gg pergerakan krn disfungsi pada basal ganglia & bag otak yg berkaitan

Gejala : . rigiditas otot skeletal . akinesia (bradikinesia) . flat facies . tremor pada waktu istirahat

Parkinson alamiahParkinson karena obat

frekwensi : usia 50-60 tahunan

patofisiologi : . kadar dopamin striatal . degenerasi neuron dopaminergik

- dopamin & acetylcholine tak seimbang

ReversibelAntipsikotikbutyrophenone & phenothiazine blok res dopamin otakReserpine dosis >> pengosongan dopamin otakMPTP

analog meperidinesering disalahgunakanparkinson irreversible destruksi neuron dopaminergik nigrostriataltx neurotoksisitas : MAOI tipe B

Tujuan tx : aktifitas dopamin atau aktifitas kolinergik muskarinik di otak

Dopamin :bioavailabilitas jelek & tak dp menembus BBBprecursornya : l-dopa (levodopa)

Carbidopa . t menembus BBB . hambat DOPA decarboxylase di perifer

gej parkinson, tu bradikinesia angka mortalitastidak menyembuhkan parkinson on-off phenomenak/ perub kadar levodopa dl plasma

dose-dependentGIT : anoreksia, nausea & emesis Kardiovaskuler : hipotensi postural, takikardi, asistole & aritmia Diskinesia : choreoathetosis, chorea, ballismus, myoclonus , tics & tremorTingkah Laku : ansietas, agitasi, confusion, delusi, halusinasi & depresi

Bromocriptine & Pergolide :alkaloid ergot agonis parsial res dopamin D2 aktifitas fungsional pada jaras neurotransmitor dopamine

digunakan sendiri-sendiridikombinasi dengan levodopa & antikolinergiku/ px refrakter levodopa

GIT : anoreksia, nausea & vomitingKardiovaskuler : hipotensi postural & aritmia jantungDiskinesia Tingkah laku : confusion, halusinasi & delusi

Levodopa, bromocriptin & pergolide : px psikosis

krn bromocriptine

infiltrasi pulmonary & erythromelalgia

agonis reseptor dopaminbukan derivat ergotefektif = bromocriptine ES ergotES : diskinesia, hipotensi postural, lassitude, sleepiness & fatigue

neurotransmisi dopaminergik sintesa atau rilis dopamin atau menghambat reuptake dopaminblok muskarinik

bradikinesia, rigiditas dan tremor efektif hanya dalam beberapa mingguefek antiviral (+)

Efek tingkah laku : reslessness, agitasi, insomnia, confusion, halusinasi & psikosis toksik akutReaksi dermatologis : livedo reticularisEfek lain : gg GIT, retensi urin & hipotensi posturaledema perifer tx diuretik

inhibitor selektif MAO tipe B kadar dopamin otaksebagai tambahan levodopa selegilin metabolisme hepatik amphetamine

ES : insomnia, perubahan mood, diskinesia, gg GIT & hipotensiMeperidine + selegiline agitasi, delirium & kematianSelegiline sindroma serotonin

inhibitor COMTu/ tambahan levodopa-carbidopamemperbaiki respons & memperpanjang on-time.ES krn kadar levodopa : diskinesia, gg GIT & hipotensi posturalTolcapone : gg hepar akut

efek eksitatori neuron kolinergik pada sel di striatum blok reseptor muskarinikBenztropine a/ trihexyphenidyl tremor & rigiditas efek bradikinesia

SSP : mengantuk, tak dp memusatkan perhatian, bingung, delusi & halusinasi

Perifer = atropine-like drug

Eksaserbasi tardive dyskinesia

Tremorbeta-bloker (propranolol)hati-hati pd Gagal jantung kongestifAsmaDiabetesHipoglikemia

penyakit yang diturunkankarena ketidakseimbangan : fungsi GABA dan fungsi dopaminergikdefisit kolinergik : krn choline acetyltransferase pada basal ganglia

amine-depleting (mis, reserpine, tetrabenazine)

antipsikotik (haloperidol) blok res dopamin

tak dp dg GABA otak dan aktifitas acetylcholine

Penyebab : ?

Tx : . haloperidol . bloker res dopamine D2 : pimozide

parkinson krn antipsikotik reversibel bila dosis obat diTx : bloker muskarinikLevodopa & bromocriptine : tidak dapat digunakan Tardive dyskinesia karena neuroleptik

peny herediter resesif metab cooper deposisi garam cooper pd liver & jar lainkerusakan hepatik dan neurologis parah & fatal

Tx : senyawa chelating penicillamine (dimethylcysteine) kelebihan cooper

Efek toksik penicilamine : gg GIT, miastenia, neuropati optik & diskrasia darah

Bradykinesia has made drug treatment necessary in a 60-year-old male patient with Parkinson's disease. You decide to initiate therapy with levodopa.

As the physician, you could tell the patient (and close family members) all of the following things about levodopa EXCEPTTaking the drug in divided doses will decrease nausea and vomitingHe should be careful when he stands up because he may get dizzyUncontrollable muscle jerks may occurA netlike reddish to blue discoloration of the skin is a likely side effect of the medication The drug will probably improve his symptoms for a period of time but not indefinitely

As the physician who is prescribing levodopa, you will note that the drugCauses less severe behavioral side effects if given with carbidopaFluctuates in its effectiveness with increasing frequency as treatment continuesPrevents extrapyramidal adverse effects of antipsychotic drugsProtects against cancer in patients with melanomaHas toxic effects that include pulmonary infiltrates