Degenerative Disorders Flashcards by Clayton Corbridge

What are the main manifestations of Degenerative disorders?

Movement or Cognitive impairment.

*Usually later in life but has a genetic and environmental aspect

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What are the 8 mechanisms through which Degenerative disorders develop?

1-Hypoxia (stroke/GABA issues)
2-Excitatory AA (glutamate on NMDA/AMPA)
3-Ion Fluxes (Ca++ distrib)
4-Free radicals 
5-Immune issues (Autoimmune)
6-Infections (Viral/Bacterial
7-Apoptosis
8-Protein Aggregation (plaque)

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What are the 3 main clinical manifestations of Parkinson’s Disease?

1-Tremor
2-Rigidity
3-Bradykinesia

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What are the two main postural abnormalities in those with Parkinson’s?

1-Stooped Posture

2-Shuffling of feet

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What are the 3 main Autonomice and neuroendocrine manifestations of Parkinson’s?

1-Salivating/drooling
2-Slurred speech (often speak softly as well)
3-Dysphagia/Choking

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What are 3 late symptoms of Parkinson’s?

1-Depression/reclusiveness
2-Immobilility
3-Loss of bowel function (usually constipation)

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Which stage of Parkinsons only affects one side with minimal or no functional impairment?

Stage 1 (Mild/Early)

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Which stage of Parkinsons affects both sides but has normal posture and balance?

Stage II

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Which stage of Parkinsons affects both sides with mild imbalance when standing or walking?

Stage III (Moderate)

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Which stage of Parkinsons affects both sides with instability while standing or walking and needs help/cannot live alone?

Stage IV (Advanced)

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Which stage of Parkinsons is fully developed and restricts the patient to bed or a wheelchair?

Stage V

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Though Parkinsons may develop in anyone that lives long enough, ____% over the age of 80 have it, _____% in those 50-60 years old and _____% in those under 50

50, 1, 0.01

*Not gender Biased

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What pathway is affected in Parkinsons?

Dopamine neuron activity in the Nigra striatal neurons between Substantia Nigra and Striatum

*Increased Cholinergic activity results

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What are 4 Possible environmental causes of Parkinsons?

1-Mg and Hg (welders/dentists)
2-Pesticides (quinones, Farmers)
3-Trauma (Brain Injuries)
4-Dopamine (creates ROS)

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What are two possible genetic components of Parkinsons?

1-Synuclein (vesicle trafficking)

2-Larkin

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L-Dopa is used as a Dopamine precursor to battle the loss of the Nigra-Striatal pathways but must be administered with what to block peripheral metabolism of L-Dopa?

Carbidopa

*L-dopa doesn’t cross the BBB really well so high plasma levels are needed. Entacapone can improve the effect as well.

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What drug is administered in combination with L-dopa and is a COMT inhibitor to block metabolism of dopamine?

Entacapone

*often with Levodopa as well as Carbidopa

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What is a typical reaction right after a patient has taken their L-dopa?

Clenched jaw, tight/twisted fist. May cause behavior, movement and psychosis issues

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Which medication for parkinsons can cause blurred vision, urinary retention, and dry mouth?

Benztropine

*anticholinergic

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Which drug is used in most parkinsons at some point?

Levodopa (L-dopa)

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Which parkinsons drug is a D2 agonist and may cause orthostatic hypotension, nausea, confusion and hallucinations?

Pramipexole

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Which parkinsons drug is a MAO inhibitor?

Selegiline

*slows DA metabolism. Only drug to not cause xerostomia

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What surgical technique is sometimes used to help control balance and tremor symptoms of parkinsons?

Deep Brain Stimulation. Enhances DA release. Best in early onset parkinsons

Besides xerostomia, what oral side effects might Combination Levodopa drugs cause?

Glossitis
Trismus (from clenching)
pigmentation/dark saliva

Though it does not cause xerostomia, what oral side effects might Selegiline cause?

- Sublingual ulcerations | - Burning mouth/lips

What should be kept in mind when treatment planning for a parkinsons patient?

Major dental interventions would be done early in PD if possible

What is the ideal treatment schedule for a parkinsons patient?

Short, morning appointments 90 minutes after PD meds, after emptying bladder

If a patient is taking levodopa and/or entacapone how should your use of local anesthetic change?

Limit to 2-3 cartridges of Epi containing anesthetic

The uncontrolled jerky movements of Huntington's disease (chorea) is related to what?

Too much dopamine in the striatum

What are the three main stages of progressive intellectual dysfunction in Huntingtons?

1-Early: Deterioration of judgement 2-Depression 3-Psychotic and compulsive

Huntingtons is found in ____% of the pop. Last __ -__ years and is _____ aggressive in males and when the gene comes from the ______

0.01 5-10 years More Father

In parkinsons the cell bodies of the Substantia Nigra deteriorate whereas in Huntingtons, the deterioration is in the?

Striatum Cell bodies *too much dopamine. Enlarged ventricles due to lose of caudate

The huntington gene seems to be related to glutamate and causes what?

NMDA receptors to be more sensitive, resulting in loss of GABA regulation

What two kinds of drugs are the best to treat huntingtons?

1-DA antagonists | 2-D2 antagonists

What are 3 drugs used to treat Huntingtons?

1-Haloperidol (D2 antagonist, antipsychotic) 2-Citalopram (SSRI, antidepressant) 3-Baclofen (GABA agonist, relieves muscle rigidity for comfort)

What disease is caused by cholinergic depletion, causes neuronal symptoms, and can last 15+ years?

Alzheimer's disease *3-4 million/ 1% of pop. have it. 50% of 80+ yr old have it

What are the 3 basic stages of alzheimers?

1-Early: still work and function but forget things. Recent memories slip 2-Moderate: difficulty with common tasks, forget location 3-Late stage: Don’t remember people or things motor functions deteriorate

What three areas of the brain are mainly effected in Alzheimers?

1-Hippocampus (memory) 2-Cortex 3-Nucleus Basalis- connects to hippocampus with Ach projections

What are the two histological effects of Alzheimers on the brain?

1-Senile Plaques | 2-Neurofibrillary tangles

What type of histological alzheimer effect has tau protein aggregates that look like railroad tracks?

Neurofibrillary Tangles *associated with microtubules

What type of histological alzheimer effect has B-amyloid protein aggregates?

Senile Plaques *APP not formed correctly

Which neurotransmitter decreases in alzheimers?

ACh *Treatments like Aricept increase ACh

What are 7 common alzheimer disease medication types?

``` 1-Cholinesterase inhibitor 2-Atypical Antipsychotics 3-Neuroleptic 4-SSRI 5-Tricyclic antidepressant 6-Serotonin and Norepi reuptake inhib 7-Central a2 autoreceptor ```

While disease is more prevalent in females, has relapse cycles with variable symptoms and is due to myelination issues?

Multiple Sclerosis *Oligodendrocyte issues. Heat tends to worsen it

Though most complain of fatigue, what are some symptoms of MS?

``` 1-Optic 2-Auditory and other sensory 3-Depression 4-Autonomic system (dangerous) 5-Cognition deficiency ```

What is the epidemiology of MS?

1-Scandenavian is more frequent. 2-Genetic based disorder. 3-Adolescents and young adults 4-2:1 female to male ratio

What likely triggers MS?

Virus which induces an autoimmune response with acute inflammatory episodes

What are the 4 classicfications of MS?

1-Benign 2-Relapsing remission (on/off) 3-Relapsing progressive (minor remissions) 4-Chronic progression (no remission)

What do you need to see on an MRI in order to diagnose MS?

2 or more lesions *Symptoms are based on location

What medication is mainly used to manage relapses in ms?

Prednisone

What is used to manage Bladder dysfunction in MS?

Tamsulosin (Flomax)

What is used to manage Bowel dysfunction in MS?

metamucil (psyllium)

What is used to manage depression in MS?

Prozac

What is used to manage fatigue in MS?

modafinil *also used for ADHD

What is used to manage pain in MS?

gabapentin (Neurotin) *enhance GABA selectively

What is used to manage tremors in MS?

clonazepam (klonopin)