In Episode 3, we talked about the pathophysiology of Parkinson’s Disease. In this episode, we dive into the therapeutics and the common drugs you will encounter when dealing with Parkinson’s.
Hello and welcome back to this my carbidopa sofa if you caught our last video we discussed the parts and systems of the body which parkinson’s disease or pd effects as well as how those changes showed themselves symptomatically since we now have at least a basic understanding on what is happening within the body we can start to discuss how it is that we try to fix
Those issues in medicine we have multiple avenues that we can use in providing care for patients we can do it pharmacologically with medications via pharmaceuticals or non pharmacological through physical therapy surgery diet exercise and other non medication related methods pharmacologically derives shockingly from the term pharmacology which means the study
Of drugs including their origin composition pharmacokinetics therapeutic use and toxicology sadly delving more intimately into all that pharmacology and tales will need to be saved for another video but let me just say that personally it’s my favorite aspect of medicine but i digress let’s begin by discussing the more common pharmacological therapies that one
Might see when being treated for pd i must note that this is not a recommendation for therapy nor is it a checklist for what your physician may or may not prescribe for you or a patient rather this is a brief overview of possible therapies that might be seen when we discuss therapies we will try to always explain how that drug works which we call its mechanism
Will also try to explain the effects in my cause often called side-effects as well as any pertinent information we feel you should know first off we’ll talk about the namesake of this channel a combination medication include two things carbidopa and levodopa it’s unbranded under the name sign iment levodopa we will refer to as al dopa for short l-dopa is what
Actively helps replace dopamine in the brain the reason we don’t just give oral dopamine is dopamine can’t pass the blood-brain barrier that’s something that you can think of is like a filter which stops some substances in the blood from getting inside of the brain l-dopa is actively converted to dopamine in the body which can cause other effects side effects
To get into the brain we need to trick the enzymes that convert alva dopa thus enter carpet dope carpet opa looks very much like al toba and when it is picked up it inhibits those enzymes that create dopamine from l-dopa this greatly improves what we call the efficacy which is the efficiency of the drug l-dopa l dope is half-life or the time it takes for 50% of
The drug to be removed from the system goes up from 50 minutes to about an hour and a half carbidopa s– reduction of l-dopa x’ conversion outside of the brain also helps limit l-dopa zaid verse effects those are those side effects we talked about of which many are related to this early conversion of l-dopa some of the more common side effects include dyskinesias
And nausea and vomiting dyskinesias going back to our favorite things greek words as greek from dis meaning bad or abnormal and kinesis meaning movement’ this manifests as flowing dance like involuntary movements usually involving more of the body in contrast to p ds rhythmic tremors we discussed in the last video disc anisha’s can be caused by excessive dopamine
Stimulation it should be noted that dosing may need to be adjusted to your response to sign ahmet dose adjustments with sign ahmet can happen a lot so that should be an identified thing in your therapy duopa is a newer form of carbidopa levodopa that is used through a pump directly into the intestine and it’s found a lesson some of l-dopa is related dyskinesias
We will see the side effects of low blood pressure hallucinations and sleep disturbance come up between multiple medications used for pd this due to most of them all working in similar ways dopamine affects many systems of the body thus whether we are increasing or decreasing dopamine’s activity we will see changes in multiple systems hallucinations alone can
Affect about 40% of pd patients especially in the later stages of the disease as we begin to look more and more into drugs we will see the word agonists and antagonists appear more agonist are activators they bind to receptors just as a receptor sub trait or target molecule would antagonists on the other hand are in activators they directly or indirectly buying a
Receptor making it unable to accept its regular target now that we know what an agonist is we know what this next class does dopamine agonists bind dopamine receptors stimulating these receptors in the brain the main ones you’ll see are pramipexole also called mira pecs and reppin all also called requip these to help limit the effects of the disease stemming from
Loss of dopamine activity dopamine agonists as they similarly affect dopamine have similar side effects as l-dopa but uniquely we see sleep attacks peripheral edema and impulse control disorders sleep attacks are sudden onset of sleep occurring up to one year following start impulse control disorders are described as a possible increase in risky behaviors such as
Gambling and other impulse behaviors these can be seen with increased dopamine activity dopamine plays an integral role in reward and anticipation by activating these receptors we also intensify the impulse response patients on dopamine have been observed to participate more commonly in impulse gambling and shopping i went to a parkinson’s disease convention once
In a casino it didn’t strike me as the best choice in venue for such an event decreasing the dose has been found to help decrease impulse behavior but not decrease sleep attacks now we’ll discuss compton hibbott errs and monoamine oxidase b inhibitors these medications work towards the same basic goal utilizing different paths to do so as l-dopa is broken down
Rather readily half of the battle of getting into the brain is making sure it is not broken down by the time it gets there let alone ensuring it doesn’t get broken down immediately after making it into the brain either comped and mao-b are such enzymes that break down l-dopa and dopamine to common compton hibbott errs are intact bone and toll capone side-effects
Manifests with similar dyskinesias as dopaminergic medications with nausea and vomiting and diarrhea all of these can be correlated to the decreased removal of dopamine with differences dependent on the central nervous system versus the peripheral nervous system the more prominent monoamine oxidase b inhibitors are saline and recycling these agents are more
Specific for cns activity than compton hibbett errs in stopping the breakdown of dopamine side effects are similar to compton hibbott errs with dyskinesias nausea and vomiting and headache as being common now we’ll move on to anticholinergics in an exceptionally oversimplified view one can think of acetylcholine another important neurotransmitter to be the foil of
Dopamine in parkinson’s disease so anticholinergics help limit acetylcholine which provides a benefit with tremor and rigidity trihex afeni dome and been strobing are two examples that can be used anticholinergic side effects are rather notorious in the world of pharmacy so notorious that it has a memory device behind which i will share with you hot as a hair blind
As a bat dry as a bone red as a beet and mad as a hatter this artistically describes the possibility of dry mouth sedation confusion constipation or urine retention flushed skin and blurred vision besides pharmacological therapy there are a host of paths they can be taken to help with the progression of pd that aren’t related to pharmacy they include physical
Therapy specifically what are known as big and loud exercises these follow well researched intensive regimens which help patients retrain sensory motor and cognitive functions often pd patients voices will become a little softer and the loud side helps with this and many will join singing groups for this purpose as well other pd focused activities include water
Aerobics cycling and even a little boxing one of the more intriguing therapies is dbs or deep brain stimulation this is a complex subject on its own and hopefully we’ll be able to dive deeper into it in the future but for simplicity sake one can think of it as a pacemaker for the movement area of the brain it helps control movement symptoms which might not be
Controlled by medications alone by electrically modulating the system’s which determine motor control there was a lot of info packed in this little video below if you follow the link in the description to our website we’ve made a tldr too long didn’t read table of the common medications discussed feel free to keep it for your reference and we’d love to hear from
You down below in the comments with that thank you as always for watching this video we’ll see you some other time
Transcribed from video
Carbidopa Sofa | Episode 4: Parkinson's Disease Part Two By The Carbidopa Sofa
