Degenerative Disorders

Question 1

What is an excitatory amino acid that could be a mechanism for a CNS degenerative disorder?

Answer 1

Glutamate overstimulating NMDA/AMPA receptors

Question 2

What is the usual age of onset for Parkinson’s disease?

Answer 2

60 yrs (only 10% will have onset before 60)

Question 3

What are some clinical manifestations of Parkinson’s disease?

Answer 3

Tremors, rigidity, bradykinesia, postural problems, drooling, slurred speech, and depression

Question 4

What histologic feature is seen in Parkinsons?

Answer 4

Lewy bodies

Question 5

What are late symptoms of Parkinson’s?

Answer 5

Depression leading to reclusiveness, immobility, and bowel incontinence

Question 6

What is the occurrence of Parkinson’s past 80 yrs of age?

Answer 6

50%

Question 7

Which neurotransmitter is diminished in Parkinson’s?

Answer 7

Dopamine (DA)

Question 8

What part of the brain degrades in Parkinson’s?

Answer 8

The striatum nigra (due to DA radicals)

Question 9

What are some possible environmental causes for Parkinson’s?

Answer 9

pesticide exposure, head trauma, DA turning into quinones, Mg or Hg exposure

Question 10

What drug combination is popular to use with Parkinson’s patients?

Answer 10

L-dopa + cabidopa

meant to increase DA levels

Question 11

What is L-dopa?

Answer 11

A precursor to DA (large doses must be given to benefit pt)

Question 12

What is cabidopa?

Answer 12

A drug inhibiting peripheral metabolism of L-dopa

Question 13

What drug might be beneficial for the Parkinson’s patient to reduce drooling?

Answer 13

Benztropin (one of the side effects is xerostomia)

Question 14

Which drug can improve the effect of carbidopa and L-dopa on Parkinson’s?

Answer 14

Entacapone

Question 15

What MAO inhibitor alters the progression of Parkinson’s?

Answer 15

Selegiline

Question 16

What surgical approach is used to increase DA in the brain?

Answer 16

Deep brain stimulation (most effective in early parkinson’s)

Question 17

What is the only drug used to medicate for Parkinson’s that doesn’t cause xerostomia?

Answer 17

Selegiline (because it isn’t a working on cholinergic pathways)

Question 18

What are some side effect of L-dopa?

Answer 18

Bruxism, psychosis, confusion

Question 19

What is one important dental consideration with Parkinson’s patients?

Answer 19

They have difficulty swallowing so we need to use high-volume suction

Question 20

What are some general dental considerations for Parkinson’s pts?

Answer 20

Major procedures should be completed in early PD, appts should be short as possible and after PD meds have been taken

Question 21

Abnormal movements seen in Huntington’s disease are from what?

Answer 21

Too much DA in the striatum nigra projection

Question 22

What symptoms are experienced in early Huntington’s?

Answer 22

Diminished judgement and depression

Question 23

What part of the brain is lost in Huntington’s?

Answer 23

The caudate neurons

Question 24

What causes Huntington’s?

Answer 24

A genetic trait that increases Glutamate activity on NMDA receptors, ultimately burning them out

Question 25

What are three drugs that are used to treat Huntington's?

Answer 25

Haloperidol (D2 antagonist), Cytalopram (SSRI), and Baclofen (GABA agonist)

Question 26

What is haloperidol?

Answer 26

A D2 antagonist meant to decrease the DA stimulation occurring in the brain

Question 27

What is Cytalopram?

Answer 27

An SSRI used to fight depression by increasing serotonin signaling

Question 28

What is Baclofen?

Answer 28

A GABA agonist used to reduce the bradykinesia and muscle rigidity

Question 29

What are three areas of the brain involved in Alzheimer's?

Answer 29

- hippocampus - frontal cortex - nucleus basalis

Question 30

What autosomal syndrome has an increased incidence in early onset Alzheimer's?

Answer 30

Down syndrome (trisomy 21)

Question 31

Name two histologic features in Alzheimer's?

Answer 31

Senile plaques of β amyloid, and Neurofibrillary tangles of tau protein

Question 32

What neurotransmitters are involved in Alzheimer's?

Answer 32

ACh is decreased, (β amyloid and tau protein are compromised)

Question 33

What drug is given to increase ACh in Alzheimer's patients?

Answer 33

Donepezil

Question 34

What happens to the patient in multiple sclerosis?

Answer 34

An immune response destroys myelination of axons

Question 35

What is the pathophysiology of MS?

Answer 35

possible viral infection causing acute inflammatory episodes, possible genetic component

Question 36

Name the four classifications of MS.

Answer 36

- benign - relapsing remission - relapsing progressive - chronic progression

Question 37

Because MS is an inflammatory problem, what could we give the patient?

Answer 37

A steroid for antiinflammation (like Prednisone)