#9 Movement disorders 10-27-06
Terms
undefined, object
copy deck
- tremor?
- rhythmic/oscillatory movement around a joint
- resting tremor
-
1) parkinson's dz
2) rigidity
3) impairment of volitional move. - essential tremor
-
1) postural tremor
2) possible beta 1 receptor mediation - intentional tremor
- 1) caused by toxic rx to alcohol and other drugs (phenytoin)
- chorea
- dopamine/Ach/GABA basal ganglia imbalance (too much dopamine?)
- athetosis
- slow, writhing abnoramal move.
- dystonia
- postural abnormality - asso. with sustained, abnormal move.
- tics
- sudden, abnormal "coordinated" move.
- choronic, multiple tics?
- Gilles de la Tourrette's syndrome
- symptoms of Parkinson's dz
-
1) tremor
2) bradykinesia
3) rigidity
4) characteristic gait/ postural abnormality - characteristics of parkinson's
-
1) choronic
2) progressive
3) begins in middle/late life
4) affects all ethnic group
5) equal gender distribution - frequency population over 65 yrs
- 1 per 100 persons
- neuronal loss in parkinson's
- loss of "substantia nigra pars compacta cells" cause reduced "nigral-striatal dopamine input" to the putamen
- D-1 mediated direct pathway
- loss of an striatal excitatory dopamine input
- D-2 mediated, indirect pathway
- loss of an striatal inhibitory dopamine input
- cause of parkinson's?
- unknown
- possible causes of parkinson's?
-
1) environmental toxin
2) endogenous toxins - clinical manifestations of parkinson's
-
1) tremor
2) rigidity
3) bradykinesia - akinesia (severe)
4) flat affect
5) blepharoclonus
6) blepharospasm
7) drooling
8) voice: hypophonic, poorly modulted
9) small, tremulous handwriting
10) festinating gait
11) tapping over the glabella
12) depression
13) impaired cognitive function (dementia in advanced cases) - Dopamine
-
1) does not cross BBB
2) ineffective if administered peripherally - L-Dopa
-
1) crosses the BBB
2) metabolic precursor dopamine
3) enters neuronal cells and is decarboxylated to dopamine - D1 receptor
-
1) anedyl cyclase stimulation
2) increase cAMP levels
3) located in substantia nigra zona compacta - D2 receptor
-
1) adenyl cyclase inhibition
2) decreases cAMP levels
3) postsynaptic localization on striatal neurons - Levodopa (Dopar)is given with?
- carbidopa (Lodosyn) = dopa decarboxylase inhibitor
- Levodopa is given with Carbidopa to decrease?
- peripheral decarboxylation of levodopa
- L-dopa is most effective in diminishing?
- bradykinesia (improves all parkinson's dz symptoms)
- SE of levodopa
- 1) GI prob.
- dyskinesias include
-
1) chorea
2) ballismus
3) athetosis
4) dystonia
5) myoclonus
6) tics
7) tremor - other medications for parkinson's
-
1) Selegiline (Deprenyl)
2) Amantadine (Symmetrel)
3) Anticholinergics - Selegiline (Deprenyl)
-
1) selective monoamine oxidase B inhibitor
2) prolongs L-dopa effect - Amantadine (Symmetrel)
-
1) antiviral drug
2) may influence dopamine release, reuptake, synthesis - anticholinergics
-
1) Bentropine (Cogentin)
2) Biperiden (Akineton)
3) Orphenadrine (Norflex)
4) Procyclidine (Kemadrin)
5) Trihexyphenidyl (Artane) - physiologic postural tremor (normal) is increased by?
-
1) thyrotoxicosis
2) isoproterenolol (Isuprel)
3) Epinephrine
4) anxiety
5) fatigue - drug-induced normal physiologic tremor?
-
1) bronchodilators
2) tricyclic antidepressants
3) lithium
4) possible beta2 receptor mediation - medications for essential tremor
-
1) beta blockers
2) Primidone (Mysoline) = anticonvulsants
3) Alprazolam (Xanax) - Huntington's disease
-
1) dominant
2) inherited
3) progressive chorea in dementia
4) adult onset - anti-dopaminergic agents to reduce chorea
-
1) Reserpine
2) Phenothiazines
3) Butyrophenones (Haloperidol) - cause of chorea
-
1) thyrotoxicosis
2) hypoCa
3) lupus erythematosus
4) hepatic cirrhosis
5) polycythemia vera rubra - drug-induced chorea
-
1) L-dopa
2) antimuscarinics
3) lithium
4) phenytoin
5) oral contraceptives
6) amphetamine - tx for ballismus
-
dopamine-blocking agents
1) Perphenazine
2) Haloperidol - tx for athetosis and dystonia
-
1) not usually satisfactory
2) Diazepam
3) high-dose antimuscarinic agents
4) L-dopa
5) Baclofen
6) Phenothiazines
7) Amantadine - tx for tics, Tourette's syndrome
- Haloperidol
- phenothiazines cause
- acute dyskinesia/dystonia
- Tardive dyskinesia
- 1) consequence of long-term antipsychotic drug tx
- newer antipsychotic agents that do not appear to cause tardive dyskinesia
-
1) Olanzapine
2) Risperidone - Wilson's disease
-
1) recessive, inherited copper metabolism error
2) reduced serum copper/ceruloplasmin
3) > copper concentration in brain and viscera - tx for Wilson's disease
-
1) Penicillamine (Dimethylcysteine) = copper chelating agent
2) Trientine (Syprine) = chelating
3) Zinc accetate = > copper excretion
4) zinc sulfate = < copper absorption