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BB2 > Pharmacology of Movement Disorders > Flashcards

Pharmacology of Movement Disorders Flashcards

1
Q

Parkinson’s disease is caused by loss of what kind of cells in which part of the brain?

A

Dopaminergic cells in substantia nigra pars compacta

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2
Q

In Parkinson’s disease (PD) there are Lewy bodies in neurons. What are these?

A

Intracellular formations enriched in the protein α-synuclein

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3
Q

Main features of PD. (6)

A 
Resting tremor
Bradykinesia
Rigidity
Frozen facial expression
Flexed posture
Gait changes
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4
Q

What non-motor features are associated with PD? (6)

By how many years do these precede the motor symptoms?

A 
olfactory dysfunction
depression
psychotic symptoms
dementia
sleep disturbance
autonomic dysfunction

12-15 years

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5
Q

What is the name of the scoring scale for disability?

A

Schwab and England Activities of Daily Living

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6
Q

How can the gradual dopaminergic nigral cell loss be monitored?

A

Through dopamine transporter imaging in the striatum

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7
Q

Are most PD cases genetic or sporadic?

What protein are genetic cases linked to?

A

Sporadic

Alpha synuclein

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8
Q

What is the prevalence and annual incidence of PD?

Is it more prevalent in males or females?

A

100-180 in 100,000 (0.1-0.18%)
4-20 per 100,000 annually
Males

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9
Q

Methyl-phenyl-tetrahydropyridine (MPTP) is transformed into which metabolite?
How is this harmful?

A

MPP+
This is neurotoxic for dopaminergic neurons. Dysfunction of complex I of the mitochondrial respiratory chain can lead to increased oxidative stress.

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10
Q

How is oxidative stress linked to PD?

A

It is increased in PD.

Dopamine is highly oxidisable and its metabolism produces free radicals.

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11
Q

What does MAO(b) stand for? What is it involved in?

A 
Monoamine oxidase (B isoform).
Oxidation of dopamine.
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12
Q

L-tyrosine is converted to ____ which is converted to ____. Which enzyme catalyses the second reaction?

A

L-dopa
Dopamine
L-aromatic amino acid decarboxylase

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13
Q

Dopamine is converted to homovanillic acid in two steps by which two enzymes?

A

MAO and COMT

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14
Q

What type of receptors are dopamine receptors?

A

G-protein coupled receptors

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15
Q

There are D1-like and D2-like receptors.
Which 2 receptors make up the D1 family?
Which 3 make up the D2 family?

A

D1 and D5

D2, D3, D4

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16
Q

What are the five main types of drugs used to treat PD?

A
  1. Dopaminergic compounds
  2. Dopaminergic agonists
  3. MAOB inhibitors
  4. Anti-cholingeric compounds
  5. COMT inhibitors
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17
Q

How do dopaminergic compounds work? Give some examples.

A

They compensate directly for dopaminergic deficit.

L-dopa/levo-dopa (biosynthetic precursor).

18
Q

Give some examples of dopaminergic agonists.

A

Ropinirole, pramipexole, rotigotine (can be used as a transdermal patch), pergolide, bromocriptine, cabergoline…
Apomorphine - given as an infusion.

19
Q

How do MAOB inhibitors work?

A

They protect residual dopamine against oxidation.

20
Q

What kind of drugs are rasagiline and selegiline?

A

MAOB inhibitors.

21
Q

Why are anti-cholinergic compounds used for PD treatment? Give some examples.

A

Dopamine loss leads to hyperactivity of cholinergic cells.

Orphenadrine, procyclidine, trihexyphenidyl.

22
Q

What are entacapone and tolcapone?

A

COMT inhibitors. They optimise the effect of L-dopa.

23
Q

How does amantadine work?

A

It inhibits dopamine reuptake and increases dopamine release.

24
Q

Give examples of peripherally acting DOPA decarboxylase inhibitors? Why are these given?

A

Carbidopa and benserazide.

To maximise the effect of L-dopa on the brain rather than in peripheral tissues.

25
Q

What are the adverse effects of L-DOPA? (6)

A 
Nausea/vomiting
Postural hypotension
Psychosis
Impulse-control disorders
Excessive day-time sleepiness
Motor complications (dyskinesia, dystonia, on-off effect)
26
Q

What is the benefit of dopamine agonists over L-dopa?

A

No motor complications

27
Q

What class of drug should be started for a PD patient at diagnosis and has mild motor disability and no cognitive impairment?

A

MAOB inhibitor

28
Q

What class of drug should be started for a PD patient at diagnosis that has mild/moderate motor disability and no cognitive impairment?

A

Dopamine agonist

29
Q

What class of drug should be started for a PD patient at diagnosis that has moderate/severe motor disability, cognitive impairment and is over the age of 70?

A

L-dopa and COMT inhibitor.

30
Q

Name two other treatment approaches for PD.

A

Human embryonic mesencephalic graft

Deep brain stimulation

31
Q

What does chorea mean?

A

Involuntary jerky movements

32
Q

How is Huntington’s disease inherited?

Which chromosome and which protein are involved?

A

Autosomal dominant disease

The protein is ‘huntingtin’ on chromosome 4. The mutated protein aggregates inside cells.

33
Q

Which amino acid has an abnormal number of repeats (36 repeats) in Huntington’s disease?

A

Glutamine (CAG codon)

34
Q

What pathological changes are associated with Huntington’s?

A

Loss of medium spiny neurons
Cortical atrophy
Striatal degeneration
Intranuclear inclusions of huntingtin

35
Q

What are the symptoms of Huntington’s? (7)

A 
Chorea
Gait abnormalities
Lack of coordination
Cognitive impairment: poor attention, memory difficulties
Psychiatric disturbances
Sleep disturbance
Weight loss
36
Q

What are the mechanisms underlying neurodegeneration in Huntington’s? (7)

A 
Excitotoxicity
Loss of neurotrophic factors
Accumulation of aggregates of mutant huntingtin protein
Dysregulation of transcription
Increased oxidative stress
Abnormalities in axonal transport
Synaptic abnormalities
37
Q

How is Huntington’s managed?

A

Tetrabenazine (synaptic vesicular amine transporter inhibitor)
Anti-dopaminergic (antipsychotic) drugs
Antidepressant drugs

38
Q

Give some examples of anti-dopaminergic drugs.

A

Haloperidol

Olanzapine

39
Q

Give some examples of anti-depressant drugs.

A

Imipramine

Amitriptyline

40
Q

How does Parkinson’s affect the direct/indirect pathways?

A

The loss of dopaminergic cells results in an imbalance between the direct and indirect pathways.

BB2 (32 decks)

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