14- mvmt disorders softchalk

Question 1

what is the micro appearance of parkinson

Answer 1

eosinophilic intracellular inclusions of alpha-synuclein called a Lewy body

Question 2

What is most effective tx for parkinsons? what is it always administered with and it’s MOA

Answer 2

Levodopa always administered with carbidopa (a peripheral dopa-decarboxylase inhibitor- prevents breakdown of L-DOPA into DA which can cause a lot of side effects in the periphery

Question 3

name 4 DA agonists

Answer 3

Pramipexole, ropinorole, rotigotine, apomorphine

Question 4

what are the ADEs assc with DA agonists? (4)

Answer 4

sedation, edema, impulse control disorders, confusion

Question 5

what is MOA of MAOB-inhibitors in parkinsons tx? and why are they not very effective

Answer 5

inhibit DA mtb; therefore dependent on endogenous DA or levodopa to be effective

Question 6

2 examples of MAOB-inhibitors

Answer 6

Selegine, rasagiline

Question 7

MOA of COMT inhibitors

Answer 7

Extend half-life of DA by inhibiting catechol-O-methyltransferase

Question 8

2 examples of COMT inhibitors

Answer 8

Entacapone, tolcapone

Question 9

Amantadine MOAs (2)

Answer 9

DA release, block reuptake

Question 10

atypical parkinsonism: sx, px?

Answer 10

sx: neurodegeneration with parkinsonism
px: worse

Question 11

why are DA-thx not effective in atypical parkinsonism?

Answer 11

diability is not driven by DA deficiency

Question 12

progressive supranuclear palsy: associated with what micro finding

Answer 12

abnormal tau protein (also seen in AZD)

Question 13

progressive supranuclear palsy: CP

Answer 13

-gait problems in 1st year
(falling in 1st year = PSP)
-can’t gaze upward
-upright posture, stiff neck (stooped = parkinsons)

Question 14

progressive supranuclear palsy: mortality

Answer 14

within 10 years

Question 15

progressive supranuclear palsy: MRI signs (2) and what are they due to?

Answer 15

Due to atrophy of midbrain:

i. Humminbird sign
ii. Mickey mouse sign

Question 16

multiple system atrophy assc with what micro findinng?

Answer 16

alpha-synuclein protein

Question 17

if both Parkinson’s and multiple system atrophy have alpha-synuclein, what differentiates them?

Answer 17

multiple system atrophy has AUTONOMIC dysfunction:
orthostatic hypotension
erectile dysfunciton
anhidrosis, etc

Question 18

what is chc MRI finding of multiple system atrophy, and what does it indicate

Answer 18

“hot-cross-bun” ix pontocerebellar degeneration at level of pons

Question 19

what 3 disease show abnormal tau protein?

Answer 19

AZD, progressive supranuclear palsy, corticobasal degeneration

Question 20

tremor: rest = ? action = ?

Answer 20

rest = parkinson's
action = essential tremor, drug-induced, physiologic, dystonia

Question 21

unilateral tremors are caused by what 4?

Answer 21

stroke, tumor, Parkinson’s, dystonia

Question 22

bilateral tremor is caused by what 3?

Answer 22

essential tremor, drug-induced, physiologic

Question 23

two 1st line medications for Treatment of Essential Tremor. Which is most effective?

Answer 23

propanolol- used first

primidone (most effective- but has side effects so propanolol is 1st)

Question 24

primidone MOA

Answer 24

Anticonvulsant and barbituate

Question 25

3 second-line medications for Treatment of Essential Tremor

Answer 25

topiramate, gabapentin, benzodiazepines

Question 26

Diagnostic criteria for tourette’s:

Answer 26

Multiple motor tics and at least one vocal or phonic tic

Question 27

two thxs for Tics

Answer 27

◊ Cognitive behavioral therapy including habit reversal therapy is most effective for motor and vocal tics
Pharmacologic therapy: Dopamine blocking drugs (antipsychotics)