Parkinson's Flashcards
(52 cards)
The presence of what 3 things are considered the hallmark motor features of idiopathic Parkinson disease (PD)?
Bradykinesia, along with tremor at rest, rigidity, and postural instability (instability of balance)
Parkinson’s is a disorder of the ________________ system
extrapyramidal
Epidemiology:
1) How many US cases?
2) Who is it found more in?
1) 1 million in US
2) Prevalence increases with age: 0.5% of population in 60s; 2.5% of population ≥ 80 years old
-Males > females
What is the true etiology of Parkinson’s?
Unknown + occurs spontaneously
What does the High levels of oxidative stress in dopaminergic neurons in substantia nigra in Parkinson’s cause? (2 things)
1) ↑ dopamine degradation = ↑hydroxyl and hydroperoxyl radicals
2) ↓ glutathione antioxidants
Etiology of Parkinson’s:
1) What are consistently associated with a lower risk?
2) What forms of parkinsonism are associated with mitochondrial dysfunction and oxidative stress?
1) Cigarette smoking and caffeine consumption
2) Pesticide exposure and genetic forms
Pathophys:
1) What degenerates?
2) What does the basal ganglia regulate?
3) Neuronal projections from the SNc to the striatum are referred to as the ________________ pathway
1) Dopaminergic neurons (axons + soma)
2) Voluntary movement
3) nigrostriatal
Pathophys:
1) D1 receptor activation results in ____________ of the striatal GABAergic neurons
2) D2 receptor activation results in ______________of striatal GABAergic neurons
1) stimulation
2) inhibition
In PD, reduced dopaminergic activation of D1 and D2 receptors and the sequential downstream effect on signaling pathways results in what?
A net inhibitory tone on the thalamus
COMT and MAOB in presynaptic neurons can both metabolize what?
Dopamine
1) Lewy bodies are aggregates composed of the protein ______________.
2) What stage of PD are they involved in?
3) What do they correlate with when not in the midbrain?
4) What do they do in the midbrain?
5) In advanced stages, Lewy pathology spreads to the ______, and this may correlate with cognitive and additional behavior changes
1) α-synuclein
2) Premotor stage
3) Changes in mood (e.g., anxiety, depression) and peripheral symptoms (e.g., constipation, impaired olfaction)
4) Leads to motor features emerging
5) cortex
1) What is the criteria for PD?
2) What are other Sx?
3) Any labs needed to Dx?
1) Patient has bradykinesia and one of the following: resting tremor, rigidity or postural instability
2) Hypomimia; Micrographia
3) No labs
Pharmacotoxicity is seen in PD with some drugs belonging to what 2 groups?
Antiemetics + antipsychotics
1) What 2 antiemetics demonstrate pharmacotoxicity with PD?
2) What is the MOA of one of them?
1) Metoclopramide, Prochlorperazine
2) Metoclopramide: dopamine antagonist; serotonin agonist
What antipsychotics demonstrate pharmacotoxicity with PD?
1) Chlorpromazine
2) Fluphenazine
3) Haloperidol
4) Olanzapine
5) Risperidone
6) Thioridazine
1st generation more so than 2nd generation
Describe the tremor seen in PD
-Tremor of an upper extremity occurring at rest (and occasionally an action or postural tremor) is often the sole presenting complaint
-Present most commonly in the hands
-Resting tremor often begins unilaterally and becomes bilateral with disease progression
-Only two-thirds of patients with PD have tremor on diagnosis, and some never develop this sign
1) What motor Sx can present as bradykinesia or akinesia?
2) What is one of the most disabling problems of the late stages that’s one of the least amenable to pharmacotherapy?
1) Hypokinesia
2) Postural instability
True or false: No treatments have been shown to effectively change the course of PD by slowing or halting its progression (disease modification)
True
Amantadine can cause hallucinations and ________________
livedo reticularis
What 4 drugs can all have dopamine excess side effects? (incl. confusion, drowsiness, edema, dizziness, nausea, orthostatic hypertension)
Ropinerole + Pramipexole, Rotigotine, MAO-B inhibitors
(all dopamine agonists)
Dopamine agonists:
1) Which do you need to rotate the patch application site for?
2) Which has the least SEs? What is its one SE?
3) What are the 2 side effects of Selegiline?
1) Rotigotine
2) Rasagiline; nausea
3) Agitation/ confusion + insomnia
What monotherapy provides greater symptomatic benefit for patients with mild-to-moderate impairment?
Dopamine agonist (start w. TID)
General Tx:
1) Ultimately, all patients will require the use of ______________ either as monotherapy or in combination with other agents.
2) With the development of motor fluctuations, patients should do what, or providers should consider what?
1) carbidopa/L-dopa
2) Administer carbidopa/L-dopa more freq., or add a COMT inhibitor, MAO-B inhibitor, or dopamine agonist to the carbidopa/L-dopa regimen
For management of carbidopa/L-dopa–induced peak-dose dyskinesias, what should be considered?
A reduction in L-dopa dose and/or addition of amantadine
