Created on 07/09/2009 03:22:00

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Module
Antiparkinson
A. Learning Objective
(please refer to Competency Standard from Indonesian Medical Council / Konsil
Kedokteran Indonesia and Level of competency of epilepsy, appendix 1 and 2 ).
Level of Competency of

Movement Disorders ( see, appendix 1 and 2 )

Parkinson's disease
Tremor
Secondary parkinsonism
Huntington disease
Chorea sydenham
Dystonia
Hemifacial spasm

3A
3A
3A
1
1
2
2

You should be able to :

1. Describe the neurochemical imbalance underlying the symptoms of Parkinsons
disease
2. Identify the mechanisms of levodopa, dopamine receptor agonists and
muscarinic blocking drugs alleviate parkinsonism
3. Describe the adverse drug reaction of antiparkinsons drugs

B.

Schematic representation of the sequence of neuron involved in

Parkinson and Huntington s chorea.

Normal
Substansia
Nigra

Corpus
Striatum
Dopamine
Acethyl
choline

GABA

Parkinsonism
Substansia
Nigra

Corpus
Striatum

Dopamine

agonists
Dopamine
Acethyl
choline

GABA

Antimuscarinic
Drugs

------------ : dopaminergic neuron is lost

Huntingtons Disease
Substansia
Nigra

Corpus
Striatum
Dopamine
Acethyl
choline

GABA

C. Drug Therapy of Parkinsonism

a. Levodopa (L-dopa)
L-dopa is precursor of dopamine
Dopamine has low bioavailability, and does not readily cross the BBB.
Levodopa

dopamine
DOPA decarboxylase

Inhibited by carbidopa
Potentiate dopamine effect
Adverse drug reaction : see ANS drug ( GIT effects, CV effects, dyskinesia
and behavioral effects )
b. Bromocriptine and other
1. Bromocriptine acts as a partial agonist at certain dopamine D 2 receptors in
the brain.
Clinical use : patients who are refractory to or cannot tolerate levodopa
Side Effects : dopamine like effects
c. Amantadine
Mechanisms : increasing synthesis and realese of dopamine by unknown
mechanisms.

Schematic representation of the sequence of neuron involved in

Parkinson and Huntington s chorea.
Normal
Substansia
Nigra

Corpus
Striatum
Dopamine
Acethyl
choline

GABA

Parkinsonism
Substansia
Nigra

Corpus
Striatum

Dopamine

agonists
Dopamine
Acethyl
choline

GABA

Antimuscarinic
Drugs

------------ : dopaminergic neuron is lost

Huntingtons Disease
Substansia
Nigra

Corpus
Striatum
Dopamine
Acethyl
choline

GABA