Parkinson
- Cracked open cogwheels: parkinsonism therapy
Lovodopa
- Bank vault threshold: blood brain barrier (BBB)
- "L" rope crank inside vault: levodopa (L-DOPA) crosses the BB
- Unfurled/untangled rope in vault: levodopa is converted to dopamine by DOPA decarboxylase in the CNS
- Unfurled rope in lobby: levodopa is converted to dopamine by DOPA decarboxylase in the periphery (can't cross BBB)
- Nauseated hostage: levodopa can cause GI distress (due to peripheral conversion into dopamine). Vomiting from triggering of peripheral chemoreceptors
- Arrhythmia rope: levodopa can cause cardiac arrhythmias (due to peripheral conversion into dopamine) (tachy, afib, Ventricular asystole)
- Passed out hostage: levodopa can cause orthostatic hypotension (due to peripheral conversion into dopamine)
- Psychiatrically disturbed hostage: levodopa can cause neuropsychiatric symptoms e.g. anxiety, agitation, insomnia, confusion, hallucination (due to excess dopamine in the CNS)
- End of rope wearing-off: chronic levodopa therapy can cause a wearing-off reaction (akinesia and dyskinesia re-emerge at the end of each dose)
- "Too long!": chronic levodopa therapy can cause response fluctuations (wearing-off reaction, on-off phenomenon) and dyskinesias
- Flashing on and off: chronic levodopa therapy can cause an on-off phenomenon (periods of akinesia alternate with periods of improved mobility, not related to dose) (episodes of restrictive mobility in hours)
- Narrowing window/watch: the therapeutic window of levodopa therapy narrows as Parkinson's progresses (unpredictable response to therapy). Too much dopamine: dyskinesia. Not enough dopamine: bradykinesia and regidity
- Writhing sneeze: chronic levodopa therapy can cause dyskinesias (choreoathetosis of the face and distal extremities) (involuntary twisting of face and extremities)
- Damaged psychotic painting: levodopa is contraindicated in psychotic patients (blocking CNS dopamine)
Carbidopa
- Police car on periphery distracting: carbidopa (peripheral DOPA decarboxylase inhibitor) (cannot cross BBB)
- Scared into vault: carbidopa increases the bioavailability of levodopa (prevents peripheral conversion into dopamine)
- Pulling away from hostages: carbidopa decreases peripheral side effects of levodopa therapy (but exacerbates neuropsychiatric side effects)
COMT inhibitors
- InTerCOM guard shooting "L" crank: catechol-O-methyltransferase (COMT) converts levodopa to 3-O-methyldopa (3-OMD) in the periphery
- Tall Al Capone gangster: tolcapone (a peripheral and central COMT inhibitor) increases the bioavailability of levodopa
- Al Capone gangster at entrance: entacapone (a peripheral COMT inhibitor) increases the bioavailability of levodopa
- InTerCOM guard in vault: catechol-O-methyltransferase (COMT) converts dopamine to 3-methoxytyramine (3-MT) in the CNS
- Tall gangster in vault: tolcapone (a peripheral and central COMT inhibitor) increases dopamine levels in CNS
- Hepatic gun: tolcapone can cause hepatic failure
MAO inhibitors
- Black mouse eating rope: monoamine oxidase B (MAO-B) selectively metabolizes dopamine
- Sledge hammer: selegiline (a selective MAO-B inhibitor) increases dopamine levels in the CNS
D Agonists
- Rope in a roll: ropinirole (D2 dopamine receptor agonists) is an important initial treatment of Parkinson's
- Double rope ladder: D2 dopamine receptor
- Big pecs: pramipexole (D3 dopamine receptor agonist) is an important initial treatment of Parkinson's
- Restless legs: dopamine receptor agonists (e.g. ropinirole, pramipexole) treat restless leg syndrome (RLS)
- "Rock and roll": dopamine receptor agonists (e.g. ropinirole) may enhance impulse control disorders (e.g. gambling, shopping, hypersexuality)
Amantaine
- Manatee: amantadine can treat some motor symptoms of Parkinson's (originally antiviral influenza agent)
- Breaking open rope: amantadine enhances the effect of endogenous dopamine (by increasing its synthesis/release and inhibiting its uptake)
Anti-M
- Tri-hex Benz car: trihexyphenidyl and benztropine (antimuscarinic agents used to treat parkinsonism) (unbalanced high levels of Ach)
- Trembling getaway car: trihexyphenidyl and benztropine (antimuscarinic agents) improve the tremor and rigidity of Parkinson's with no effect on bradykinesia
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