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parkinson & alzheimer disease pharmacology Flashcards

1
Q

what is neurodegenerative disease?

A

nerve cells in brain or PNS lose functions and ultimately die
progressive & incurable

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2
Q

what is parkinson disease?

A
  • Progressive neurodegenerative disease
  • Extrapyramidal motor symptoms (tremors, rigidity and bradykinesia) due to striatal dopaminergic deficiency
  • Various other neurotransmitters involved in non-motor symptoms (autonomic, psychiatric, sensory, ocular, gait imbalance)
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3
Q

what are the motor symptoms of PD?

A
  • Tremor at rest (“pill-rolling”)
  • Bradykinesia (slowness of movement)
  • Rigidity (“cogwheeling”)
  • Postural instability and gait disturbances
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4
Q

what is the pathophysiology of PD?

A

Impaired clearing of abnormal/damaged intracellular proteins by ubiquitin-proteasomalsystem.
- Failure to clear toxic proteins –> accumulation of aggresomes –> apoptosis
- Lewybodies ≈ aggresome, containing α-synucleinand ubiquitin
- Degeneration of dopaminergic neurons with Lewybody inclusions in substantia nigra –> dysfunction of nigrostriatalpathway

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5
Q

what is the function of basal ganglia?

A

motor control
Involved in “action selection”
– Normally inhibit a number of motor systems
– Substantia nigra-mediated release of inhibition permits a motor system to become active
– Involves both excitatory D1 and inhibitory D2 receptors

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6
Q

how is dopamine synthesis?

A

-L-tyrosine –> L-dopa (tyrosine hydroxylase)
-L-dopa –> dopamine (DOPA decarboxylase)

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7
Q

how is dopamine broken down?

A

dopamine –> homovanillicacid (catechol-O-methytransferase,
COMT & monoamine oxidase, MAO)

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8
Q

which (dopamine or L-dopa) crosses BBB?

A

L-dopa
dopamine dont cross BBB

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9
Q

what drugs can be used to treat parkinson?

A

increase synthesis: levodopa
inhibit breakdown: COMT inhibitor, MAOI
dopamine receptor agonist

others: NMDA antagonist, anticholinergic

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10
Q

what is the MOA of levodopa?

A

increase synthesis of dopamine
can cross blood brain barrier
gold standard

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11
Q

what is levodopa administered together with to minimise side effects?

A

carbidopa, bensarazide = peripherally DOPA-decarboxylase inhibitor

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12
Q

what are the side effects of levodopa?

A

short term: nausea, vomiting, postural hypotension
long term: motor fluctuations, dyskinesia

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13
Q

what are the COMT inhibitor available?

A

entacapone
tolcapone

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14
Q

what is the MOA of COMT inhibitor?

A

inhibit conversion of dopamine/L-dioa into inactive form –> more levodopa available

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15
Q

indication of COMT inhibitor

A

adjunct with levodopa
increase duration of each dose of levodopa, help with “wearing off” responses

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16
Q

what are the side effects for COMT inhibitor?

A

increase abnormal movements (dyskinesia)
liver dysfunction (tolcapone)
nausea, diarrhea
urinary discoloration
visual hallucinations
day time drowsiness, sleep disturbances

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17
Q

what are the MAOI used in PD?

A

irreversible MAOB inhibitor
selegiline, rasagiline

18
Q

what are the indication for MAOI?

A

mild antiparkinson activity
monotherapy in early stages

19
Q

what is the MOA of MAOI

A

inhibit enzyme monoamine oxidase B & interferes with the breakdown of dopamine
may delay nigral brain cell degeneration

20
Q

what are the side effects of MAOI?

A

heartburn, loss of apetite
anxiety, insomnia, palpitation
nightmare, visual hallucinations

21
Q

what are the dopamine agonist available?

A

pramipexole
pergolide
ropinirole

22
Q

what is the MOA for dopamine agonist?

A

act directly on dopamine receptors in brain to reduce symptoms of PD

23
Q

place in therapy for dopamine agonist?

A

prevent or delay onset of motor complications
preferred choice in younger indiv

24
Q

what are the side effects for dopamine agonist?

A

common: nausea, vomiting, orthostatic hypotension, headache, dizziness & cardiac arrhythmia
pergolid: ‘ergot’ derivative, peritoneal fiborsis, cardiac valve regurgitation
pramipexole & ropinirole: sedation, somnolence, daytime sleepiness

25
Q

what is the MOA for amantadine?

A

enhance release of stored dopamine
inhibit presynaptic uptale cathecolamine
dopamine receptor agonist
NMDA receptor antagonist

26
Q

what is amantadine use for?

A

antidyskinetic
reduce dyskinesia in those with motor fluctuations

27
Q

what are the side effects for amantadine?

A

cognitive impairment
hallucination
insomnia
nightmares
livedo reticularis

28
Q

what is the anticholinergic used in PD?

A

trihexyphenidyl (benzhexol)

29
Q

what is anticholinergic used for in PD?

A

may be effective in controlling tremor
peripherally acting agents may be useful in treating sialorrhoea

30
Q

what are the side effects of anticholinergics?

A

dry mouth, sedation, constipation, urinary retention, delirum, confusion, hallucinations

31
Q

the pathological characteristic of AD?

A
  1. senile plaques: aggregates of beta-amyloid, formed from cleavage of amyloid precursor protein
  2. neurofibrillary tangles: hyper-phosphorylated tau protein –> paired helical filament
32
Q

pathophysiology of AD?

A

neurodegeneration –> brain atrophy
neurochemical deficits & alterations –> cognitive decline & neuropsychiatric behaviours

33
Q

what is the difference between MAO vs cholinergic synapse?

A

MAO reuptake into presynpatic –> broken down by COMT/MAO

acetylcholine broken down to choline & acetyl by acetylcholinestearse in the synapse then choline reuptake

34
Q

what is the goal of AD management?

A

disease modifying (currently not possible)
slow progression
delay need to institutionalization

35
Q

what is use in mild to moderate AD?

A

acetylcholinesterase inhibitors
- donepezil
- galantamine
- rivastigmine

36
Q

compare between galantamine vs rivastigmine

A

formulation: galantamine available as PO tablet only, rivastigmine available as PO & transdermal
half life: rivagstigmine shorter t1/2 than galantamine
other receptor activity: galantamine may also act on nicotinic receptor brain
clearance: galantamine metabolized by liver CYP450, rivastigmine primarily cleared by kidneys

37
Q

what are the side effects for acetylcholinesterase inhibitors?

A

nausea, vomiting, diarrhea
muscle cramp, bradycardia, loss of appetite, increased gastric juice secretion

38
Q

what is used for moderate to severe AD?

A

memantine

39
Q

what is memantine?

A

noncompetitive NMDA receptor antagonist

40
Q

what are the side effects of memantine?

A

hallucination, confusion, dizziness, headaches

41
Q

what is the clinical implication of the cholinergic synapse?

A

drug that work in synapse to inhibit breakdown of acetylcholine to prevent choline from being reuptake, dont need enter cells

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