an infusion for major motor fluctuations?

bromocriptine,
pramipexole
ropinirole
rotigotine
Apomorphine

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Pharmacological management of Parkinson’s disease

Name three drugs that are monoamine oxidase inhibitors [3]

Describe their MoA [1]

rasagiline
selegiline (in PBL)
safinamide

MAO-B inhibitors stop Monoamine oxidase type B breaking down dopamine into DOPAC or homovanillic acid

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What is the MoA of COMT inhibitors? [1]

Explain why [1]

Which drugs are they used in conjunction with? [1]

COMT is an enzyme involved in the breakdown of dopamine (DOPAC –> homovanillic acid) and hence may be used as an adjunct to levodopa therapy

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Pharmacological management of Parkinson’s disease

Name 2 COMT inhibitors [2]

entacapone
tolcapone

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Pharmacological management of Parkinson’s disease

Name three anticholinergic compounds [3]

Which symtpom are they particularly good for treating? [1]

orphenadrine, procyclidine, trihexyphenidyl

Block tremors (as block muscarinic receptors on muscles) but also cause dry mouth and constipation

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Pharmacological management of Parkinson’s disease

What is the MoA of Amantadine? [3]

inhibits dopamine reuptake, increases dopamine release, also weak antagonist at NMDA glutamate receptors

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Pharmacological management of PD:

Other treatment approaches

Name two cell based approaches that can use to treat PD [2]

Striatal graft of embryonic mesencephalic cells: intrastriatal transplant of foetal nigral cells
Systemic administration of mesenchymal stem cells: Improvement following repeated intravenous injection of adipose tissue-derived cells

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Surgical approaches in Parkinson’s disease

Describe the surgical approaches to PD treatment [4]

Electrode stimulation of the subthalamic nucleus

Thalamotomy

Pallidotomy

deep brain stimulation for people with advanced Parkinson’s disease whose symptoms are not adequately controlled by optimised pharmacological therapy

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Pharmacological management of Huntington’s disease

Name drugs for that used to treat HD that use following mechanisms:

Vesicular amine transporter inhibitor [1]
Antidopaminergic (antipsychotic) drugs [2]

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Vesicular amine transporter inhibitor: tetrabenazine
Antidopaminergic (antipsychotic) drugs: haloperidol, olanzapine

Pharmacological management of Huntington’s disease

Name three antidepressant drugs used in the management of HD [3]

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Antidepressant drugs: citalopram, fluoxetine, sertraline

Brain areas involved decision making & movement planning:

Which area of the brain is where conscious intentions are formed and we become aware of motor movement? [1]

Name another key function of this area? [1]

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The posterior parietal cortex

Also provides a representation of the body and how it is situated in space

Broadmann areas 39 & 40

What is the function of the pre-frontal cortex? [2]

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Pre-front cortex controls executive function (allows us to use perceptions, knowledge & to bias / choose the from the selection of actions and thoughts from multiple possibilites)

This allows you to overide habitual responses

Prefrontal cortex:

Dorsolateral prefrontal cortex

What is this region of the pre-frontal cortex involved with? [3]

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Planning of goal-directed behaviours AND simulating the consequences of plans

Initiating, inhibiting and swtiching executive behaviour: input to the basal ganglia about stop / start

Involved with:
Problem-solving
Goal-driven attention
Planning
Decision making
Working memory

# dorsolateral prefrontal cortex: Lesions in Brodmann area 46 affects which functions? [1]

Attention and working memory: **affects ability to inhibit a response to a stimulus**

What is the role of the medial prefrontal cortex ?

**Guide and monitor actions** that are internally guided according to preferences and goals: I.e. it **modulates the degrees of cognitive control** need to keep in behaviour in line with the goal

# Prefrontal cortex What is the role of the orbitofrontal cortex? [1]

Representation of **value for rewards and punishers** (what is good for you / bad for you)

Is damage to frontal eye fields a perceptual or motor problem? [1] What is the effect of bilateral FEF lesion? [2] In which direction does the eye move if have a frontal eye field defect? [1]

Frontal eye fields: **motor problem**: Bilateral lesion: causes **oculumotor apraxia** - have to move head horizontally as they c**annot move their eyes** Eye deviates **towards** the side of lesion

# supplementory motor area: Location: Broadmann area? [1] Lobe? [1] Role? [2]

Location: **medial part of BA 6; frontal cortex** Role: * **Orgnaises actions that are internally guide according to preferences and goals**: choosing objects * Determines response threshold to initiate movement - **the urgency of movement** * Response to **start** or **stop** a **movement** (interconnects to basal ganglia) e.g which object to choose (in alignment with goals) plan sequence of learned actions - e.g. playing piano

Which area of the brain is where conscious intentions are formed and we become aware of motor movement? orbitofrontal (pre-frontal) cortex posterior parietal cortex medial pre-frontal cortex dorso-lateral pre-frontal cortex

Which area of the brain is where conscious intentions are formed and we become aware of motor movement? orbitofrontal (pre-frontal) cortex **posterior parietal cortex** medial pre-frontal cortex dorso-lateral pre-frontal cortex

Which of the following areas are involved in Initiating, inhibiting and swtiching executive behaviour: input to the basal ganglia about stop / start orbitofrontal (pre-frontal) cortex posterior parietal cortex medial pre-frontal cortex dorso-lateral pre-frontal cortex

which of the following guides and monitos actions that are internally guided according to preferences and goals orbitofrontal (pre-frontal) cortex posterior parietal cortex medial pre-frontal cortex dorso-lateral pre-frontal cortex

which of the following guides and monitos actions that are internally guided according to preferences and goals orbitofrontal (pre-frontal) cortex posterior parietal cortex **medial pre-frontal cortex** dorso-lateral pre-frontal cortex

Which of the following modulates the degrees of cognitive control need to keep in behaviour in line with the goal orbitofrontal (pre-frontal) cortex posterior parietal cortex medial pre-frontal cortex dorso-lateral pre-frontal cortex

Which of the following modulates the degrees of cognitive control need to keep in behaviour in line with the goal orbitofrontal (pre-frontal) cortex posterior parietal cortex **medial pre-frontal cortex** dorso-lateral pre-frontal cortex

Which of the following modulates value for rewards and punishers orbitofrontal (pre-frontal) cortex posterior parietal cortex medial pre-frontal cortex dorso-lateral pre-frontal cortex

Which of the following modulates value for rewards and punishers **orbitofrontal (pre-frontal) cortex** posterior parietal cortex medial pre-frontal cortex dorso-lateral pre-frontal cortex

“pseudopsychopathic” behaviours occurs due to lesions in which of the following brain areas orbitofrontal (pre-frontal) cortex posterior parietal cortex medial pre-frontal cortex dorso-lateral pre-frontal cortex

“pseudopsychopathic” behaviours occurs due to lesions in which of the following brain areas **orbitofrontal (pre-frontal) cortex** posterior parietal cortex medial pre-frontal cortex dorso-lateral pre-frontal cortex

Label the orange, purple, green and grey barts of the brain

Purple: premotor orange: dorsolateral prefrontal green: orbitofrontal grey: FEF

Which region of the brain is responsible for this image? (chosing a food option) [1]

supplementory motor area:

Which tract controls the movement of the face? [1]

**Corticobulbar tract**

# Extrapyramidal tracts: Describe the course of the lateral vestibulospinal tract [1] Which type of muscles does it synapse onto? [1]

Fibres descend **ipsilaterally** though the anterior funiculus of the same side of the spinal cord, **synapsing on the extensor antigravity motor neurons**: help maintain upright and balanced posture.

# Extrapyramidal tracts: Desribe the function and path of medial vestibulospinal tract

Function: Performs the **synchronization of the movement of the eyes** with the **movement** **of the head** so that **eyes do not lag** behind when the head moves to one side Pathway: Descends **bilaterally in the medial longitudinal fasciculus**. Synapses with the excitatory and inhibitory neurons of the cervical spine

Describe the function and path of the rubrospinal tract [2]

Function: **Controls muscle tone in flexor muscle groups; Inhibits extensor tone** Path: - Arises from the red nucleus in the brainstem - crosses at medulla - terminates primarily in the cervical and thoracic portions of the spinal cord

Describe how rigidity occurs [1]

If have a lesion above the pons occurs, the inhibitory system is lost; **extrapyramidal system becomes hyperactive**

Where would damage occur for the following: Decorticate posturing [1] Decerebrate posturing [1]

Decorticate posturing: * Damage to the **corticospinal** tract **above or in midbrain** Decerebrate posturing * Damage to the corticospinal tract at the **level of upper brainstem**, including **corticospinal and rubrospinal tracts**

Which of the following ensures that the eyes do not lag behind when the head moves to one side rubrospinal tract reticulospinal tract lateral vestibulospinal tract medial vestibulospinal tract

Which of the following ensures that the eyes do not lag behind when the head moves to one side rubrospinal tract reticulospinal tract lateral vestibulospinal tract **medial vestibulospinal tract**

Which of the following controls posture and balance rubrospinal tract reticulospinal tract lateral vestibulospinal tract medial vestibulospinal tract

Which of the following controls posture and balance rubrospinal tract reticulospinal tract **lateral vestibulospinal tract** medial vestibulospinal tract

Which of the following controls flexor muscle tone rubrospinal tract reticulospinal tract lateral vestibulospinal tract medial vestibulospinal tract

Which of the following controls flexor muscle tone **rubrospinal tract** reticulospinal tract lateral vestibulospinal tract medial vestibulospinal tract

Which extra-pyrimadal tract originates in the superior colliculus? [1]

tectospinal

Which of the following synapses on the extensor antigravity motor neurons rubrospinal tract reticulospinal tract lateral vestibulospinal tract medial vestibulospinal tract

Which of the following synapses on the extensor antigravity motor neurons rubrospinal tract reticulospinal tract **lateral vestibulospinal tract** medial vestibulospinal tract

BBEOYS2 Flashcards

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