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Akathisia
An inner sense of
(motor restlessness)
restlessness
Dyskinesias
Trigeminal Neuralgia
Wernicke-Korsakoff Syndrome
Neurologic
disorder
caused by
thiamine deficiency; often seen in
chronic alcoholic patients; symptoms
include
confusion,
ataxia,
and
memory impairment.
PARKINSONS DISEASE
Parkinsonism is a progressive neurological disorder of muscle movement,
characterized by tremors, muscular rigidity, bradykinesia (slowness in
initiating and carrying out voluntary movements), and postural and gait
abnormalities. Most cases involve people over the age of 65, among whom
the incidence is about 1 in 100 individuals.
Etiology
Secondary Parkinsonism
Drugs such as the phenothiazines and haloperidol, whose major
pharmacologic action is blockade of dopamine receptors in the brain,
may
produce
parkinsonian
symptoms
(also
called
pseudoparkinsonism).
Treatment
Many of the symptoms of parkinsonism reflect an imbalance between the
excitatory cholinergic neurons and the greatly diminished number of
inhibitory dopaminergic neurons. Therapy is aimed at restoring dopamine in
the basal ganglia and antagonizing the excitatory effect of cholinergic
neurons, thus reestablishing the correct dopamine/acetylcholine balance.
Drugs for Parkinsonism
1 Levodopa
2. Carbidopa
Adverse effect
- Anorexia
- Nausea
- Tachycardia
- Hypotension
- Psychiatric problem - Visual and auditory hallucinations
Interaction
o Pyridoxine
o Monamine Oxidase Inhibitor
Ex. Phenelzine
3. Selegiline (deprenyl)
-
Rasagiline
4. Catechol-O-methyltransferase inhibitors
- 3-O-methyldopa
- Ex Entacapone, Tolcapone
- Albumin
- Cirrhosis
- Adverse effect fulminating hepatic necrosis
5. Dopamine receptor agonist
a. Bromocriptine
- hallucinations, confusion, delirium, nausea, and orthostatic
hypotension
- use in precaution in patient with myocardial infarction
- ergot derivative tend t lead to retroperitoneal fibrosis.
b. Apomorphine, pramipexole, ropinirole, and rotigotine
- pramipexole and ropinirole are oral form while apomorphine and
rotigotine are available for injection
- constipation
- interaction with cimetidine and flouxetine or other cytochrome P450
enzyme inhibitor
6. Amantadine
- used to treat influenza
- increasing the release ofdopamine, blocking cholinergic receptors,
and inhibiting the N-methyld- aspartate (NMDA) type of glutamate
receptors.
,
- restlessness,agitation, confusion, and hallucinations at high doses
may lead to toxic psychosis
- less potent than levodopa but less side effect
7. antimuscarinic agents
- benztropine, trihexyphenidyl, procyclidine, biperiden
- induce mood changes and produce xerostomia (dryness of the
mouth), constipation, and visual problems typical of muscarinic
blockers
- contraindicated with gastrointestinal peristalsis, glaucoma, prostatic
hyperplasia, or pyloric stenosis.
ALZHEIMERS DISEASE
- DEMENTIA
MULTIPLE SCLEROSIS
an autoimmune inflammatory demyelinating disease of the CNS
chronic, relapsing, or progressive disease that may span 10 to 20
years
DRUGS TO TREAT MS
A. Disease-modifying therapies
1. Interferon 1a and interferon 1b: The immunomodulatory
effects of interferonhelp to diminish the inflammatory responses
that lead to demyelination of the axon sheaths. Adverse effects of