Question

2. Discuss a generally accepted drug plan for intervening in status epilepticus (generalized convulsive) and state why prompt suppression seizures is essential but insufficient as the only goal. 3. Discuss why phenobarbital is no longer the drug of choice for epilepsy. (What are the disadvantages or serious risks of this drug?) 4. Discuss the drug treatment for Parkinson's disease (PD), and discuss the current consens on which agent or agents are recommended for initiating therapy in most patients with PD. 5. Discuss the interrelationships between the central nervous system (CNS) activities of dopamine and acetycholine as they affect the signs and symptoms of Parkinsonism and as they relate to the general biochemical approach to correcting neurotransmitter imbalances with anti-Parkinsonian drugs.

Answer 1

2)

The accepted drug plan for intervening in status epilepticus is :-

First line drugs :-

• Diazepam
• Lorazepam
• Midazolam

Second line drugs :-

• Phenytoin
• Valproate
• Levetiracetam
• Phenobarbital

​​​​​​​Refractory drugs :-

• Midazolam
• Phenobarbital

​​​​​​​Prompt suppression of seizures is essential but insufficient as the only goal because it is necessary to control the seizures immediately but still there are chances of seizures occurring again.

3)

Phenobarbital is no longer the choice for epilepsy due it's certain disadvantages and serious risks. These risks and disadvantages are :-

• It can cause tolerance and dependence.
• It may cause headache, vomiting, confusion, and lack of coordination.
• It can also cause respiratory arrest and some memory loss.
• It can also cause poor judgment, drowsiness, slurred speech, and difficulty in thinking.
• Sudden stopping of this drug can cause withdrawal symptoms

​​​​​​​4)

Drugs used in the treatment of Parkinson's disease are :-

• Anticholinergics : Biperiden, Trihexyphenidyl, etc
• COMT inhibitors : Tolcapone, Entacapone
• Dopamine agonists : Bromocriptine, Cabergoline, Pergolide, etc
• Dopa decarboxylase inhibitor / dopamine precursor : Carbidopa, Levodopa
• MAO inhibitors : Selegiline ,Rasagiline
• NMDA antagonist : Amantadine

​​​​​​​5)

There is interrelationship between CNS activities of dopamine and acetylcholine. Dopamine and acetylcholine, both have the role in the part of the mid brain called substantia nigra pars compacta. In normal mid brain, there is a balance between dopamine and acetylcholine. The loss of dopamine shifts the balance towards too much acetylcholine, which also contributes to motor symptoms. The nigrostrial pathway is affected in the Parkinson's disease.