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Untitled Prezi

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manar elropi

on 8 April 2013

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Parkinsonism Epidemiology - Very short half-life
- Not active orally
- Precursor of dopamine ,, levodopa
- Levodopa is extensively metabolized peripherally to dopamine by dopa decarboxylase
- Co-adminstration of carbidopa or benserazide -a pripheral dopa decarboxylase inhibitor- will decrease this metabolism , permitting smaller doses of levodopa to be given The on/off syndrome
- Older people, brain injury or viral infection & toxins 1- Sinemet 1- Metoclopramide is a centrally acting dopamine antagonist
- Side effect of Metoclopramide causing deterioration in parkinsonian symptoms
- An oculogyric crisis {OGC } rotating of eyeballs
is an extreme form of extrapyramidal adverse effect.

2-Domperidone is a dopamine antagonist
- Advantage: not pass the blood–brain barrier
- Side effect: unacceptable cardiovascular AE
- Availability: oral and rectal

3- 5HT3 antagonists (e.g. ondansetron)
- Advantage: useful and efficacious, does not adversely affect parkinsonian symptoms as they do not affect dopamine
- Disadvantage: expensive
- Availability: orally and injection

4-Anticholinergics (e.g. cyclizine and cinnarizine)
- Advantage: useful and efficacious
- Side effect:drowsiness, anticholinergic symptoms
- Availability: i.v. Achieving adequate dopamine levels
Avoiding excessive fluctuation in those levels
Produces better control of symptoms.

* Frequent dosing is preferred to long Pathophysiology - A loss of dopamine in corpus striatum Clinical features - Depression and constipation , in the later stages aphagia, tremor, restlessness, rigidity, gait, featureless expression and involuntary movements. Nausea and vomiting caused by the Sinemet - Levodopa is peripherally metabolised to dopamine
- High peripheral levels of dopamine cause nausea and vomiting.
-Levodopa also causes nausea and vomiting due to irritation of the gastrointestinal tract. Treatment nausea & vomiting Reducing the dosage interval rather
than increasing the
dosage: - Levodopa motor complications, including large fluctuations in response and dyskinesias.
- This is known as the on/off syndrome.
- During the ‘on’ period normal function occurs
but there is weakness and restricted mobility during the ‘off’ period.
- The main risk factors for the on/off syndrome :
after six months and the fact that the Parkinson’s disease is treated. 2-Dopamine agonists - Include bromocriptine, cabergoline, apomorphine
- Action: not converted into dopamine, but have a direct effect on dopamine receptors in the brain.
- Side effect: involuntary movements &hallucinations or sleepiness. 3-Apomorphine
- Action: a potent dopamine agonist, advanced Parkinson’s disease for patients with severe unpredictable ‘off’ periods
- Available as a subcutaneous injection or infusion 4-Monoamine-oxidase B inhibitors - Such as selegiline and rasagiline
- Used: in the management of early disease
-Both drugs can be used in conjunction
with levodopa preparations to reduce end-of-dose deterioration in advanced disease. *Entacapone and tolcapone
-Tolcapone :hepatotoxicity.
*Amantadine : antiparkinsonian
-It improves mildbradykinetic symptoms as well as tremor and rigidity. Tolerance occurs
*Anticholinerigics such as orphenadrine, procyclidine and trihexyphenidyl
(benzhexol), block the effect of acetylcholine,
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