1. Salvador Dali (Painter) Mao Zedong (Chinese Politician) Michael J Fox (Actor) Pope John Paul II Muhammad Ali (Boxer) Janet Reno (Former AG)

2. The Pharmacology of Parkinson’s Disease May 22, 2014

4. Symptoms of PD Resting tremor (“shaking”)- improved with activity Rigidity Impaired balance Bradykinesia (brady=slow, kinesia=motion) – Gait disturbances – Loss of automatic movement (blinking, smiling, etc.) Additional symptoms: – Muscle aches, pains – Slurred speech – Cognitive (depression, anxiety, confusion)

6. PD Age of Onset

7. Substantia Nigra Changes in PD

8. Major Circuit Important in PD Substantia Nigra Caudate

9. Just Add Dopamine! But what’s the problem here? Not lipid soluble, can’t cross the BBB NH 3 +

10. What about its precursor- L-DOPA? L-DOPA is also charged, but it crosses the BBB anyway… How? NH 3 +

11. LAT1 transporter L-DOPA is transported across BBB by active transport

12. DDC in the periphery can also convert L-Dopa to DA-still can’t cross

13. Current PD Therapy Carbidopa + L-Dopa – Peripheral DOPA decarboxylase (DDC) inhibitor What could be some other drug targets?

14. Targets for Another Drug?

15. DA Receptor Agonists Apomorphine Ropinirole

16. MAO Inhibitor Selegiline – Retards degradation of DA – Somewhat selective inhibitor of an enzyme (MAO)

17. Can there be a placebo effect in treating PD? How might you answer that question?

18. STN Firing

19. PD involves degeneration of the dopaminergic neurons (in the substantia nigra) that results in tremors, rigidity, and gait disturbances Occurs mostly in the elderly (prevalence increases with age) Drugs available to treat PD increase DA synthesis, prevent metabolism, or activate DA receptors The placebo effect is real and produces physiological changes in patients that can be measured and quantified Major Points of Today’s Lecture

20. Concept Map Parkinson’s Disease Dopamine Gait disturbances Substantia nigra L-DOPA BBB DDC Tremors Placebo effect