Parkinson's disease-BPT
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Transcript of Parkinson's disease-BPT
Parkinsonism
Dr.Rathnakar U.P.MD.DIH.PGDHM
BPT20 NOV 2013
Contents
• Examples of antiparkinsonian drugs• Adverse effects of levodopa• Basis for combining levodopa with
carbidopa• Drugs used in drug-induced
parkinsonism and their mechanism of action
PD[Poverty of movements, tremors and rigidity]
Clinical features ofPD
Parkinson's disease (PD) is the second commonest neurodegenerative disease, exceeded only by Alzheimer's disease (AD). 5 million persons in the world suffer from this disorder.
Pathophysiology of PD
• "Dopaminergic" pathology Degeneration of dopaminergic neurons in SN [Deficiency of DA]
• “Non-dopaminergic" pathology Over activity cholinergic neurons,
DA and Ach in PD
AchAch Ach
DADA DA
NormalDA=Ach
PDDeficiency of DA
Relative excess of Ach
Treatment PDDopaminergics
Anticholinergics
DAAntichlonergics
Sites of action of drugs used to treat Parkinson's disease
Levodopa 3-MDOPADopamineDDC COMT
EntacaponeTolcapone
CarbidopaBenserazide
BBBBBB
Levodopa
Dopamine 3MTDOPACCOMTMAOB
SelegilineRasagiline
Tolcapone
D1 & D2 Receptors
DA agonists
1
2 2
33
4
Anticholinergics• Trihexyphenidyl• Procyclidine• Biperiden• Antihistaminics
5
0Stupid
6
DA facilitatorAmantadine
Drugs for PDI.Drugs affecting brain dopaminergic
system
1. DA precursor- Levodopa
2. DDC inhibitors-Carbidopa
3. DA agonists-Bromocriptine
4. MAO-B inhibitors-Selegiline
5. COMT inhibitors-Entacapone
6. DA facilitator-Amantadine
II.Drugs affecting brain cholinergic system
1. Central anticholinergics
Trihexyphenydyl, procyclidine, biperiden
2. Antihistaminics
Orphenadrine, promethazine
Levodopa
LevodopaPharmacological actions
• CNS
1. Normal persons-no effect
2. PD: Excellent clinical improvement initially- rigidity, hypokinesia, Tremors other non-motor symptoms later
3. Psychosis
4. Sexual activity↑
• CVS
1. Tachycardia
2. Postural hypotension[central action]
3. Tolerance develops• Endocrine
Prolactin↑
LevodopaADEs
At initiation of therapy• Nausea & vomiting• Postural hypotension• Cardiac arrhythmias• Exacerbation of angina• Alteration of taste
Prolonged therapy• Abnormal movements
[dyskinesia]-chorea, grimacing. Worsen with time• Dose limiting• Behavioral-Anxiety-
depression-psychosis• End of dose effect• On-off phenomenon[worsening and improvement in a few minutes-progressive degeneration]
Centrally acting anticholinergics
• Restore Ach/ DA balance in striatum
• Tremor is benefitted more than rigidity
• Less effective than L.dopa
• Cheap, less side effects• Atropine like side
effects
• Trihexyphenidil• Procyclidine• Biperiden• Orphenadrine• Promethazine
Drug induced Parkinsonism[Extrapyramidal symptoms]
Drug induced extrapyramidal reaction
• Antipsychotics - Phenothiazines• Antiemetic - Metoclopramide• Tt of acute reactions - Promethazine
25 mg.i.v
• Other drugs-Anticholinergics & antihistaminics with antiucholinergic activity
Physiotherapy and Parkinson’s Disease
• The main areas in which physiotherapists help people with Parkinson's Disease are:
• posture,• range of movement,• walking and turning,• balance and transfers.http://www.parkinsons.ie/aboutparkinsons_treatments_physio2