PARKINSON’S

DISEASE

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https://youtu.be/rFoc4ACFehQ

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NEURODEGENERATIVE DISORDERS

•Characterized by a progressive and irreversible

loss of neurons from specific regions of the
brain
• Parkinson’s Disease
• Huntington’s Disease
PARKINSON’S DISEASE
• Parkinson’s disease (PD) is the second commonest
neurodegenerative disease, exceeded only by Alzheimer’s disease
(AD).
• Its cardinal clinical features were first described by the English
physician James Parkinson in 1817.
• Clinically, PD is characterized by rest tremor, rigidity,
bradykinesia (slowing), and gait impairment, known as the
“cardinal features” of the disease.
• Pathologically, the hallmark features of PD are degeneration of
dopaminergic neurons in the substantia nigra pars compacta
(SNc), reduced striatal dopamine, and intracytoplasmic
proteinaceous inclusions known as Lewy bodies that primarily
contain the protein alpha synuclein
PROTOTYPICAL NEURODEGENERATIVE DISORDERS

Parkinson’s Disease (PD)

• is a progressive, neurodegenerative,
movement disorder
• The motor symptoms of Parkinson's
disease result from the death of dopamine-
generating cells in the substantia nigra, a
region of the midbrain
PARKINSON’S DISEASE: CLINICAL FEATURES
• Motor Features
• Non- Motor Features
PARKINSON’S DISEASE: CLINICAL FEATURES
 4 cardinal
Characteristics
(motor symptoms):
➢Resting tremors (first
and prominent)
➢Muscle rigidity
➢Bradykinesia (akinesia)
➢Abnormal gait and
posture
Parkinsonism

Occurs because of a loss of

dopamine in the nigrostriatal
pathway, thus disrupts the
delicate balance between
dopaminergic and cholinergic
systems within the striatum
and basal ganglia
Basal ganglia Brain stem

Cerebellum
PARKINSON’S DISEASE: PATHOPHYSIOLOGY
PARKINSON’S DISEASE: DIAGNOSIS
PARKINSON’S DISEASE: DIAGNOSIS

Consider also drugs that could

induce Parkinsonism
•What are the therapeutic goals
in Parkinsonism?
 Restore
Negative Positive
dopaminergic
Disturbances – Disturbances –
loss of function abnormal
activity involuntary
by the
basal ganglia movements and
due to rigidity
poverty of due to lesions of
movement the
basal ganglia

Restore a
balance
PARKINSON’S DISEASE: TREATMENT
• Parkinson’s Disease
• Dopamine Precursor
• Dopamine Agonist
• MAO Inhibitors
• COMT Inhibitors
• Muscarinic Agonist

• Movement Disorders
• Propanolol
• Haloperidol & Tetrabenazine
• Penicillamine
 QUESTION: THE EFFICACY OF DRUG
THERAPY FOR THIS DISEASE CAN BE INCREASED
BY CO-ADMINISTRATION OF THIS DRUG, AN
INHIBITOR OF PERIPHERAL DEGRADATION OF
PRIMARY TREATMENT DRUG

A. Aspirin
B. Antacids
C. Carbidopa
D. Diazepam
E. Ibuprofen
CEREBROVASCULAR
DISEASE

Watch: https://youtu.be/7lpqxDEfszY
CEREBROVASCULAR
DISEASE

• Cerebrovascular Disease,
Brain Attack & TIA
• Risk Factors
• Modifiable & Non-
Modifiable
PATHOPHYSIOLOGY
 CLINICAL MANIFESTATIONS:
ISCHEMIC VS HEMORRHAGIC STROKE
 CLINICAL MANIFESTATIONS:
ANTERIOR AND POSTERIOR CIRCULATIONS
DIAGNOSIS

• CT Scan
• MRI
MANAGEMENT

• Medical Management
• BP Measurement
• Management ICP
• Underlying Symptoms

• Surgical Management
THROMBOLYTIC THERAPY
ANTITHROMBOTIC THERAPY

• Noncardioembolic ischemic stroke or TIA

• o Start ASA 160-325 mg/day as early as possible and
continue for 14 days
• o Long-term ASA 80-100 mg/day monotherapy for
secondary stroke prevention
• o Acceptable options for initial therapy:
• Clopidogrel 75 mg OD ƒ
ƒ
• Aspirin 25 mg plus extended release (ER)
• Dipyridample 200 mg BID ƒ
• Cilostazol 100 mg BID
• ƒTrifusal 300 mg BID
NEUROPROTECTION
PRIMARY & SECONDARY
PREVENTION OF STROKE
Class Case Questions:

• Mr CD, a 59-year-old man, has had PD for 12

years. He has responded well to levodopa in the
past but now finds that he has unpredictable ‘off’
periods during the day and peak dose dyskinesias
that are present for several hours every day. He
has a medical history of hypertension and is
known to have benign prostatic hypertrophy. His
current regimen is Sinemet 110 six times a day;
Half Sinemet CR twice a day, amantadine 100 mg
three times a day and a rotigotine patch 12 mg
once a day.
• What treatment would you recommend and
why?
REFERENCES

• Clinical Pharmacy and Therapeutics 6th Edition by

Whittlesea & Hudson
• Katzung & Trevor’s Pharmacology
• Harrison’s Principles of Internal Medicine
QUIZ:

• November 13, 2021

• P.S. Magaral kayo ng Mabuti

para hindi ganto yung drama
niyo hahahaha ☺