Parkinson's

Question 1

Parkinson’s

Answer 1

Progressive degeneration of the basal ganglion function

Question 2

Basal ganglia fxn

Answer 2

slow coordinated mvts

Question 3

Which cells are affected with parkinson’s

Answer 3

substantia nigra - cells in the basal ganglia that make dopamine

Question 4

CM of Parkinson’s

Answer 4

• BIG 3–rest tremor, rigidity, bradykinesia with nonmotor CM
• upper tremor (pill roll), shuffling gait, flat affect, postural instability (fall risk)

Question 5

Primary Parkinson’s

Answer 5

• idiopathic Parkinson’s disease
• genetic or sporadic

Question 6

Secondary Parkinson’s

Answer 6

Parkinsonism but not the disease
- acquired–infx, drug tox, trauma
- most often drug-induced (antiemetic and antidepressive)

Question 7

How to fix drug-induced parkinsonism

Answer 7

stop the drug and it usually resolves

Question 8

Risk fx for Parkinson’s

Answer 8

• avg onset 60s, peak in 70s
• more men than women
• dom or recessive family (10%)
• enviro exposure to agricultures and pests

Question 9

2nd fx that bring Parkinson’s out more

Answer 9

depression, head trauma, hysterectomy

Question 10

Protective fx for Parkinson’s

Answer 10

coffee!

Question 11

Dopamine in Parkinson’s

Answer 11

• inhibitory and excitatory NTs
• causes smooth motion w/o extra mvt normally
• lack inhibitory Dp receptors so unnecessary mvts aren’t inhibitory

Question 12

ACh in Parkinson’s

Answer 12

• excitatory NT that causes uncoordinated mvts
• muscle fxn and balances with Dp so if Dp is wrong and ACh is right, still fxn well

Question 13

Patho of Parkinson’s

Answer 13

• excess ACh with Dp –lose coordination
• don’t balance each other out
• primary–damage to sub nigra causes dec DP and dp/ACh imbalance, inc ACh and lose coordination
• secondary–altered Dp production

Question 14

How do Parkinson’s sx progress

Answer 14

Gradual to prog–develop alone or in combo
- begin with 1 side and move to both

Question 15

First sign of Parkinson’s often

Answer 15

resting tremor
- handwriting affected
- worse with stress and concentration

Question 16

Parkinson’s vs essential tremor

Answer 16

Parkinson’s–DP deficit and ACh inc
- occur with rest and fixed with mvt
Essential–from faulty neuro impulses with motor fxn
- no other CM of parks

Question 17

Rigidity

Answer 17

resistance to passive mvt
- “cogwheel rigidity”
- inc ACh causes continuous ctx with muscle soreness, aches, and pains
- often bilat but can be unilat

Question 18

Bradykinesia

Answer 18

loss of automated mvt
- no blinking, no swing arms/balance, drool (no swallow), no self-expression with hands and feet

Question 19

Major cause of disability with Parkinson’s

Answer 19

Bradykinesia

Question 20

Comps of Parkinson’s

Answer 20

dementia (Lewy bodies form and cause memory, cog, hallucinations), sleep probs, fatigue, anx/dep, dec mobility (PNA, asp, malnut, UTIs (urine retention)), skin b/d)

Question 21

Goals of Parkinson’s pharm

Answer 21

Maintain motor fxn best you can
- inc Dp or stim of Dp receptors
- block ACh with anticholinergic drugs

Question 22

Levodopa/carbidopa (Sinemet) class and MOA

Answer 22

Dopaminergic
- Levodopa converts to Dp in brain and activates DP rec; carbidopa blocks destruction of levodopa–keep Dp in sys for longer

Question 23

Levodopa/carbidopa (Sinemet) SE

Answer 23

• All r/t levodopa; N/V, dyskinesias (annoying to disabling uncontrolled mvts), CV postural hypotension and dysrhythmias, psychosis (hallucinate, nightmare, paranoia), dark sweat and urine, can activate malignant melanoma

Question 24

Levodopa/carbidopa NC

Answer 24

• takes several months to work
• doesn’t work long-term–dose wears off
• may need shorter dose intervals
• abrupt loss of effect “on-off” phenomenon–can occur anytime w/ dosing and can’t predict (“off” pd inc with time)
• take with small food to dec GI (does dec drug abs tho)
• vit B6, antipsychotics, and pro can dec effect
• carbidopa, antiACh, MAOIs can inc fx (tox)–psychosis

Question 25

Duopa class and MOA

Answer 25

Same as Levidopa/Carbidopa

Question 26

Duopa SE

Answer 26

Fall asleep w/o warning (watch with driving), orthostatic hypotension, hallucination, unusual urges (compulsive), dep, dyskinesia; g tube-assoc sx and surg (infx risk, dislodge, body image)

Question 27

Duopa NC

Answer 27

- infusion thru feeding tube or g tube into sm int - gel-like - cont up to 16h/d for cont blood level (can do at night) - response fluctuates - don’t take w/i 2W MAOIs, antiHTN, antipsychotic, metoclopramide, isonazid, iron, vitamins (B6) - don’t take with high pro

Question 28

When is Duopa used instead of Levidopa

Answer 28

When you don't respond well to oral PD drugs or want to dec the "on-off"

Question 29

Pramipexole (Mirapex) class and MOA

Answer 29

- DP receptor agonist - Bind with D2 receptors to stim inhib Dp rec

Question 30

Pramipexole (Mirapex) SE and NC

Answer 30

- Nausea, sleep attack, pathologic gambling and compulsive behaviors - With levodopa, ortho hypo, dyskinesias, and hallucination risk doubles

Question 31

When is Pramipexole used

Answer 31

Monotherapy in early PD and combo in advanced PD, RLS

Question 32

Ropinirole (Requip) class and MOA

Answer 32

- Dp rec agonist - MOA unknown–may inc nerv impulses w/i substantia nigra

Question 33

What is ropinirole for

Answer 33

Idiopathic PD

Question 34

Ropinirole (Requip) SE and NC

Answer 34

- sim to other drugs - long term inc risk of DM and acromegaly (excess growth hor)

Question 35

Rigotine (Neupro)

Answer 35

Dp agonist - once daily patch for Parkinson's

Question 36

Apomorphine

Answer 36

Dp agonist - fast sx relief - short acting SQ ij - often used in "off" phase