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Neuropharmacology  Key  Concepts    

For  many  patients  with  neurodegenerative  disease,  outside  environmental  factors  impact  cellular  mechanisms  as  well  as  other  co-­‐morbidities  that  contribute  to  cell  death  in  the  central  nervous  system  (CNS).    Enough  cellular  degeneration  causes  loss  of  cellular  or  brain  mass,  and  the  cell  bodies  that  utilize  various  neurotransmitters  in  their  circuitry  are  no  longer  capable  of  function.  These  are  times  when  medication  is  certainly  viable  and  sometimes  necessary.    Sometimes  medications  are  needed  earlier  and  are  usable  to  control  symptoms  that  are  a  result  of  degeneration  in  multiple  systems.      

 Nutrition  has  the  ability  to  manage  mitochondrial  failure,  glial  cell  activation  or  priming  

pathologies.  Nutrition  can  stabilize  bi-­‐lipid  cellular  membranes,  reduce  reactive  oxygen  species,  and  stabilize  some  of  the  intra-­‐  and  extracellular  mechanisms  related  to  neurodegeneration.    Many  times,  the  brain  also  needs  to  be  activated  to  generate  long  term  potentiation,  plasticity,  and  a  better  cellular  central  integrated  state.    Some  medications  for  the  neurodegeneration,  including  excitotoxicity  induced,  include  Namenda,  which  is  a  medication  that  stops  the  influx  of  pathological  levels  of  calcium  into  a  cell,  thus  avoiding  excitotoxicity,  cellular  apoptosis,  and  death.    When  there  is  enough  death,  cell  volume  depletes,  cell  mass  depletes,  and  the  brain  atrophies  and  function  is  lost.    At  times,  protective  nutrients  are  given  along  with  medications,  or  one  or  the  other.      

 Neurotransmitters  that  need  to  be  manipulated  include  dopamine,  serotonin,  acetylcholine,  

GABA,  glutamate  and  histamine,  to  say  the  least.    In  the  realm  of  neurodegeneration,  the  patient  might  need  the  cholinergic  pathways  treated  with  meds  that  upregulate  that  transmitter.    This,  along  with  meds  that  stop  excitotoxicity,  are  the  reasonable  and  customary  medications.    After  this,  if  there  is  depression  or  associated  psychosis,  a  serotonergic  medication  might  be  necessary  to  control  these  symptoms;  often  various  serotonin  medications  are  used  as  an  atypical  antipsychotic.    At  times,  traditional  dopamine  antagonists  are  used  in  the  form  of  typical  antipsychotics.      

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 Sometimes  medications  are  needed  to  control  anxiety  and  sleep.  The  benzodiazepine  

category  for  anxiety  and  the  “z”  drugs  for  sleep  are  utilized  for  the  control  of  symptoms  that  are  common  with  degenerative  processes.    Often,  nutritional  products  combined  with  medications  and  brain  exercises  produce  optimal  results.    A  process  for  thinking  in  a  linear  and  empirical  fashion  is  very  necessary.    Here  are  some  forms  of  thinking  when  looking  at  patients.        Process  of  evaluation:  

-­‐ The  patient  might  need  medications  initially  if  symptoms  need  to  be  managed  due  to  severity  or  rapid  progression.  

o Severe  depression,  hallucinations,  delusions,  behavior  alterations,  possible  self-­‐harm,  cognitive  loss,  or  other  symptom  not  controllable  by  other  methods.      

-­‐ Nutrition  to  control  energy  and  mitochondrial  function.  o Mitochondria  has  to  be  managed  to  give  energy  and  ATP  and  reduce  the  rate  of  

dying  cells.      -­‐ Nutrition  to  control  inflammation  or  immune  dysregulation  if  present.    

o Cytokines,  glial  priming,  and  breached  blood-­‐brain  barrier  needs  to  be  controlled.      -­‐ Nutrition  to  control  cellular  membranes  if  necessary.      

o With  energy  loss  and  inflammation,  cellular  membranes  can  become  unstable.      -­‐ Nutrition  to  control  oxidative  stress  if  necessary.    

o Reactive  oxygen  species,  super  oxide  anions,  and  peroxynitrite  damage.  -­‐ Nutrition  to  control  nitric  oxides  and  vessel  function  if  necessary.    

o Can  perpetuate  immune  issues  and  small  vessel  disease  along  with  lipid  issues  and  inflammation.      

-­‐ Dietary  changes  to  deal  with  protein,  carbs,  fats,  autophagy  and  energy  levels.    o Must  have  energy  and  the  ability  to  metabolize  various  types  of  nutrients.    Some  

patients  do  well  with  higher  fat  and  protein  and  lower  carb  levels  as  long  as  they  are  not  hypoglycemic  and  have  the  kidney  function  to  manage  this  type  of  diet.      

-­‐ Nutritional  and  dietary  management  to  control  transmitter  levels.    o There  may  be  a  need  to  support  monoamines  that  turn  into  transmitters.    This  at  

times  makes  using  meds  not  necessary,  or  helps  medications  work  optimally.      -­‐ Nutritional  and  dietary  management  to  control  associated  comorbidities.    

o A  good  example  of  this  would  be  blood  sugar.    All  comorbid  factors  need  to  be  considered.    If  it  produces  inflammation,  it  can  harm  a  deteriorating  brain.        

           

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