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year three exam 2 > Parkinson's clinical > Flashcards

Parkinson's clinical Flashcards

1
Q

what is Parkinson’s disease

A

chronic, progressive neurodegenerative disease resulting from the loss of dopamine containing cells in the substantia nigra

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2
Q

which pathway in the brain affects motor control

A

nigrostriatal pathway

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3
Q

which pathway in the brain affects behaviour

A

mesolimbic and Mesocortical pathways

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4
Q

which pathway in the brain affects endocrine control

A

Tuberhypophyseal pathway

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5
Q

what are the motor symptoms of parkinsons disease

A

bradykinesia
muscle rigidity
tremor

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6
Q

what is bradykinesia

A

slowness of voluntary movement that is asymmetrical and unpredictable

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7
Q

what are the signs of bradykinesia

A

mask like face
soft voice - hypophonia
micrographia
shuffling gait
difficulty with fine actions

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8
Q

what is muscle rigidity

A

increased tension
mainly in flexor muscles, trunk or limbs
stooping posture

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9
Q

what are the signs of tremor

A

when resting, usually in hands - pill rolling movements
improves with concentration or voluntary movement

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10
Q

which medicines can cause tremor

A

antipsychotics
beta agonists
anti-emetics

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11
Q

what are the non-motor symptoms of parkinsons disease

A

depression
anxiety
fatigue
cognitive impairment
sleep disturbance
constipation
hyposmia
sialorrhea
excessive sweating
urinary issues
pain
hypotension

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12
Q

what are the extrinsic environmental causes of parkinsons disease

A

drugs
- antipsychotics EPSEs
- antiemetic EPSEs
- reserpine
- recreational drugs

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13
Q

how does reserpine cause parkinsons disease

A

depleted monoamines from presynaptic storage reduces dopamine release

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14
Q

what are the extrinsic physical factors that can cause parkinsons disease

A
  • cerebral ischaemia
  • viral encephalitis
  • brainstem injury
  • dementia pugilistica from repeated head injury
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15
Q

what are the intrinsic causes of parkinsons disease

A
  • genetic
  • age
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16
Q

what mutations can cause parkinsons disease

A

alpha synuclein mutations
lewy body formation
parkin gene mutation

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17
Q

what do alpha synuclein mutations do

A

causes lewy body formation, which causes DNA damage

18
Q

what does the parkin gene do

A

neuroprotective gene - mutations are responsible for early onset

19
Q

what are the exclusion factors for diagnosis of parkinsons

A

stroke
head injury
antipsychotics
encephalitis

20
Q

supportive criteria for the diagnosis of parkinsons

A

unilateral onset
response to levodopa
progressive

21
Q

what are the guidelines for the treatment of motor symptoms in PD

A
  1. levodopa
  2. when dyskinesia or fluctuations develop - add
    - dopamine agonist
    - monoamine oxidase B inhibitors
    - catechol-o-methyl transferase inhibitors
    - amantadine
22
Q

which medications are co-administered with levodopa and why

A
  • Given with carbidopa or benserazide - reduces peripheral absorption Or COMT inhibitors such as entacapone
23
Q

side effects of COMT inhibitors

A

red/orange urine
diarrhoea

24
Q

what are the side effects of levodopa

A

nausea
anorexia
hypotension
sleep disturbances
psychological effects

25
Q

how is levodopa to be taken

A

up to 800mg/day in divided doses
30-60 minutes after eating - inhibited by protein
must be brand prescribed!

26
Q

what are dopamine agonists and how do they work

A

mimics actions of dopamine
ergot derived - bromocriptine (lots of s/e)
non-ergot derived - ropinirole, pramipexole

27
Q

dopamine agonist s/e

A

less dyskinesias but more s/e - especially ergot derived which should not be used unless absolutely necessary
- N&V
- heart and lung fibrosis

28
Q

how are dopamine agonists taken

A

TDS usually but can get in MR formulations

29
Q

what are monoamine oxidase inhibitors and how do they work

A

reduces metabolism of dopamine - may partially slow disease progression
- selegeline - metabolised to amphetamine
- rasagiline

30
Q

what are the side effects of monoamine oxidase inhibitors

A

nausea
postural hypotension
dyskinesia
confusion

31
Q

how does amantadine work

A

increases dopamine levels in the brain - mild benefit to symptoms
adjuvant only
efficacy diminishes after a few months

32
Q

what are the side effects of amantadine

A

hallucinations
sleep disturbances
N and V
anorexia
hypotension
palpitations

33
Q

what are impulse control disorders and how are they caused

A

caused by amantadine, dopamine agonists
can last for 4-5 years post treatment
- more likely to happen in younger males, with smoking or alcohol history

34
Q

what happens if a dose of levodopa

A

acute akinesia or neuroleptic-like malignant syndrome

35
Q

what is neuroleptic-like malignant syndrome

A

fever, rigidity, elevated CK and leucocytosis -
caused by sudden drop in dopamine activity - more common in high levodopa doses

36
Q

how are the non-motor symptoms of mental health treated in parkinsons

A

depression and anxiety - SSRI as per NICE
dementia - rivastigmine (donepezil off label)
impulse control - optimise therapy
confusion/hallucinations - if severe quetiapine/clozapine

37
Q

how are the non-motor symptoms of autonomic dysfunction treated in parkinsons

A

constipation - stimulant (PRN) and softener
orthostatic hypertension if severe - midodrine/fludrocortisone
dysphagia - optimise/switch meds
excessive salivation and sweating - Glycopyrronium
bladder issues - anti-muscarinic
sexual dysfunction - sildenafil

38
Q

how are the non-motor symptoms of N and V treated in parkinsons

A
  1. domperidone
  2. cyclizine or ondansetron
    protein free snacks before taking
39
Q

how are the non-motor symptoms of pain treated in parkinsons

A

follow pain ladder
consider s/e

40
Q

how are the non-motor symptoms of sleep disturbances treated in parkinsons

A

○ Sedatives
○ Short term occasional - can cause falls etc
○ Daytime sleepiness - modafinil - specialist

41
Q

how are patients medicines managed in parkinsons

A
  • Review every 6-12m
    • Titrate to optimise
    • Sudden drug cessation may precipitate acute akinesia or neuroleptic malignant syndrome
    • Small doses of levodopa at increased intervals decrease peaks and troughs
      ○ Do not eat protein 30-60 mins before dose
      ○ Must be prescribed by brand
42
Q

which OTC medications can worsen parkinsons symptoms

A

○ OTC avoid sympathomimetics (e.g. pseudoephedrine) with MAO-B inhibitors
○ OTC antihistamines
○ Calcium channel blockers – occasional EPSE, frequency unknown

year three exam 2 (38 decks)

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