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Neurology > Parkinson Dse > Flashcards

Parkinson Dse Flashcards

(75 cards)

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1
Q

Peak age of onset of PD

A

6th decade

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2
Q

Tetradof PD

A

Hypokinesia, Bradykinesia
Resting tremor
Postural instabilility
Rigidity

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3
Q

CF of PD

A

Expressionless face (hypomimia), stooped posture, festinating gait

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4
Q

Speech in PD

A

Monotomous soft cluttered

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5
Q

early sign of PD

A

Infrequency of blinking

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6
Q

initial sign of PD

A

Tremor - 4 per sec pill rolling tremor of thumb and fingers

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7
Q

Aborts tremor in PD

A

Complete relaxation

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8
Q

Rigidity

A

Cogwheel rigidity

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9
Q

Graphia in PD

A

Micrographia

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10
Q

Speech do in PD

A

Hypokinetic dysarthria

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11
Q

Gait in PD

A

Festinating gait - rapid but short steps

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12
Q

Walking in PD

A

Reduced to shuffle

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13
Q

Spine in PD

A

Extreme forward flexion

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14
Q

Tremors in PD

A

begin in 1 limb spread to one side -> both limb

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15
Q

Inability to resist blinking in response to taapping bridge of nose or glabella

A

Myerson sign

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16
Q

DDx of Parkisonism

A 
PD
Progressive supranucleur palsy
Dysautonomia
Lewy body dse 
NPH
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17
Q

indicates PD

A

Sustained response to Levodopa

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18
Q

Rapid onset of Parkinsonism

A

Neuroleptic meds, Metoclopramide

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19
Q

Pathology of PD cells and nuclei

A

Loss of pigmented cells in substantia nigra and other pigmented nuclei

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20
Q

Pathology of PD, what appears pale

A

Substantia nigra appears pale

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21
Q

Histopath of PD

A

Eosinophilic cytoplasmic inclusions surr by faint halo (Lewy bodies)

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22
Q

Other regions ofn euronal loss in PD

A

Mesencephalic reticular formation, sympathetic ganglia

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23
Q

Causes destruction of dopaminergic neurons

A

MPP+

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24
Q

MPTP converted to what which produces irreversible Parkinsonism

A

MPP+

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25
This mutatation is the mc genetic abn in EARLY ONSET PD
Park2 (parkin)
26
early onsent PD
parkin, alpha synuclein
27
normal component of synapse but in high concentration, aggregates and is a main constituent of Lewy Body
Alpha synuclein
28
Other constituents of LB
Ubiquitin and tau
29
Ubiquitin protein ligase that functions in removal of unnecessary proteins from cells
Parkin
30
Mutation of parkin leads to
Misfolding of synuclein
31
In PD, what cells are lost? What NT is loss?
Substantia nigra cells loss | Dopamine input loss
32
With lost of DOPAMINE in PD, 2 nuclei become overactive
Subthalamic nucleus | Globus pallidus interna
33
2 anatomic targets in Deep brain stimulation
Subthalamic nucleus | Globus pallidus interna
34
Tx of PD most effective
L Dopa and L Dopa modifying drugs
35
Crosses BBB
L Dopa
36
Does not cross BBB
Dopamine
37
Motor complications
Fluctuations ("on-off) Dyskinesias Wearing off effect Delayed on
38
Decarboxylase inhibitor
Carbidopa
39
Moa of Carbidopa
inhibits L dopa decarboxylation --> More of L dopa available --> crosses BBB
40
Dose L Dopa-Carbidopa
Levodopa/Carbidopa 25/100 mg BID titrated to 4 tablets 5 or more times daily
41
Tx of PD extends plasma half life of L dopa
COMT Catechol.o.methyltransferase inhibitors
42
COMT Catechol.o.methyltransferase inhibitors MOT
extends plasma half life of L Dopa
43
COMT Catechol.o.methyltransferase inhibitors sample
Entacapone
44
Directly act on dopamine rc
Dopamine agonists
45
Dopamine agonists MOA
Directly acts on dopamine rc
46
May be initial tx esp younger individuals
Dopamine agonists
47
Less likely to cause DYSKINESIAS
Dopamine agonists
48
Donwside of dopamine agonists and AE
Less potent | More motor and cognitive SE
49
Dopamine agonists are derivatives of
Ergot
50
Dopamine agonists Ergot derivatives
Bromocriptine Pergolide Cabergoline
51
2nd gen dopamine agonists
Ropinirole, pramipexole (minimal ergot) | Rotigotine patch
52
2nd dopamine agonists Minimal ergot like effects
Ropinirole and premipexole
53
2nd dopamine agonists patch
Rotigotine
54
Adjunctive meds in PD
Trihexyphenidyl and benztropine (anticholinergic) for tremors Amantidine - antiviral
55
adjunctive meds (anticholinergic) for tremors
Trihexyphenidyl and benztropine
56
Adjunctive meds antiviral
Amantidine
57
Moa of Amantidine (adjunctive meds)
NMDA antagonist | Antiviral
58
Mild tremors on tremor hypokinesia postural sx
Amantidine
59
Neuroprotective agents
MAO B inhibitor reduces oxidative stress (Selegeline, Rasagiline) Ropinirole, pramipexole Vitamin antioxidants (Vit E)
60
Mao B inhibitor samples
Selegeline and Rasagiline
61
MAO B inhibitor (Selegeline, Rasagiline) moa
reduces oxidative stress
62
SE of dopamine tx
``` nausea dyskinetic movements end of dose reduction on-off phenomenon (motor fluctuations) psychosis depression, patho gambling ```
63
Reduction of tremor and bradykinesia
L DOPA Carbidopa-L-dopa
64
May prolong L dopa effects
Controlled release Carbidopa-L-dopa
65
Moderate effects on all aspects; reduced motor fluctuations of L dopa, less dyskinesia
Dopamine agonists (Ropinerole, Pramipexole)
66
Smoothing of motor fluctuations
Glutamate antagonist (Amantidine)
67
Tremor reduction
Anticholinergics (Benztropine, Trihexyphenidyl)
68
Prolonged effect on L Dopa
COMT inhibitors (Entacapone)
69
Reduced off time, Neuroprotection
MAO inhibitors (Rasagiline, Selegline)
70
SE meds Nausea DYSKINESIA Orthostatic hypotension
L Dopa Carbidopa-L-dopa, Controlled release Carbidopa-L-dopa
71
``` SE meds Orthostatic hypotension Excessive sleepiness CONFUSION hallucination ```
Dopamine agonists (Ropinirole, Pramipexole)
72
``` SE meds Leg swelling CHF Prostatic outlet obstruction Insomia ```
Glutamate antagonists (Amantidine)
73
``` SE Meds Dry mouth Urinary outlet obstruction Confusion Psychosis ```
Anticholinergics (Benztropine, Trihexyphenidyl)
74
SE Meds Urine discoloration diarrhea dyskinesias
COMT inhibitor (Entacapone)
75
SE of meds | Hypertensive crisis with tyramine rich foods and sympathomimetics
MAO inhibitors (Rasagiline, Selegiline)

Neurology (4 decks)

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