Parkinson's Flashcards
(26 cards)
What causes Parkinson’s disease
degeneration of dopaminergic neurons in the substantia nigra
Classic triad of features in Parkinson’s
radykinesia, tremor and rigidity
Typically asymmetrical
Epidemiology of Parkinson’s
More likely in older men
Features of bradykinesia in Parkinson’s
poverty of movement also seen, sometimes referred to as hypokinesia
short, shuffling steps with reduced arm swinging
difficulty in initiating movement
Features of tremor in Parkinson’s
most marked at rest, 3-5 Hz
worse when stressed or tired, improves with voluntary movement
typically ‘pill-rolling’, i.e. in the thumb and index finger
Other characteristic features of Parkinson’s
mask-like facies flexed posture micrographia drooling of saliva Impaired olfaction Fatigue
Main autonomic dysfunction in Parkinson’s
Postural hypotension
Psychiatric features of Parkinson’s
depression is the most common feature (affects about 40%); dementia, psychosis and sleep disturbances may also occur
How might drug-induced Parkinsonism present in comparison to Parkinson’s disease
motor symptoms are generally rapid onset and bilateral
rigidity and rest tremor are uncommon
(in drug-induced)
Diagnosis of Parkinson’s
Usually clinical
123I‑FP‑CIT single photon emission computed tomography (SPECT) if difficulty in diagnosis
1st line treatment of Parkinson’s disease - if motor symptoms
if the motor symptoms are affecting the patient’s quality of life: levodopa
1st line treatment of Parkinson’s disease if motor symptoms not affecting QOL
Dopamine agonist (non-ergot derived), levodopa or monoamine oxidase B (MAO‑B) inhibitor
NICE advice for treatment if resistant to levodopa
addition of a dopamine agonist, MAO‑B inhibitor or catechol‑O‑methyl transferase (COMT) inhibitor as an adjunct
Risks if Parkinson’s medication is not taken/absorbed
Acute akinesia
NMS
(Risk if drug holiday or gastroenteritis resulting in reduced absorption)
Key side effect of Parkinson’s disease medication
Impulse control disorders more likely with:
dopamine agonist therapy
a history of previous impulsive behaviours
a history of alcohol consumption and/or smoking
Management of excessive daytime sleepiness in Parkinson’s disease therapy
avoid driving
Medication should be adjusted to control symptoms. Modafinil can be considered if alternative strategies fail
Mx of orthostatic hypotension in Parkinson’s disease
Medication review
Midodrine(acts on peripheral alpha-adrenergic receptors to increase arterial resistance)
Mx of drooling of saliva in Parkinson’s disease
glycopyrronium bromide
Side effects of levodopa
Dyskinesia
‘On-Off’ effect
Dry mouth
Anorexia
Palpitations
Psychosis
Postural hypotension
What can be given if a person with Parkinson’s disease is admitted to hospital and medication has not been taken
Dopamine agonist patch as rescue medication to prevent acute dystonia
What have ergot-derived dopamine receptor agonists been associated with(bromocriptine, cabergoline)
pulmonary, retroperitoneal and cardiac fibrosis
Echo, ESR, creatinine and CXR recommended prior
Use of antimuscarinics in Parkinson’s management(procyclidine)
block cholinergic receptors
now used more to treat drug-induced parkinsonism rather than idiopathic Parkinson’s disease
Help tremor and rigidity
Drugs associated with Parkinsonism
Antipsychotics
Metoclopramide
Causes of Parkinsonism
Progressive supra nuclear palsy
Multiple system atrophy
Wilson’s disease
Carbox monoxide
