Chapter 4 - Movement Disorders Flashcards Preview

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Flashcards in Chapter 4 - Movement Disorders Deck (86)
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1

How is pain managed in cerebral palsy?

Pain related to spasticity or muscle spasm:
Baclofen
Diazepam

Other causes of pain
Usual analgesic ladder

2

How is drooling managed in cerebral palsy?

Give an antimuscarinic e.g.
Glycopyronium
Hyoscine

If this doesn’t work
Botulinum toxin type A can be administered into the salivary glands

3

What should patients with cerebral palsy be given to protect their bones?

Vitamin D and calcium

4

What symptoms should patients be warned of when taking Botulinum toxin type A?

Swallowing or breathing difficulties
Breathing difficulties

5

What is motor neurone disease?

A neurodegenerative condition affecting the brains and spinal chord

6

List some symptoms of motor neurone disease

Muscle weakness
Muscle pain
Muscle stiffness
Muscle wasting
Cognitive decline
Decline in respiratory function

7

What is amyotrophic lateral sclerosis and what can be used to extend life?

The most common form of motor neurone disease

Riluzole can be used to extend life

8

What is the aim of drug therapy in motor neurone disease?

To manage symptoms (MND is incurable)

9

What can be given to manage the muscular symptoms in motor neurone disease?

First line - quinine
Second line - baclofen
Alternatives - gabapentin, tizanidine, dantrolene

10

What are the options for saliva problems in motor neurone disease?

Glycopyronium
Botulinium toxin type A

If saliva is this
Carbocisteine
Nebuliser
Humidifier

11

Can glycopyronium be given to patients with motor neurone disease and cognitive impairment?

Yes
Glycopyronium bromide has the advantage of having few CNS side effects

12

What can be used to manage respiratory symptoms in motor neurone disease?

Opioids
Benzodiazepines if there is co-existing anxiety

13

When do patients need to inform the DVLA about having Parkinson’s disease?

At the point of diagnosis

14

What are some motor symptoms associated with Parkinson’s disease?

Bradykinesia
Rigidity
Postural instability (increased falls)
Freezing
Shuffling
Tremor

15

What are some non-motor symptoms associated with Parkinson’s disease?

Dementia
Depression
Urinary incontinence
Constipation
Pain
Sleep disturbances
Dysphagia
Speech and language changes
Weight loss

16

Which analgesic shouldn’t be used in Parkinson’s disease?

Tramadol - may exacerbate symptoms

17

How should dementia associated with Parkinson’s disease be managed?

AChE Inhibitors/memantine

Don’t use antipsychotics - can cause EPSEs and worsen Parkinson’s symptoms

18

What is off time in Parkinson’s disease?

Amount of time in the day the patient experiences symptoms of Parkinson’s

19

What is on time in Parkinson’s disease?

Amount of time in the day the patient does not experience the symptoms of Parkinson’s

20

What are the 3 main mechanisms of anti-Parkinson’s drugs?

Give a dopamine precursor
Give a dopamine receptor agonist
Reduce the breakdown of dopamine

21

What is the first line option if symptoms of Parkinson’s are affecting QoL in the elderly?

Levodopa combination

22

What can levodopa be combined with and what is the brand name of these combinations?

Dopa decarboxylase inhibitors

Sinemet
Levodopa + carbidopa (co-careldopa)

Madopar
Levodopa + benserazide (co-benledopa)

23

Why are dopa decarboxylase inhibitors given alongside levodopa?

Then don’t cross the BBB
So they block the conversion of levodopa in the periphery, but not in the brain

Therefore there are less peripheral side effects e.g. nausea, arrhythmia, BP changes

And levodopa can be initiated at a lower dose

24

What is the first line option if symptoms of Parkinson’s are not affecting QoL in the elderly?

Either:
Levodopa
Non ergot derived dopamine receptor agonist
MOAB inhibitor

25

What is the mechanism of levodopa?

Crosses BBB
Gets converted into dopamine

26

What is the mechanism of rasagiline?

Inhibits the breakdown of dopamine

27

What is the mechanism of pramiprexole?

Dopamine receptor agonist

28

Why aren’t ergot derived dopamine receptor agonists used?

Risk of cardiac and pulmonary fibrosis

29

Give examples of non-ergot derived dopamine receptor agonists

Pramiprexole
Ropinirole
Rotigotine

30

Why do you need to consider when prescribing ropinirole in the elderly?

Clearance is reduced by approx 15%