Neurodegenerative Diseases
There are six CARDINAL features of parkinson's disease, they include?
Hypomimia (mask-like face)
Tremor at rest
Loss of postural reflexes (lose balance and fall)
Microphagia (illegible handwriting)/pill-rolling
Freezing phenomenon (feet 'stuck' to the ground) thus difficult to initiate body movement
Increased muscle tone
Reduced muscle tone
Rigidity
Monominia (mask-like face)
Akinesia
Gait impairment (postural problems, propulsion problems)
Festination (accelerated gait to avoid falling)
Callonate (accelerated gait to avoid falling)
Incontinence
Dysphagia
The cogwheel phenomenon is?
Inability to move wrist
Elevated muscle tone that allows movement then stop and stays stuck
Inability to rotate along elbow due to reduced muscle tone
Trembling of joints due to reduced muscle tone
Early signs of parkinson's include?
Rigidity
Festination (accelerated gait to avoid falling)
Callonation (accelerated gait to avoid falling)
Hypokinesia (lead to postural change)/Akinesia
Incontinence
Tremor at rest
Dyspnoea
Monomimia (mask-like face)
Freezing phenomenon
Gait impairment
Hypomimia (mask-like face)
Parkinson's disease is a ___ disorder?
Co-ordination
Movement
Cognitive only
Neurotransmitter
There is dysfunction WHERE in the brain in parkinson's disease?
Hippocampus
At GABAergic neurons
Basal ganglia
Hypothalamic-pituitary adrenal axis
Serotonergic neurons
Parkinson's disease mainly manifests as an imbalance between what 2 neurotransmitters?
GABA & dopamine
Dopamine and norepinephrine
Acetylcholine and dopamine
Acetylcholine and GABA
Acetylcholine & norepinephrine
Parkinson's involves a progressive degeneration of neurons located where? (2 answers)
Hippocampus
Amygdala
Substantia nigra
Pituitary gland
Hypothalamic pathway
Nigrostriatal pathway
The progressive degeneration of neurons in parkinson's disease results in?
Increased influence on GABAergic receptors at the frontal lobes
Increased dopaminergic influence on the striatal neurons
Decreased numbers of acetylcholine at neuromuscular junctions
Increased sensitivity to acetylcholine in the basal ganglia
Decreased dopaminergic influence on striatal neurons
Protein misfolding or aggregation is associated with neurodegenerative diseases, which is associated with parkinsons AND cause what characteristic pathology? (2 answers)
Tau protein
Huntington
Lewy bodies
B-amyloid protein
A-synuclein
Neurofibrillary tangles
Amyloid plaques
Prion proteins
The substantia nigra innervates the striatum (which requires a balance of dopamine and acetylcholine) in an inhibitory or excitatory way?
Excitatory
Inhibitory
If dopamine transmission decreases then cholinergic transmission increases/decreases?
Increases
Decreases
Although usually idiopathic, parkinson's disease can also be caused via? (more than 1 answer)
Virus infection
Post-cancer
Diet
Stroke
Antipsychotic drugs
The nigrostriatal pathway is a cholinergic/dopaminergic pathway that connects what 2 parts of the brain?
Cholinergic
Dopaminergic
Hippocampus
Substantia nigra
Amygdala
Olfactory bulb
Striatum
Levodopa is a(n)
Anticholinergic
Dopamine receptor agonist
Dopamine precursor
Dopamine inhibitor blocker
Levodopa is readily absorbed in the GIT (leading to low bioavailability) and metabolised by what enzyme?
Monoamine oxidase A
De-oxiamine B
Dopa-decarboxylase
Acetylcholinerase
Catechol-O-methyl transferase
Levodopa gets converted to dopamine by what enzyme?
Catechol-O-methyl transferase
Monoamine oxidase A
De-oxiamine B
Dopa-decarboxylase
In order to reduce the conversion of levodopa to dopamine in the peripheries and thus require less medication (and thus reduce side effects) what are 2 medications prescribed in conjunction with levodopa AND what do they do?
Benserazide
Carbidopa
Amantidine
Rasagiline
Inhibit MAO
Inhibit decarboxlyase
After 5 years of use, response to levodopa usually remains the same OR decreases?
Decreased response
Remain relatively unchanged
Entacapone and tolcapone are also administered with levodopa to reduce its inactivation and this side effects, what enzyme does it inhibit?
MAO-b
Catechol-O-methyl transferase (COMT)
Methyl-O-Catechol transferase
MAO-a
Levodopa side effects include
Fluctuations in clinical state such as worsening and then improvement of rigidity
Hepatotoxicity
Cardiac conduction defect
Mild and transient cholinergic effects
Dyskinesia (involuntary writing movements).
Anxiety, confusion, delusions, depression
Anorexia
Name 2 ERGOT derived dopamine receptor agonists and the receptors they target, are they associated with MORE or LESS dyskinesia than levodopa?
Bromocriptine
Pergolide
Amantidine
Pramipexole
Levodopa
Ropinirole
More dyskinesia than levodopa
Less dyskinesia than levodopa
D1 and 2
D3 and 4
D2 and 3
Name 2 ergot derived dopamine receptor agonists, which receptors do they act on?
Bromocriptine
Pergolide
Ropinirole
Pramipexole
D2 and 3
D3 and 4
D1 and 2
Non-ergot derives drugs (which have replaced ergot-derived) pramipexole and ropinirole are associated with what side effects?
Cardiac valvular and pulmonary fibrosis
Hallucinations
Somnolence (sleepiness/drowsiness)
Vomiting and nausea
Compulsive behaviours (gambling, sex, eating)
Enzymes that are involved in breaking down/deactivating/inhibiting dopamine include?
Decarboxylase
MAO-b
COMT
MPTP
Which drug inhibits prolactin from the pituitary gland?
Ropinirole
Pramipexole
Amantidine
Bromocriptine
Dopamine breakdown inhibitors include?
COMT inhibitors
MAO-b inhibitors (primarily CNS)
MPTP inhibitors
Selegiline/Rasagiline is a(n)? Selegine has side effects of anxiety and excitement due to it's conversion to?
MPTP inhibitor
Reversible dopamine inhibitor
Irreversible dopamine inhibitor
Reversible MAO-b inhibitor
Irreversible MAO-a inhibitor
Irreversible MAO-b inhibitor
Dopamine
Acetylcholine
Amphetamine
Name a drug that releases dopamine AND potentiates levodopas effects?
Entacapone
Amantidine
Carbidopa
Rasagiline
Amantadine functions by?
NMDA agonist and increases dopamine release
NMDA and COMPT antagonist
NMDA antagonist and decreases dopamine release
NMDA antagonist and increases dopamine release
Benzotropine and benzhexol are forms of what?
Dopamine receptor agonsits
Dopamine breakdown inhibitors
Dopamine precurors
Anticholinergics
What drugs were used before first line levodopa?
Dopamine breakdown inhibitors
Anticholinergics
Dopamine receptor agonists (ergot and non-ergot derived)
Drugs that released dopamine
Choose 3 drugs that antagonise muscarinic acetylcholine receptors and thus inhibit these receptors from inhibiting dopamine release at dopaminergic nerve terminals
Levodopa
Benztropine
Biperiden
Amantidine
Entacapone
Benzhexol
Anticholinergic side effects include?
Impaired vision, constipation
Muscle rigitidity
Dry mouth
Joint pain in patients over 65
Diarrhea
Hallucination and confusion in patients over 65
Anticholinergics (muscarinic receptor antagonists) is avoided in patients..
Under 30
Over 65
Patients with liver damage
Patients with hypokinesia
Anticholinergics such as benztropine and biperiden reduce what symptoms of parkinsons?
Gait issues
Tremor and rigidity
Festination
Flexed neck and trunk posture
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