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Flashcards in Psyc ppt (Part 2) Deck (40):
1

What is the pathological finding of Parkinson's?

Degeneration of the neurons

2

The degeneration of Neurons originate where in the Brain

The substantia nigra of the midbrain and terminate in the basal ganglia

3

Name the 2 most reliable and effective drugs to treat Parkinson's

Levodopa and Carbidopa

4

Levadopa crosses the blood brain barrier and is converted by what enzyme ______into what?

L-aromatic amino acid decorboxylase
Dopamine

5

Does dopamine cross the BBB?

NO

6

Levadopa works for Parkinson's disease because it is a ________ to _______ and is converted upon crossing the BBB

precursors
Dopamine

7

Does Carbidopa cross the BBB?

NO

8

Carbidopa is classified as a ________ ________ ?

decarboxylase inhibitor

9

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)

10

First symptoms to improve with the use of Levodopa/Carbidopa are?

rigidity and bradykinesia late improvement is the tremors

11

Levodopa/Carbidopa side effects

NV and anorexia D/T activation of the chemoreactive trigger zone in the medulla oblangata
orthostatic hypotension
Cardiac arrythmias D/T Beta adrenergic dopamine stimulation

12

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

13

Levodopa/Carbidopa contraindications

MAO Inhibitors
narrow angle glaucoma
cardiac arrythmias
recent MI
Phenothiazines, butrophenones and reserpine can cause extrapryamidal symptoms

14

Selegiline first line drug for parkinsons before moving to levodopa by?

Enhancing endogenous dopamine

15

Interacts with TCA's causing

Fever agitation deilerium and coma

16

Belladonna Alkaloids

Used in mild cases
combats tremors and dystonia

17

Antihistamines like benadryl

Can be used to control minor tremors in the elderly

18

What % of people respond favorably to Dopamine agonists

only 20-30%

19

Names of Dopamine agonists

Bromocriptine (parlodel), Pergolide (permax)

20

Dopamine agonists side effects are

Anorexia and Nausea due to stimulation of the Chemotatic trigger Zone (CTZ)

21

Anesthetic Implications

-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

22

Anesthetic Implications

-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

23

Anesthetic Implications

-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

24

Anticonvulsants _______ the Seizure threshold

Raise

25

Only ____ % of Pts become SZ free on meds

40%

26

______% of Pts get no benefit from currently avalilable meds

20%

27

Anticonvulsants MOA

Inhibition of neuronal Na+ channels in hyperexcitable cells
Disinhibition may increase SZs
Reduction in GABA increases SZs

28

Anticonvulsants Classes

I-IV based on MOA

29

Type I

Blocks sustained high frequency repetitive firing by enhancing Na+ channel inactivation
-Phenytoin
-Carbamazepine

30

Type II

Multiple actions: enhances GABA inhibition reduces T calcium currents, possibly blocks SRF
-Valproic Acid
-Benzos
-Phenobarbital

31

Type III

Blocks T calcium currents only
-Trimethadione

32

Type IV

only enhances GABA inhibition
-Gabapentin

33

Na+ Channel blocking agents such as

Dilantin used for general tonic clonic and partial SZ

34

Dilantin adverse effects

Overdose- nystagmus, ataxia, vertigo, diplopia
Common- enlarged lips and nose, gingival hyperplasia
idiosyncratic- dermatitis, hepatic necrosis

35

Carbamazepine (Tegretol)

Used for tonic clonic and absent SZ
common SE id drowsiness
Increases metabolism in other anticonvulsants

36

Barbiturated

Increases GABA inhibition
main SE sedation and disturbance in cognitive function

37

Valproic Acid

Blocks Na+ channels and increases GABA in the brain
SE hepatotoxic and Fetal neural tube defects

38

Benzos

interacts with GABA and causes sedation with a rapid development of tolerance

39

Phenytoin

resistant to NDNMB
causes decreased duration of muscle relaxants
rate of administration is 25-50 mg / min to avoid hypotension
Stevens-Johnson syndrome

40

Anesthetic Implications

Induction w/ thiopental or propofol
N2O/Narcotic techniques
Avoid enflurane and methohexital
opoid tolerance r/t enzyme activation by the anticonvulsants