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cteems1's version from 2016-12-13 00:01

Parkinsonism

Question Answer
The etiology of Parkinsonism is not well understood (obscure) but list 6 known contributing factorsSyphilis, Carbon monoxide, cerebral hypoxia, traumatic brain injury, antipsychotic medications, environmental factors/toxins (i.e., MPTP)
One theory of Parkinsonism (Intraneuronal metabolism of dopamine--> generation of free radicals) theorizes that low levels of dopa in _____ _____ and _______ → leads to overactivity of _____ pathwaysSubstantia Nigra & Striatum; Cholinergic pathways
Another suggested cause of Parkinsonism Decreased antioxidant defenses due to decreased ________Glutathione (an endogenous antioxidant)
Parkinsonism drug that treats by "replenishing dopamine"Levodopa
Bromocriptine, Pergolide, & Apomorphine are all agonists for what receptor?Dopa receptor
This drug prevents the intraneuronal breakdown of dopamine by inhibiting MAO-B isoenzyme (which is specific for dopamine)Selegline
catechol-O-methyl transferase (COMT) inhibitors are used to inhibit formation of _______ because it causes loss of ____, and competition for _____ transporters... lowering _____ efficacyinhibit formation of 3-O-methyldopa; Dopamine, L-dopa transporters, LevoDopa efficacy (drug e.g. Entacapone & Tolcapone)
What antiviral for influenza can be used to treat Parkinsonism because of its dopa agonistic activity and anticholinergic activityAmantadine***
What is the rate limiting enzyme for catecholamine synthesis?tyrosine B-hydroxylase***
T/F: Levodopa treatment cures Parkinsonism and alters progression of the diseaseFalse (NOT a cure does NOT alter progression; but does help relieve symptoms)
T/F: Levodopa is NOT a cure for Parkinsonism and doesn’t alter progression of disease, but does help relieve symptomatologyTrue (beneficial in 75% of cases)
Levodopa treatment of Parkinsonism is beneficial in ____% of cases75%
What is the administration route of Levodopa for parkinsonism tx?Oral route
High ______ content in diet can adversely affect absorption/transport of Levodopa to the CNSprotein
Dopamine is metabolized by what 2 enzymes?MAO (monoamine oxidase) & COMT (catechol-O-methyl transferase)
What are the 2 major "side effects" (these are really fluctuations in therapeutic effectiveness & not what you would usually consider side effects) of Levodopa (Parkinsonism tx)?Wearing effect (periods of ineffectiveness as dose wears off, at some point of prolonged use of LevoDopa the medication is not effective for the intended therapeutic time) & On-Off phenomenon (periods of therapeutic fluctuations ranging from efficacy to failure that are unrelated to administration timing of drug, so different than wearing off)
T/F: Dopa doesn't cross the BBB, but Levodopa doesTrue
T/F: Levodopa doesn't cross the BBB, but Dopa doesFalse (vice-versa)
____ induced dyskinesia is a common problem for patients undergoing parkinson's treatmentLevodopa
what are the CV effects associated with Levodopa: inc incidence of ______ and occasional ______arrhythmia; hypertension
Tyramine (in meats, wine & cheese) can negatively interact with what class of drugs that are sometimes used to treat ParkinsonismMAO-Inhibitors
_________ (in meats, wine & cheese) can negatively interact with MAO-Inhibitors (which are sometimes used for Parkinsonism)Tyramine
Severe HTN from Parkinsonism treatment is most likely associated with _______ (selective/non-selective) drugs from what class?Non-selective; MAO-Inhibitors
The GI side effects of Levodopa (nausea, GI disturbances) can be minimized by also prescribing ________ or decarboxylase inhibitorCarbidopa (drug most commonly prescribed with Levodopa)
What drug is most commonly prescribed with LevodopaCarbidopa (has added benefit of improving GI side effects)(acts by decreasing peripheral metabolism of levodopa)
This drug (5HT-3 antagonist) is used as an anti-emetic and to decrease Levodopa induced visual hallucinationsOndanestrone
Can you give typical antipsychotics (such as Phenothiazine) to alleviate the psychosis side effects that are associated with Levodopa?No, (b/c they will lower dopamine levels and increase Parkinsons symptoms)(can still give the atypical antipsychotic Clozapine) (and also the drug Ondansetrone)
This drug is a 5HT-2a receptor antagonistNuplaside
List 2 Dopamine Receptor agonistsBromocriptine & Pergolide
______ (dopamine receptor agonist) may cause hallucinations, cardiac arrhythmia, hepatotoxicity, worsen dyskinesia, and can cause sudden episodes of ‘freezing’Pergolide
This drug is a Selective Irreversible Inhibitor of MAO-B IsozymeSelegiline
Selegiline (Selective Irreversible Inhibitor of MAO-B Isozyme) is Metabolized to ____/______ in liver and brainAmphetamine/Methamphetamine
COMT inhibitors such as ______ (peripheral action only) & _______ (central & peripheral action) block COMT and inc/extend effects of l-dopa in patients with advanced or fluctuating Parkinson’s diseaseEntacapone & Tolcapone
These 2 Anticholinergic Agents restore DA-Ach balance and tremors often respond better to this treatment than to Levodopa/CarbidopaBenztropine & Trihexyphenidyl
Loss of what sense is a biological marker for Parkinsonism?Olfaction (can't smell none)
T/F: Use of epinephrine is contraindicated for patients with ParkinsonismFalse (but if they are taking COMT inhibitors, e.g. Entacapone & Tolcapone, then there are interactions with epi)
What class of drugs for tx of Parkinsonism may cause possible interaction with epi?COMT inhibitors (e.g. Entacapone & Tolcapone)
What class of drugs for tx of Parkinsonism has interactions with Erythromycin (antibiotic) & MAO-inhibitors?COMT inhibitors (e.g. Entacapone & Tolcapone)
What Antiviral, weak anticholinergic, Glutamate receptor (NMDA) antagonist is commonly used in combo with Levodop/carbidopa?Amatadine (b/c of its dopa agonist and anticholinergic actions)
The ______ is the most affected of orofacial structures in patients with parkinsonism, making it difficult to do dentistry on patientsTongue
The _______ effect is a complication in the effectiveness of LevoDopa therapy where the medication is not effective for the intended duration (tolerance that manifests as medicine not being effective as long)Wearing effect (a form of tolerance)
The ___-___ phenomenon is a complication of the effectives of Levodopa therapy where symptoms can suddenly onset and the medication can fluctuate in its effectivenessOn-Off Phenomenon (related to tolerance)
T/F: MAO (pre-synaptic) and COMT (post-synaptic)True
T/F: MAO (post-synaptic) and COMT (pre-synaptic)False (other way around)
MAO is ____-synaptic in its actions and COMT is ___-synapticMAO pre COMT post
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