So, there's six ways that we can restore dopamine balance, they're all listed for you there.
We can conserve dopamine by blocking the breakdown,
we can block the actions of the neurotransmitter’s glutamate,
we can use agents that mimic dopamine, we can replace missing dopamine,
we can optimize the delivery of levodopa by blocking CMT
or you can reduce the activity of the neurotransmitter acetylcholine. Okay, yeah.
What you learned from that was just nothing, right?
I'm sure what you heard was blah, blah, blah ginger, right,
cuz again you can't learn anything from just a straight list on a slide, nobody’s brain works that way.
So let's break it down the Lecturio way.
Alright, for Parkinson drugs we can use MAO-B inhibitors.
We have less MAO-B we're gonna have a better effect for our patient.
It will conserve dopamine in the brain.
We can use NMDA-type glutamate antagonist, these are blockers.
They will increase the release of dopamine in your brain.
Dopamine agonist they mimic dopamine.
Now you know because you've been hanging out with us in our video series,
agonists mean they act on a receptor and they activate that receptor to do what its intended to do,
so dopamine agonist mimic dopamine, they do the same thing that the actual dopamine would.
Now dopamine prodrug means we get one drug over that blood brain barrier
and it can turn it into dopamine so it replaces the missing dopamine.
Now number 4a down there is carbidopa, decarboxylase inhibitor
and we’ll get more of that when it is super cool what it does.
Now COMT inhibitors they optimize the delivery of levodopa to the brain, that’s helpful
and anticholinergic now this one is not like the others, right?
Everything else - one conserves dopamine, two increases dopamine release, three mimics dopamine,
four replaces missing dopamine and five will help us get more levodopa to the brain
which will help us replace missing dopamine but number six deals with the acetylcholine receptors,
it blocks those receptors.
Anti means blocking, cholinergic means a type of receptors.
Now a cholinergic receptor is activated by - that’s right, acetylcholine.
So if we give an anticholinergic I'm giving in acetylcholine receptor blocker,
that means that medication will connect to that receptor
and it will stop acetylcholine from connecting to that receptor.
So an anticholinergic binds to a cholinergic receptor, it blocks the action of that receptor
and it won't allow acetylcholine which would be an agonist to connect to that one
so that one medication is slightly different than the other five that we’re talking about
but that’s the important difference that you need to understand.
Since we have an imbalance of acetylcholine and dopamine we try
and block up those acetylcholine receptors will help bring a little more balance
to the brain because you see the goal of Parkinson’s medication
is to maintain functional ability in their activities of daily living.
We don’t currently have a cure for Parkinson’s disease
so we just want to help them be as functional as possible and be able to live their daily life,
we want to improve their quality of life and so we're gonna need to try
the increase the amount of dopamine available or decrease the action of acetylcholine.
So how do we pick which drugs are best?
Well, drug selection and dosages is based on what the patient is experiencing,
so this involves a lot of communication between the patient, the family and the health care provider.
Now if they have mild symptoms, we might start with an MAO-B inhibitor.
If they have more severe symptoms we have levodopa,
now we’ll combine it with carbidopa or dopamine agonist so this is just kinda an overview of where we’d go.
Very mild symptoms and we catch this early, we try an MAO-B inhibitor
so we’ll have more dopamine.
If they have more severe symptoms we're gonna go for the bigger gun,
levodopa we combine it with carbidopa so more of that will make it over the blood brain barrier or dopamine agonist.
Now the problems with these medications is they have times where they wear off might be during the day,
it might be after a long period of time so these medications don’t last forever.
In fact, there is an actor who was diagnosed with Parkinson’s Disease
and he didn’t tell anyone that he had the disease so he would take the medications
but when he’d be on set, sometimes he would refuse to come out of his trailer.
Well, they thought he was just being a diva because he was a big star that wasn’t it at all.
He had Parkinson’s Disease and he had not disclosed to it because he wanted
to not tell people yet, so what he was doing was waiting for his medication to kick in.
If he had times that it had worn off, he would be in his trailer waiting for the medication to come back on.
So be aware that there’ll have times that are good and times that are not.
There are times that when the medications are really effective and it might have some off times.
Sometimes in the same day which is why we use these off times to try to reduce them
we use dopamine agonist or CMT inhibitors and some MAO-B inhibitors.
So what do you want to take away from these slide because right now, I know like these names like, "Are you kidding me?
I am never gonna remember MAO-B, CUBA, what is that?"
Just know that mild symptoms are MAO-B. M is for mild in MAO-B,
now we're getting severe I want you to just have in mind that levodopa with carbidopa is one of our go to medications
but we try not to use it until we have to. Know that all these medications can end up with off time
so we have medications we can use to help minimize the amount of times the drugs are off.