Brain 6 Flashcards
(40 cards)
Which factors contribute to the pathophysiology of Parkinson’s disease?
a. decreased dopamine in the basal ganglia
b. increased glutamate in the substantia nigra
c. decreased acetylcholine in basal ganglia
d. increased GABA in the thalamus
A. decreased dopamine in the basal ganglia
D. increased GABA in the thalamus
Parkinson’s disease is a
chronic neurodegenerative disorder of the basal ganglia
With Parkinson’s disease there is an imbalance between
dopamine (not enough) and acetylcholine (too much)
When given together ___ & ___ increase the concentration of dopamine in the basal ganglia
cabidopa & levodopa
Patients with Parkinson’s disease are at risk for
autonomic instability, orthostatic hypotension, dysrhythmias, and aspiration
_________ may be used to treat acute exacerbation of Parkinsonian symptoms
Anticholinergics
_____________________ can be used to treat the s/sx. of Parkinson’s disease.
A deep brain stimulator can be implanted
Procedure-related considerations for the insertion of a deep brain stimulator include
lack of airway access during the procedure and risk of venous air embolism
____________________ may exacerbate extrapyramidal s/sx and are contraindicated
Antidopaminergic drugs & phenothiazines
An example of a phenothiazine is
promethazine
Examples of antidopaminergic drugs include
metoclopramide
butyrophenones (haloperidol & droperidol)
Diagnosis of Parkinson’s disease requires 2 of the 4 cardinal signs:
- resting “pill-rolling” tremor
- skeletal muscle rigidity
- postural instability -loss of balance with an altered gait
- bradykinesia- very slow movement and reflexes
Risk factors for the development of Parkinson’s disease include
old age- greatest risk factor
exposure to manganese in welders as well as herbicides, pesticides, and possibly genetics
Levodopa is a precursor to
dopamine
Carbidopa is a
decarboxylase inhibitor
By preventing levodopa metabolism in the blood, more
levodopa can enter the CNS
In the circulation, levodopa is metabolized to
dopamine and DA in the blood does not penetrate the CNS
Cardiovascular effects of levodopa and carbidopa include
increased inotropy, tachycardia and orthostatic hypotension
Other side effects of levodopa & carbidopa include
dyskinesia, nausea and vomiting
Selegiline is a
MAO-B inhibitor
MAO-inhibitors restore
dopamine concentration by reducing dopamine metabolism in the CNS
Unlike non-selective MAOIs, selegiline does not increase the risk of
tyramine-induced hypertensive crisis
Other treatments for Parkinson’s disease include
dopamine agonists
anticholinergics
amantadine
hormonal replacement
catechol-o-methyltransferase inhibitors
Patients with Parkinson’s disease are at risk for
autonomic instability, orthostatic hypotension, dysrhythmias and aspiration