Parkinson's DZ - RS

Question 1

pathology

Answer 1

refers to a group of disorders producing abnormalities in the BG

excessive cholinergic activity, tremor and rigidity

loss of dopamine –> akinesia, bradykinesia

Question 2

tremor

Answer 2

most common initial clin man (75%)

Question 3

how does a tremor usually appear

Answer 3

unilaterally in a single UE

can progress to bilateral

Question 4

how are tremors first seen

Answer 4

pill-rolling tremor in fingers

Question 5

which side to symptoms usually start on

Answer 5

right side

61%

Question 6

tremors are present

Answer 6

at rest

Question 7

increase in tremors

Answer 7

with exertion or tension

stress test

Question 8

decrease in tremors

Answer 8

or disappear with sleep or action

Question 9

tremors occur as a result

Answer 9

of an imbalance b/w cerebellar actions and BG inhibition

Question 10

overtime…

Answer 10

tremor will spread to other body parts including

-legs

face (blepharospasm)

-shoulder

-neck/trunk (titubation)

Question 11

how do tremors progress

Answer 11

unilateral –> bilateral

appendicular –> axial

Question 12

reduction in

Answer 12

medical efficacy

Question 13

progression causes

Answer 13

increased akinetic rigidity

postural/balance/gait disturbance

motor initiation difficulty (freezing)

speech/swallowing/drooling problems

vocal production dysfunction

non-motor symptoms

medication side effects

complications

Question 14

common presenting

Answer 14

TRAP

shuffling gait

decreased arm swing (w/ gait)

dysphasia

micrographia

Question 15

TRAP

Answer 15

cardinal signs

3/4 required for diagnosis

Question 16

T-Trap

Answer 16

resting tremor

pill rolling

Question 17

R- trap

Answer 17

rigidity

lead pipe, cogwheel

Question 18

A - trap

Answer 18

akinesia

bradykinesia

Question 19

P -trap

Answer 19

postural instability

late stage finding

decrease balance and coordination

Question 20

Heohn and Yahr scales

Answer 20

stages 0-5

Question 21

stage 0

Answer 21

no signs of dz

Question 22

stage 1

Answer 22

unilateral dz

Question 23

stage 1.5

Answer 23

unilateral plus axial involvement

Question 24

stage 2

Answer 24

BIL dz w/o balance impairments

Question 25

stage 2.5

Answer 25

mild bilateral dz with recovery on pull test

Question 26

stage 3

Answer 26

mild/moderate BIL dz

some postural instability but physically dependent

Question 27

stage 4

Answer 27

severe disability

still able to walk/stand unassisted

Question 28

stage 5

Answer 28

w/c bound or bedridden unless aided

Question 29

common medication

Answer 29

replace dopamine

block acetylcholine

neuroprotective drugs

Question 30

dopamine replacement therapy

Answer 30

aimed at replacing deficient dopamine

Sinemet: L-dopa/Carbidopa combination

amantadine

dopamine agonists

enzyme inhibitors

Question 31

L-dopa

Answer 31

precursor to dopamine that crosses BBB

Question 32

carbidopa

Answer 32

given with L-dopa

inhibits the release of L-dopa in the peripheral tissue and increases it release into the brain

Question 33

what does the combo do (meds)

Answer 33

decrease total amount of L-dopa needed

cutting down on side effects

limits bradykinesia, rigidity, tremor

Question 34

what doesnt the sinemet treat

Answer 34

motor planning deficits

postural instability

non-motor symptoms

Question 35

overtime (meds)

Answer 35

therapeutic window decreases and toxic window increases

Question 36

side effects sinemet

Answer 36

dyskinesia

dystonia

on/off motor fluctuations

Question 37

50-60% of people on L-dopa

Answer 37

will have motor complications within 5 yrs

Question 38

dopamine agonists

Answer 38

bromocriptine (parlodel)

pergolide (permax)

Question 39

when dopamine agonists are added with sinemet

Answer 39

decrease clinical fluctuations

Question 40

what do dopamine agonists

Answer 40

boost output of remaining substantia nigra cells

Question 41

block acetylcholine

Answer 41

anticholinergics

parsidol

cogentin

akinetin

artane

Question 42

anticholinergics do

Answer 42

improve symptoms by restoring the balance of ACh and dopamine

Question 43

when are anticholinergics used

Answer 43

less frequently than others

more used early in the dz when tremor is the most prominent problem

Question 44

anticholinergics are affective for

Answer 44

tremor only

Question 45

side effects of anticholinergics

Answer 45

confusion

memory

hallucinations

dry mouth

constipation

urinary retention

orthostasis

Question 46

neuroprotective drugs

Answer 46

monoamine oxidase inhibitors (MAOs)

Question 47

MAOs

Answer 47

neuronal degradation can be controlled with antioxidants

which control the synthesis and elimination of free radicals

Question 48

problems with medical management –> sinemet

Answer 48

can cause dyskinesia, orthostatic hypotension, behavioral signs (confusions, hallucinations, paranoia, psychosis)

Question 49

problems with medical management –> on/off

Answer 49

on/off phenomenon and short duration therapeutic response followed by rapid decrease in symptomatic relief

Question 50

on/off phenomenon and short duration therapeutic response followed by rapid decrease in symptomatic relief

Answer 50

d/t the fact that PD meds are toxic to receptor site

grows more dramatic over time

“On” time becomes shorter with “off” time having dyskinesia or severe bradykinesia

“narrowing therapeutic window”

“wearing off” phenomenon

Question 51

when is PT attempted

Answer 51

ideally during “on” time

Question 52

how many respond to sinemet for a lifetime

Answer 52

1/3

Question 53

how many respond to sinemet for 3-5 yrs

Answer 53

1/3

Question 54

how many respond to sinemet for 5-7 yrs

Answer 54

1/3