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Pharmocolgy > Neuro Pharmological > Flashcards

Neuro Pharmological Flashcards

(45 cards)

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1
Q

What is IPD ?

main cause?

A

neurodegenerative disorder
progessive course
low dopamine in substania nigra-

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2
Q

what are the clinical features (Motor) of parkinson’s ?

A 
one sided at the start
motor symptoms -
Tremor - at rest pill rolling 
bradykinesia 
Postural instability 
rigidity - lead pipe
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3
Q

what are Non-motor manifestations of PD?

A 
Mood changes 
pain
cognitive change 
urinary symptoms 
sleep disorder 
sweating 
drooling
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4
Q

what are common prognostic problems of PD?

A 
Dyskinesia 
falls
cognitive decline 
somnolence 
swallowing difficulty 
speech problems
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5
Q

what other causes other then idiopathic for Parkinson’s ?

A

Drug induce - Metoclopramide

vascular (stroke)

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6
Q

what histological features are seen in IPD ?

A

Lewy bodies

loss of pigment of Sn

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7
Q

what is problem with treating parkinson’s when it manifests?

A

by then 50% of dopamingeric neurones are lost and we are trying to persevere them

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8
Q

explain the basal ganglia circuit malfunction in Parkinson’s

A

loss of dopamingeric neurones in Sn = reduced inhibition on neostriatum = increased ACh to motors cortex and spinal cord

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9
Q

what is the synthesis chain of dopamine?

A

L-Tyrosine –> L-Dopa –> Dopamine –> NA –> A

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10
Q

what 2 enzymes breakdwon Dopamine?

A

MAO -Monoamine oxidase

COMT - Catechol-O-Methyl transferase

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11
Q

what possible scan is done for PD? what does it measure?

A

DAT

measures presynaptic uptake of dopamine

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12
Q

Why don’t you use Dopamine for Parkinsons?

A

does not cross BB

L-DOPA crosses via active transport

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13
Q

why is L-Dopa only good in early Parkinson’s ?

A

a substantial amount of dopmingeric cells in Sn are still present to convert L-Dopa to dopamine . fewer cells = less reliable effect

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14
Q

what is the Absorption of L-Dopa like ?

A

Active transport , competed with amino acids (dont eat high protein meals)
90% inactivated at intestinal wall

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15
Q

what is the Metabolism of L-Dopa?

A

T1/2 = 2 hrs so many doses
9% converted to dopamine in periphreal tissues
less than 1% enters CNS - competing with amino acids

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16
Q

what is L-Dopa given with ? why and name the 2 drugs combined ?

A

Dopa decarboxylase inhibitor
reduced dopamine production at peripheral tissues = reduce dose of L-Dopa and side effects

Co-Beneldopa
Co-careldopa

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17
Q

what is formulations of L-Dopa?

A

tablets
controlled release preps
dispersible madator

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18
Q

what drugs should you not use with L-Dopa ?

A

D2 antagonist: Domperidone, Metoclopramide

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19
Q

what are Low-Side effects of L-Dopa?

Study These Flashcards
A

Nausea / vomiting
hypotension
Psychosis
tachycardia

20
Q

what are long term side effects of L-Dopa ?

Study These Flashcards
A

Loss of efficacy
involuntary movements
motor complication- dyskinesias , dystonia and freezing

21
Q

what drugs have adverse interactions with L-Dopa ? why?

Study These Flashcards
A

Pyridoxine (Vit D) - Increase periphrel breakdown of L-Dopa
MAOs = risk of hypertension
Antipsychotics = Metoclopramide , Chlopromazine

22
Q

Name some D agonists used in parkinson’s

Study These Flashcards
A

Apomorphine - SC
Ropinirole-
Rotigotine- Patch

23
Q

When is apomorphine indicated ?

Study These Flashcards
A

sever motor fluctuations

24
Q

what D agonists used for ?

Study These Flashcards
A

first line in PD

or added one therapy

25
what advantages of Ropinirole ?
``` Direct acting • Less dyskinesias/ motor complications • Possible neuroprotection ```
26
what disadvantages of Ropinirole ?
``` Less efficacy than L-DOPA • Impulse control disorders • More psychiatric s/e • Dose limiting • Expensive ```
27
what is Impuilse control disorder ? what behavioural issues does it lead to ?
Dopamine dysregualtion syndrome Pathological gambling , shopping , Punding hypersexuality , desire to increase dosage
28
what are ADRs of Ropinirole ?
sedation , hallucinations , confusions , nausea and hypotension
29
Name 2 MAOI type B drugs
Rasagiline, Selegiline
30
Name a COMT inhibitor
Entacapone
31
what is Entacapone's MOA?
Inhibits COMT in the periphery (but not, or at most marginally, in the brain[10]) and the metabolism of levodopa, thus increasing plasma levels of levodopa
32
Why do you give L-Dopa with Entacapone ? indications ?
Entacapone cant cross BB wearing off symptoms
33
What symptoms of PD treated by Anti-ACh ? Name 1 , name 1 side effects
Orphenadrine, Procyclidine, tremor ``` No effect on bradykinesia • Side effects • Confusion • Drowsiness • Usual anticholinergic s/e ```
34
what are surgery criteria for parkinsons ?
* Dopamine responsive * Significant side effects with L-DOPA * No psychiatric illness
35
what causes Myasthenia Gravis?
IgG blocks of neuromuscular junctions leading to less ACh binding to post synaptic receptors
36
what is key symptoms in Myasthenia Gravis?
Fluating and fatiguable weakness of skeletal muscles
37
what are common presentations of Myasthenia Gravis?
Extraocular muscles – commonest , Ptosis and diplopia ) – Bulbar involvement – dysphagia, dysphonia, dysarthria, slurring of speech – Limb weakness – proximal symmetric – Respiratory muscle involvement may be combined
38
what common drugs exacerbate Mg ?
``` Aminoglycosides • Beta-blockers, CCBs, quinidine, procainamide • Chloroquine, penicillamine • Succinylcholine • Magnesium • ACE inhibitors ```
39
what do you give in myasthenic crisis ? what must you be careful of ?
• IV immunoglobulin or plasmapheresis ABC approach over treatment lead to cholinergic crisis
40
what symptoms seen in myasthenic crisis ?
resp distress dilation of pupils increased pulse , BP Dysphagia and weakness
41
what is treatment options for MG?
``` Acetylcholinesterase inhibitors • Corticosteroids – Decrease immune response • Steroid sparing – Azathioprine • IV immunoglobulin Plasmapheresis – Removes AChR antibodies ```
42
how to Acetylcholinesterase inhibitors help in MG? | What are disadvantages
– Enhance neuromuscular transmission in Skeletal and smooth muscle Excess dose can cause depolarising block – cholinergic crisis Muscarinic side effects
43
Name 1 Acetylcholinesterase inhibitors
Pyridostigmine -
44
what must you be aware of when giving Pyridostigmine - ?
peak onser of action 60-120 mins | give before meal times so patients with MG can eat properly
45
what are side effects of cholingerics ?
``` miosis and the SSLUDGE syndrome: » Salivation, » Sweating, » Lacrimation » Urinary incontinence » Diarrhea, » GI upset and hypermotility » Emesis) ```

Pharmocolgy (22 decks)

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