Parkinson's

Question 1

What hormone is lost in parkinsons

Answer 1

Dopamine

Question 2

What is the motor symptom triad

Answer 2

Bradykinesia
Muscle rigidity
Tremor

Question 3

What are non motor symptoms of parkinsons

Answer 3

Depression
Fatigue
Anxiety
Constipation
Sweating
Dysphagia
Hypertension
bladder problems
sleep disturbance

Question 4

Outline the 3 dopaminergic pathways

Answer 4

Motor –> nigrostriatal
Behavioural –> mesolimbic, mesocortical
Endocrine –> tuber hypophyseal

Question 5

What is the main dopaminergic pathway for parkinsons

Answer 5

Nigrostriatal
affects motor movement

Question 6

What are the characteristics of bradykinesia

Answer 6

Expressionless face
Shuffling gait
Soft voice
small handwriting

Question 7

What are the characteristics of rigidity motor movements

Answer 7

Stooping posture
Muscle pain
Increased falls

Question 8

What are the characteristics of tremor motor symptoms

Answer 8

Occurs at rest
improves on voluntary movement
One or both hands

Question 9

What type of drugs can cause tremors?

Answer 9

Antiarrhythmics
antidepressants
mood stabilisers
bronchodilators
anti epileptics

Question 10

What prescription drugs can cause Parkinson’s

Answer 10

Antipsychotics
antiemetics
Reserpine –> bp
tetrabenazine –> movement disorders

Question 11

What physical factors can cause parkinson’s

Answer 11

Viral encephalitis
Brainstem injury

Question 12

What genetic factors can increase the risk

Answer 12

Alpha-synuclein mutations
Lewy body formation
parkin gene

Question 13

What is parkin

Answer 13

PARK2 gene
Has mitochondrial control
increases neuronal cell damage and death

Question 14

How do antipsychotics contribute to parkinsons

Answer 14

Extra-pyramidal side effects
dose related
decrease dose = reduction in parkinsons symptoms

Question 15

How do Reserpine and tetrabenazine contribute to parkinsons

Answer 15

Depletes MOA from pre-synaptic storage
Decrease in dopamine release

Question 16

How do recreational drugs contribute to parkinsons

Answer 16

MPTP kills dopaminergic neurons
in substantia nigra
Irreversible

Question 17

What can increase the risk of dementia pugilistica

Answer 17

Head ijuries
stroke

Question 18

What is the first line therapy of parkinsons

Answer 18

Levodopa
+
Dopa decarboxylase inhibitors

Question 19

What are the side effects of levodopa

Answer 19

Dyskinesia
Nausea
Hypotension
Sleep disturbances

Question 20

What must you avoid 30-6- minutes after taking levodopa

Answer 20

Protein

Question 21

What must you wait 2-3 hours to take after levodopa

Answer 21

Iron supplements

Question 22

What are the risks of dopamine receptor agonists

Answer 22

Impulsive control disorders
Gambling
hypersexuality
binge eating
obsessive money spending/ shopping

Question 23

What are the side effects of MOA-B inhibitors

Answer 23

Nausea
postural hypotension
dyskinesia
confusion

Question 24

What is dyskinesia

Answer 24

Involuntary muscle movements

Question 25

When do we consider adjuvant therapy

Answer 25

When dyskinesia have wearing off episodes

Question 26

What treatments do we use as adjuvant therapy

Answer 26

COMT inhibitor MOA-B inhibitor Dopamine agonists

Question 27

Give an example of a dopamine agonist

Answer 27

Pramipexole ropinirole

Question 28

Give an example of a COMT inhibitor

Answer 28

Entacapone

Question 29

Give a example of a MOA-B inhibitor

Answer 29

Selegiline Safinamide

Question 30

Give examples of DOPA decarboxylase inhibitor

Answer 30

Carbidopa Benserazide

Question 31

Why are DOPA carboxylase inhibitors given alongside Levodopa

Answer 31

Levodopa converted to dopamine in periphery before it can reach the brain Dopamine cannot cross BB to exert therapeutic effect if in periphery DOPAC prevents conversion of levodopa in periphery and allows it to get into the brain before being converted

Question 32

What should you do if a patient displays obsessive behaviours on a dopamine agonist

Answer 32

Reduce dosage Offer CBT if needed

Question 33

What does amantadine do

Answer 33

Increase dopamine release

Question 34

What are the side effects of amantadine

Answer 34

Psychological sleep disturbances Nausea vomiting weight loss dry mouth hypotension palpitations

Question 35

What happens if patients miss a dose

Answer 35

Akinesia acute Inability to swallow Increased fall risk neuroleptic like malignant syndrome

Question 36

Symptoms of neuroleptic like malignant syndrome

Answer 36

Fever rigidity hypoventilation altered consciousness

Question 37

What causes neuroleptic like malignant syndrome

Answer 37

sudden reduction in dopamine activity

Question 38

How do we treat depression in parkinsons

Answer 38

SSRI's

Question 39

How do we treat dementia in parkinsons

Answer 39

Rivastigmine

Question 40

How do we treat hallucinations in Parkinson's

Answer 40

Quetiapine

Question 41

How do we treat constipation in parkinsons

Answer 41

Stimulant + softener

Question 42

How do you treat postural hypotension in parkinsons

Answer 42

Midodrine fludrocortisone

Question 43

How do you treat drooling in parkinsons

Answer 43

Glycopyrronium

Question 44

How do you treat daytime sleepiness in Parkinson's

Answer 44

Modafinil

Question 45

What drugs should you avoid when treating Parkinson's

Answer 45

OTC antihistamines OTC sympathomimetics with MOA-B inhibitors CCB

Question 46

What is the precursor for dopamine synthesis

Answer 46

Tyrosine

Question 47

What is the role of MOA-B in synthesis

Answer 47

Converts dopamine to inactive metabolite in pre synaptic terminal to regulate dopamine levels if needed

Question 48

What transporter facilitates the reuptake of dopamine

Answer 48

DAT

Question 49

What pathway des the D1 receptor take

Answer 49

GPCR G alpha S Activated DARPP-32 Inactivated PP1 PP1 cant dephosphorylate proteins so they can continue to have their downstream signalling effects

Question 50

What does the D2 pathway dake

Answer 50

GPCR G alpha i Activates K+channels --> hyperpolarisation Beta/Gamma subunit inhibits Ca2+ cell entry --> Less excitability less neurotransmitter release

Question 51

Where does the dopamine release start from in the nigra striatal pathway

Answer 51

Pars compacta in substantia nigra

Question 52

Where are the D1 and D1 receptors found in the nigra striatal pathway

Answer 52

Corpus striatum

Question 53

What role does dopamine play with acetylcholine

Answer 53

Releases it from the corupus striatum

Question 54

What causes a tremor

Answer 54

Decrease in dopamine means increase in Ach in synapse Hyperactivity trremor

Question 55

What protein are lewy bodies made from

Answer 55

Alpha-synuclein

Question 56

What is the role of alpha-synuclein

Answer 56

Exocytosis in synaptic vesicles

Question 57

How do lewy bodies form

Answer 57

Aggregation and plaque formation of alpha-synuclein

Question 58

What causes mitochondrial damage

Answer 58

lots of energy required to allow dopaminergic neurons to work

Question 59

How does mitochondrial damage cause cell death

Answer 59

Produces ROS oxidative stress

Question 60

What genes are responsible for mitochondria turnover

Answer 60

Parkin PINK -1