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Parkinson’s patient tries Marijuana for the first time.
Parkinson’s patient tries Marijuana for the first time.
<aside> 📇 Definition Parkinson disease is a neurodegenerative disorder that mostly presents in later life with generalized slowing of movements (bradykinesia) and at least one other symptom of resting tremor or rigidity.
Other associated features are a loss of smell, sleep dysfunction, mood disorders, excess salivation, constipation, and excessive periodic limb movements in sleep (REM behavior disorder).
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<aside> 📇 Look through Pathophysiology
Pathophysiology in Parkinson's syndrome: dopamine deficiency of striatum receptors → Decrease in "disinhibition" → Increasing inhibition of motor skills → Bradykinesis
The primary etiology appears to be the accumulation of alpha-synuclein in various parts of the brain, primarily the substantia nigra, leading to degeneration and subsequent loss of dopamine in the basal ganglia that control muscle tone and movement.
Other affected transmitter systems in idiopathic Parkinson's syndrome:
<aside> 📇 Approach to Histopathology
Neuronal inclusions of alpha-synuclein in neuronal cell bodies (Lewy bodies) and within neuronal cell processes (Lewy neurites)
Neural loss in the substantia nigra pars compacta
Pathology extends to the basal forebrain, amygdala, and medial temporal lobe structures in later stages, with convexity cortical areas affected in the last stages </aside>
<aside> 📇 Therapy
Choice of remedy: Depending on age, comorbidity and psychosocial factors
Mechanisms of action: Common Parkinson's drugs
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Apomorphine: a non-selective dopamine agonist which activates both D2-like and, to a much lesser extent, D1-like receptors. It also acts as an antagonist of 5-HT2 and α-adrenergic receptors with high affinity. The compound is historically a morphine decomposition product made by boiling morphine with concentrated acid, hence the -morphine suffix. Contrary to its name, apomorphine does not actually contain morphine or its skeleton, nor does it bind to opioid receptors.
Dopamine antagonist
<aside> 📇 Carbidopa vs Levodopa
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Cannabis has two main active ingredients Tetrahydrocannabinol THC and cannabidiol (CBD) are obtained from the hemp plant and usually consumed inhaled as twisted cigarettes (joints) or orally, e.g. in the form of biscuits (so-called space cookies).
Marijuana: Dried leaves and flowers of the hemp plant.
<aside> 📇 Mechanism of action: Binding to the specific cannabinoid receptors CB1, CB2 → E.a. Inhibition of a GABAergic interneuron → Inhibition of the inhibitory effect on downstream dopaminergic neurons → Increase in dopamine secretion in the nucleus accumbens of the mesolimbic reward system
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