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PARKINSON'S DISEASE, both agonists and antagonists try to work…
PARKINSON'S DISEASE
A progressive, chronic, neurodegenerative disorder from the degeneration of dopamine producing neurones in the substantia nigra of the basel ganglia characterised by tremor and disturbance of voluntary movement, posture and balance
Caused by:
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Environmental factors - linked to pesticides, herbicides + industrial pollution
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Clinical Signs of PD
Primary
Bradykinesia/Akinesia - lack of movement/no movement - (due to a suppression of movement in the cortex because of decreased dopamine leading to increased inhibitory effect on thalamus)
Resting Tremor - movement is not being inhibited - occurs when muscle is relaxed due to release of inhibition of tremor
Rigidity - not getting movement, still or inflexible muscles, resistance to passive movement, lead pipe/ cog wheel rigidity - difficult to initiate so risk of falls
Secondary
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'festinating' gait pattern (more rapid, short stride gait cant stop), slow shuffling gait
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Medical Management
Medicine
Dopamine Replacement - Levedopa (e.g. Sinemet, madopar) aims to replace lost dopamine - but also contain drugs that facilitate crossing of blood/brain barrier
Dopamine Copycats or dopamine agonists do the same thing as dopamine e.g. apomorphine, pergolide
Dopamine Protectors - MAO-B inhibitors e.g. selegiline and COMT-inhibitors e.g. entacapone - protects current levels of dopamine by blocking enzymes that break it
Anticholinergics - (e.g. Arpicoline) Correct imbalance between D/acetylcholine: imbalance can cause Increase in m/tension and tremor and salivation and urgency
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Surgery
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Pallidotomy - tiny electrical probe placed in globus pallidus - heated to 80oC for 60seconds to destroy area of brain cells
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Stem cell research - research on rats show possibility to make dopamine cells from embryonic stem sells and transplant in the brain - replace lost cells
Life Expectancy
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Immobility and mental disability can cause/ exacerbate illnesses that contribute to death e.g. pneumonia
With advances in proscribed medication - life expectance is not significantly shorter for pd patients but different on individual basis
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both agonists and antagonists try to work together - lack of reciprocal inhibition - fails to inhibit antagonists
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