Flashcards in Drug Treatments of Movement Disorders Deck (50)
What are the main features of neurodegenerative disorders? (3)
-Loss of neurons
-Irreversible (cannot regenerate neurons)
When was Parkinson’s first described, and what were the main features?
How does Parkinson’s progress?
Slowly; usually die within 10-15 years.
-death usually due to bronchopneumonia / sepsis
What is remission, and how common is it in Parkinson’s?
Disappearance of signs.
-rare, and only lasts for seconds/minutes
What are the main symptoms of Parkinson’s? (6)
-Rigidity (increased tone)
-Postural changes (stoop, shuffling)
What are the unusual ways to describe some of the symptoms of Parkinson’s?
TREMOR – ‘pill rolling’
RIGIDITY - ‘lead piping limbs’
DECREASED BLINKING – ‘serpentine stare’
POSTURAL CHANGES – ‘telegraph pole falls’
What is akinesia?
Difficulty initiating voluntary movements.
What is the general pathology of Parkinson’s?
-Loss of neruones in substantia nigra
-Lewy body accumulation (eosinophilic proteins in cells)
-Loss of nigro-subtantia inhibitory-excitatory pathway
What type of neurones are affected by Parkinson’s?
What causes Parkinson’s?
What disorders are associated with Parkinson’s? (3)
What are the 2 pathways affected by Parkinson’s?
Indirect and direct.
-both involve dopamine (D1/D2)
What is the direct pathway?
-signals from striatum
What is the indirect pathway?
-signals from striatum
What is the abbreviation of dopamine?
What are the general mechanisms of Parkinson’s treatment? (2)
-Increase DA activity
-Decrease Ach activity
How is DA activity increased? (4)
-Decrease DA breakdown
-Increase DA release
What drug is used to replace DA?
What drugs are used to decrease DA breakdown? (2)
What drug is used to increase DA release?
What drugs are used as DA agonists? (2)
What class of drugs decrease Ach activity?
What is the 1st line treatment for Parkinson’s?
-MAO / COMT inhibitors
How does L-DOPA increase dopamine levels?
L-DOPA is a precursor for dopamine.
-DOPA decarboxylase converts it
How does L-DOPA act?
-L-DOPA crosses the BBB >> neurones.
-converted to DA in neurones and glia
What is the main problem with L-DOPA?
Metabolised in the periphery >> only 1% reaches brain.
-90% in intestine
What is given with L-DOPA to prevent it being broken down, and how does it work?
-inhibits DOPA decarboxylase
-doesn’t pass BBB
What are the main side effects of L-DOPA?
-‘On-off’ effect (worsening symptoms)
-Nausea / anorexia
What happens to the side effects of L-DOPA with time?
Increased side effects with time.
-partly due to increased dose