Tratamiento de los trastornos degenerativos del SNC.pptx

Tratamiento del Alzheimer y similares

1. Tratamiento de los trastornos degenerativos del SNC Cristian Oswaldo Muñoz Polo R2 NEUROLOGÍA ADULTOS

2. Trastornos neurodegenerativos Parkinson Huntington Alzheimer ELA *Alivio de síntomas Goodman & Gilman’s . The Pharmacological Basis of Therapeutics by Brunton , Laurence L., Hilal-Dandan , Randa and Knollmann , Björn C., editors . Copyright © 2018 by McGraw-Hill

3. Características comunes Proteinopatías Alfa sinucleina A beta y tau asociada a microtúbulos TDP-43 Huntingtina Goodman & Gilman’s . The Pharmacological Basis of Therapeutics by Brunton , Laurence L., Hilal-Dandan , Randa and Knollmann , Björn C., editors . Copyright © 2018 by McGraw-Hill

4. Vulnerabilidad selectiva Parkinson  sustancia negra Alzheimer  hipocampo y neocorteza Huntington  neoestriado ALS  Neuronas motoras Goodman & Gilman’s . The Pharmacological Basis of Therapeutics by Brunton , Laurence L., Hilal-Dandan , Randa and Knollmann , Björn C., editors . Copyright © 2018 by McGraw-Hill

5. Genética y ambiente Cada uno puede ser de naturaleza familiar Factores de riesgo genéticos P. ej. Fenotipo Apo E Factores ambientales Agentes infecciosos Toxinas ambientales Daño cerebral adquirido Goodman & Gilman’s . The Pharmacological Basis of Therapeutics by Brunton , Laurence L., Hilal-Dandan , Randa and Knollmann , Björn C., editors . Copyright © 2018 by McGraw-Hill

6. Enfoque para la terapia Neuroquímicas Neuroprotectoras Objetivo neurotoxicidad Antagonistas de glutamato ( memantina y riluzol ) Envejecimiento Pérdida del metabolismo oxidativo Goodman & Gilman’s . The Pharmacological Basis of Therapeutics by Brunton , Laurence L., Hilal-Dandan , Randa and Knollmann , Björn C., editors . Copyright © 2018 by McGraw-Hill

7. parkinson 4 características fundamentales Idiopática + Sin tratamiento progresa en 5-10 años Neuronas dopaminérgicas (+) Trastornos no motores Goodman & Gilman’s . The Pharmacological Basis of Therapeutics by Brunton , Laurence L., Hilal-Dandan , Randa and Knollmann , Björn C., editors . Copyright © 2018 by McGraw-Hill

8. fisiopatología Síntesis de dopamina TH Tirosina hidrolasa AADC L aminoácido aromatico descarboxilasa VMAT 2: Trasportador de monoaminas vesiculares 2 OCT: Transportador de cationes orgánicos ALDH: Aldehido deshidrogenasa HVA: Ácido homovanilico

9. Goodman & Gilman’s . The Pharmacological Basis of Therapeutics by Brunton , Laurence L., Hilal-Dandan , Randa and Knollmann , Björn C., editors . Copyright © 2018 by McGraw-Hill

10. Goodman & Gilman’s . The Pharmacological Basis of Therapeutics by Brunton , Laurence L., Hilal-Dandan , Randa and Knollmann , Björn C., editors . Copyright © 2018 by McGraw-Hill

11. Tratamiento Levodopa Maximo 0.5-2 horas Vida media 1-3 hr Inhibidores de la AADC periférica ( carbidopa , beserazida ) Carbidopa / levodopa 25/100 mg Goodman & Gilman’s . The Pharmacological Basis of Therapeutics by Brunton , Laurence L., Hilal-Dandan , Randa and Knollmann , Björn C., editors . Copyright © 2018 by McGraw-Hill

12. Fenómeno de desgaste Discinesias Trastornos en el control de impulsos Alucinaciones y confusión Goodman & Gilman’s . The Pharmacological Basis of Therapeutics by Brunton , Laurence L., Hilal-Dandan , Randa and Knollmann , Björn C., editors . Copyright © 2018 by McGraw-Hill

13. Preservación farmacológica de levodopa y DA ESTRIATAL Goodman & Gilman’s . The Pharmacological Basis of Therapeutics by Brunton , Laurence L., Hilal-Dandan , Randa and Knollmann , Björn C., editors . Copyright © 2018 by McGraw-Hill

14. Agonistas del receptor de dopamina Duración más larga Ropinirol y pramipexol Rigotina ( transdérmico ) Alivio de síntomas clínicos Goodman & Gilman’s . The Pharmacological Basis of Therapeutics by Brunton , Laurence L., Hilal-Dandan , Randa and Knollmann , Björn C., editors . Copyright © 2018 by McGraw-Hill

15. Agonistas del receptor de dopamina Apomorfina Subcutanea Receptores D4 Goodman & Gilman’s . The Pharmacological Basis of Therapeutics by Brunton , Laurence L., Hilal-Dandan , Randa and Knollmann , Björn C., editors . Copyright © 2018 by McGraw-Hill

16. INHIBIDORES DE COMT Tolcapona entacapona Goodman & Gilman’s . The Pharmacological Basis of Therapeutics by Brunton , Laurence L., Hilal-Dandan , Randa and Knollmann , Björn C., editors . Copyright © 2018 by McGraw-Hill

17. Inhibidores selectivos de MAO-B Combinación segura con levodopa Selegilina Rasagilina Goodman & Gilman’s . The Pharmacological Basis of Therapeutics by Brunton , Laurence L., Hilal-Dandan , Randa and Knollmann , Björn C., editors . Copyright © 2018 by McGraw-Hill

18. Agosnistas del receptor muscarinico Trihexfenidilo , mesilato de benzotropina , hidrocloruro de difenhidramina La base biológica no se entiende completamente Terapia inicial en parkinson leve Goodman & Gilman’s . The Pharmacological Basis of Therapeutics by Brunton , Laurence L., Hilal-Dandan , Randa and Knollmann , Björn C., editors . Copyright © 2018 by McGraw-Hill

19. Amantadina Antiviral Actividad antiparkinsoniana Propiedades anticolinérgicas y bloqueo de receptores de glutamato Dosis: 100 mg dos veces al día Goodman & Gilman’s . The Pharmacological Basis of Therapeutics by Brunton , Laurence L., Hilal-Dandan , Randa and Knollmann , Björn C., editors . Copyright © 2018 by McGraw-Hill

20. alzheimer Etapa preclínica Etapa de deterioro cognitivo leve (perdida de la memoria episódica) Etapa de demencia Goodman & Gilman’s . The Pharmacological Basis of Therapeutics by Brunton , Laurence L., Hilal-Dandan , Randa and Knollmann , Björn C., editors . Copyright © 2018 by McGraw-Hill

21. Diagnóstico Clínico Marcadores RMN estructural y PET Florbetapir , flutemetanol y florbetaben Goodman & Gilman’s . The Pharmacological Basis of Therapeutics by Brunton , Laurence L., Hilal-Dandan , Randa and Knollmann , Björn C., editors . Copyright © 2018 by McGraw-Hill

22. genética Mutación en tres genes A beta PSEN 1 PSEN 2 Goodman & Gilman’s . The Pharmacological Basis of Therapeutics by Brunton , Laurence L., Hilal-Dandan , Randa and Knollmann , Björn C., editors . Copyright © 2018 by McGraw-Hill

23. FISIOPATOLOGÍA Placas amiloides Goodman & Gilman’s . The Pharmacological Basis of Therapeutics by Brunton , Laurence L., Hilal-Dandan , Randa and Knollmann , Björn C., editors . Copyright © 2018 by McGraw-Hill

24. Neurquímica Deficiencia de ACH Degeneración de neuronas colinérgicas subcorticales Goodman & Gilman’s . The Pharmacological Basis of Therapeutics by Brunton , Laurence L., Hilal-Dandan , Randa and Knollmann , Björn C., editors . Copyright © 2018 by McGraw-Hill

25. Tratamiento Tratamiento de los síntomas cognitivos Memantina Antagonistas reversibles de colinesterasas Tratamiento de los síntomas conductuales Citalopram Antipsicóticos atípicos Benzodiacepinas Haloperidol

26. Goodman & Gilman’s . The Pharmacological Basis of Therapeutics by Brunton , Laurence L., Hilal-Dandan , Randa and Knollmann , Björn C., editors . Copyright © 2018 by McGraw-Hill

27. Enfermedad de huntington Descoordinación motora y deterioro cognitivo Goodman & Gilman’s . The Pharmacological Basis of Therapeutics by Brunton , Laurence L., Hilal-Dandan , Randa and Knollmann , Björn C., editors . Copyright © 2018 by McGraw-Hill

28. fisiopatologia Goodman & Gilman’s . The Pharmacological Basis of Therapeutics by Brunton , Laurence L., Hilal-Dandan , Randa and Knollmann , Björn C., editors . Copyright © 2018 by McGraw-Hill

29. Genética Autosómico dominante Edad entre 35-45 años Brazo corto cromosoma 4 Repetición trinucleotida polimórfica (CAG) Goodman & Gilman’s . The Pharmacological Basis of Therapeutics by Brunton , Laurence L., Hilal-Dandan , Randa and Knollmann , Björn C., editors . Copyright © 2018 by McGraw-Hill

30. tratamiento Tratamiento sintomático Ninguno ralentiza la progresión Tetrabenazina y reserpina (inhibidores de VMAT 2) Antidepresivos Antipsicóticos atípicos Benzodiacepinas Goodman & Gilman’s . The Pharmacological Basis of Therapeutics by Brunton , Laurence L., Hilal-Dandan , Randa and Knollmann , Björn C., editors . Copyright © 2018 by McGraw-Hill

31. Esclerosis lateral amiotrófica Neuronas motoras asta ventral y neuronas corticales Debilidad rápidamente progresiva Cambios conductuales Disfunción cognitiva Goodman & Gilman’s . The Pharmacological Basis of Therapeutics by Brunton , Laurence L., Hilal-Dandan , Randa and Knollmann , Björn C., editors . Copyright © 2018 by McGraw-Hill

32. etiología 10% casos familiares Expansión de la repetición de hexanucleotidos en C9ORF72 90% casos esporádicos Goodman & Gilman’s . The Pharmacological Basis of Therapeutics by Brunton , Laurence L., Hilal-Dandan , Randa and Knollmann , Björn C., editors . Copyright © 2018 by McGraw-Hill

33. tratamientos Riluzol PO Metabolismo hepático Vida media 12 horas Inhibición de liberación de glutamato Bloquea receptores NMDA 50 mg dos veces al día Goodman & Gilman’s . The Pharmacological Basis of Therapeutics by Brunton , Laurence L., Hilal-Dandan , Randa and Knollmann , Björn C., editors . Copyright © 2018 by McGraw-Hill

34. Edaravona FDA 2017 Eliminación de radicales libres IV Ciclos de 14 días Excreción urinaria Goodman & Gilman’s . The Pharmacological Basis of Therapeutics by Brunton , Laurence L., Hilal-Dandan , Randa and Knollmann , Björn C., editors . Copyright © 2018 by McGraw-Hill

35. Terapia sintomática : espasticidad Baclofeno Agonista del receptor GABA b 5-10 mg al día dosis inicial Tizanidina Agonista de receptores adrenérgicos alfa 2 2-4 mg en HS Goodman & Gilman’s . The Pharmacological Basis of Therapeutics by Brunton , Laurence L., Hilal-Dandan , Randa and Knollmann , Björn C., editors . Copyright © 2018 by McGraw-Hill

36. GRACIAS