Flashcards in Psyc ppt (Part 2) Deck (40)
What is the pathological finding of Parkinson's?
Degeneration of the neurons
The degeneration of Neurons originate where in the Brain
The substantia nigra of the midbrain and terminate in the basal ganglia
Name the 2 most reliable and effective drugs to treat Parkinson's
Levodopa and Carbidopa
Levadopa crosses the blood brain barrier and is converted by what enzyme ______into what?
L-aromatic amino acid decorboxylase
Does dopamine cross the BBB?
Levadopa works for Parkinson's disease because it is a ________ to _______ and is converted upon crossing the BBB
Does Carbidopa cross the BBB?
Carbidopa is classified as a ________ ________ ?
Carbidopa inhibits decarboxylase in the Liver, Kidneys and GI tract and prevents the breakdown of _________?
Levadopa (Carbidopa just prevents Levadopa from being broken down before it crosses the BBB)
First symptoms to improve with the use of Levodopa/Carbidopa are?
rigidity and bradykinesia late improvement is the tremors
Levodopa/Carbidopa side effects
NV and anorexia D/T activation of the chemoreactive trigger zone in the medulla oblangata
Cardiac arrythmias D/T Beta adrenergic dopamine stimulation
Long term therapy Side Effects
Abnormal Choreiform movements of the limbs and hands, trunk and tongue.
serious mental disturbances such as psychotic episodes and a need for a 1 week drug holiday
narrow angle glaucoma
Phenothiazines, butrophenones and reserpine can cause extrapryamidal symptoms
Selegiline first line drug for parkinsons before moving to levodopa by?
Enhancing endogenous dopamine
Interacts with TCA's causing
Fever agitation deilerium and coma
Used in mild cases
combats tremors and dystonia
Antihistamines like benadryl
Can be used to control minor tremors in the elderly
What % of people respond favorably to Dopamine agonists
Names of Dopamine agonists
Bromocriptine (parlodel), Pergolide (permax)
Dopamine agonists side effects are
Anorexia and Nausea due to stimulation of the Chemotatic trigger Zone (CTZ)
-Have Pt take meds preoperatively effects last 6-12 hrs
-Avoid Phenothiazines, butyrophenones, metoclopramide
-Muscle rigidity may impede mask ventilation
-Increased aspiration risk
-Intravascularly volume depleted
-Normal response to muscle relaxants
-Increased risk of post op laryngospasm
-violent tremors on emergence
- No ephedrine in taking Deprenyl
-Ketamine can cause exaggerated sympathetic response
-Potential hyperkalemic response to Sucs
-Skeletal muscle tremor may mimic VFIB on ECG
-May have diminished reserve due to poor exercise tolerance
-Muscle relaxants will relax even the most rigid of patients
Anticonvulsants _______ the Seizure threshold
Only ____ % of Pts become SZ free on meds
______% of Pts get no benefit from currently avalilable meds
Inhibition of neuronal Na+ channels in hyperexcitable cells
Disinhibition may increase SZs
Reduction in GABA increases SZs
I-IV based on MOA
Blocks sustained high frequency repetitive firing by enhancing Na+ channel inactivation