Brock

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Author:
Spykenard
ID:
188320
Filename:
Brock
Updated:
2012-12-12 22:23:11
Tags:
Pharmacology
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Description:
Brock - Anti Parkinsonians
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  1. Where is the basal ganglia and what is its function?
    In the forebrain; motor response and habitual action selection
  2. _____________ receives input from the substantia nigra pars compacta and is the primary input of the substantia nigra.
    caudate putamen
  3. From where does the substantia nigra pars compacta receive its name?
    The high concentration of melanin within its dopaminergic neurons.
  4. What two neuromodulators act on the caudate putamen?
    DA and ACh
  5. _____ is an inhibitory NT;
    _____ is an excitatory NT
    • GABA - inhibitory
    • Glutamate - excitatory
  6. The basal ganglia has two efferent neurons.  One goes to the 'go' pathway (which is the _____), and the other goes to the 'no go' pathway (which is the _____)
    • globus pallidus/substantia nigra reticulata [GO]
    • external globus pallidus [NO GO]
  7. What is the function of the direct/GO pathway?
    Leads to movement through binding of D1 receptors
  8. What is the function of the indirect/NO GO pathway?
    Activate the D2 receptor; NO MOVEMENT
  9. What will ACh do to the DA neurons in the caudate putamen?
    ACh tends to excite the indirect pathway and inhibit the direct pathway.
  10. What is the primary deficit of PD?
    Loss of melanic DA neurons in the substantia nigra pars compacta
  11. Why are DA reuptake inhibitors not effective in treating PD?
    PD is a loss of dopaminergic neruons.
  12. Why is L-DOPA co-administered with carbidopa?
    Carbidopa is a peripheral decarboxylase inhibitor, which prevents the L-dopa in the periphery from being synthesized into DA
  13. What is the major side effect of L-DOPA being synthesized into DA in the gut?
    Nausea, because of activation of DA receptors in the chemoreceptor zone.
  14. What are the two major contraindications for L-DOPA?
    1. MAO inhibitors - a major enzyme used in the metabolism of DA, inhibiting this may lead to a build of DA, which could be life threatening and/or result in psychosis/hallucinations

    2. Patients with closed-angle glaucoma.  DA becomes NE in the eye and can result in even less outflow of aqueous humor.
  15. Name 2 COMT inhibitors.
    • Entacapone (Comtan)
    • Stalevo (carbidopa+levodopa+entacapone)
  16. What is the most frequently prescribed DA agonist?
    Pramipexole (Mirapex)
  17. Name a direct acting DA agonist that is formulated as a transdermal system.
    Rotigotine (Neupro)
  18. What are the general class features of DA agonists?
    • 1. Selective for D2
    • 2. Effective as monotherapy, or adjunct therapy with L-DOPA
    • 3. Longer duration of action than L-DOPA
    • 4. May reduce on-off fluctuations or "wearing off" effect
    • 5. May help more in late disease stages
    • 6. Significantly lower rates of motor side effects (dyskinesias)
    • 7. Possibly slows disease progression
  19. Name three DA agonists.
    • Pramipexole
    • Ropinirole
    • Rotigotine
  20. What are three common adverse effects associated with DA agonists?
    • Increased sedation
    • Hallucinations/psychosis
    • Impulse control disorders
  21. Which pathway to DA agonists target? Direct, indirect, or both?
    Direct
  22. Name 2 MAO-B inhibitors.
    • Selegiline
    • Rasagiline
  23. Name the "other" DA agonist.
    Apomorphine
  24. What makes apomorphine special?
    • D2 agonist
    • Administered s.c. via pen
    • Used to treat sudden on/off periods
    • Significant N/V
    • Contraindicated in patients taking 5HT3 agonists because of exacerbated hypotension
  25. Name 2 anticholinergic agents used for PD.
    • Trihexyphenidyl
    • Benztropine mesylate
  26. What is amantadine?
    An antiviral agent
  27. What are the three classes of Anti-Parkinsonian drugs?

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