Parkinson's Disease

Question 1

Parkinson’s Disease: What are the four clinical features? (TRAP)

Answer 1

• Tremor
• Rigidity
• Akinesia
• Postural instability

Question 2

Parkinson’s Disease: Define Tremor

Answer 2

Trembling, shaking of one hand, pill-rolling

Question 3

Parkinson’s Disease: Describe Rigidity

Answer 3

Cogwheel -> rigid and jerky movements

Question 4

Parkinson’s Disease: Describe Akinesia

Answer 4

Impaired movement, altered gait

Question 5

Parkinson’s Disease: Describe postural instability

Answer 5

Stooped posture

Question 6

Parkinson’s Disease: Where does pill rolling tremor occur?

Answer 6

Fingers and thumb but other muscle groups of the neck, jaw, lips, tongue, eyelids, arm and foot may be affected.

Question 7

Parkinson’s Disease: What is the first sign in 70% of untreated patients?

Answer 7

Resting Tremor

Question 8

Parkinson’s Disease: What occurs with rigidity and hypertonicity

Answer 8

• Gait is slow and short stepped; eventually a shuffle
• Cogwheeling (rigid/jerky movement)
• Arm swing is lost
• Bradykinesia
• Hypophonia (Soft speech)
• Balance is easily lost with continuing declines of postural reflexes
• Handwriting become illegible
• Initiation of movement difficult
• Weight loss
• Fatigue

Question 9

Parkinson’s Disease: Signs and symptoms of head and neck area

Answer 9

• Seborrhea of the face and scalp
• Lack of facial expression
• Diminished blink
• Loss of decline in sense of smell
• Slowness and softness of speech
• Drooling becomes an issue

Question 10

Parkinson’s Disease: Three psychologic symptoms

Answer 10

Depression, anxiety, dementia (50%)

Question 11

Parkinson’s Disease:

Answer 11

Look at slide (8)

Question 12

Parkinson’s Disease: Function of Dopamine Precursors

Answer 12

Metabolized to dopamine

Question 13

Parkinson’s Disease: Dopamine precursors drugs

Answer 13

-Levadopa (L-dopa) and carbidopa (Sinemet, Madopar)

Question 14

Parkinson’s Disease: Function of Dopamine Agonists

Answer 14

Mimics dopamine at receptor level

Question 15

Parkinson’s Disease: Dopamine Agonist Drugs

Answer 15

Bromocriptine (Parlodel), Ropinirole (requip), pramipexole (Mirapex)

Question 16

Parkinson’s Disease: Function of Dopamine Releasing Agent

Answer 16

Anticholinergic properties enhancing dopamine transmisison

Question 17

Parkinson’s Disease: Dopamine Releasing Agent Drug

Answer 17

Amantadine (symmetrel)

Question 18

Parkinson’s Disease: MAO-B Inhibitor Function

Answer 18

Prevents metabolism of dopamine in the brain

Question 19

Parkinson’s Disease: MAO-B Inhibitor Drug

Answer 19

Selegiline (Eldepryl)

Question 20

Parkinson’s Disease: Anticholinergic Drug Function

Answer 20

Blocks effects of ACH to rebalance levels with dopamine

Question 21

Parkinson’s Disease: Anticholinergic Drugs

Answer 21

-Trihexyphenidyl (Artane), Beztropine mesylate (Cogentin), levodopa, carbidopa, and entacapone (Stalevo)

Question 22

Parkinson’s Disease: Catechol-O Methyltransferase Inhibitor Function

Answer 22

Blocks an enzyme which prevents levodopa from breaking down

Question 23

Parkinson’s Disease: Catechol-O-Methyltransferase Inhibitor Drugs

Answer 23

Tolacapone (Tasmar) and Entacapone (Camtan)

Question 24

Parkinson’s Disease: Epinephrine consideration

Answer 24

Limit to 0.04 mg

Question 25

Parkinson's Disease: Effectiveness of Drugs over time

Answer 25

After 5 years, 50-70% of patients will become partially unresponsive to meds

Question 26

Parkinson's Disease: What can occur while the disease progresses?

Answer 26

Reduction in responsivenss to L-dopa and narrowing therapeutic window leading to fluctuations, dyskinesias, and drug failure

Question 27

Parkinson's Disease: Function of implantable electrode

Answer 27

-Emits electrical impulses at higher frequencies than the physiological normal

Question 28

Parkinson's Disease: What does the implantable electrode disrupt?

Answer 28

-Disrupts the normal functioning of the target area in the brain.

Question 29

Parkinson's Disease: What does the implantable electrode block?

Answer 29

Neural circuits

Question 30

Parkinson's Disease: What does the implantable electrode inhibit?

Answer 30

The overactivity of the thalamus which is cause of tremors

Question 31

Parkinson's Disease: Describe how cell implants are used as therapy

Answer 31

- Implantation of fetal nigral cells | - The cells survive and replace dopamine

Question 32

Parkinson's Disease: What should clinicans be prepared for when it comes to patient's ability?

Answer 32

- To care for self | - To understand others caring for oral needs

Question 33

Parkinson's Disease: What events may make it difficult for patients to receive dental care?

Answer 33

- Can't get into the office/clinic - Physical opening and providing access to treatment may be difficult - Inability to put head back

Question 34

Parkinson's Disease: What tools can be used to help with opening and providing dental care?

Answer 34

- Mouth pop - Provide protection for airway - After treatment, incline chair slowly - Allow patient to sit upright and remain sitting for 3 to 5 minutes - Oral or IV sedation helpful to reduce tremors or dyskinesias to provide treatment

Question 35

Parkinson's Disease: What motor strength problems can these patients face?

Answer 35

- Chewing - Drooling - Oral hygiene - Swallowing - Reflexes

Question 36

Parkinson's Disease: What drugs should we be aware of when treating these patients?

Answer 36

Antiparkinsonian drugs can be CNS depressants -> additive effect with sedation

Question 37

Parkinson's Disease: What are some oral treatment guidelines we should keep in mind as clinicans?

Answer 37

- Frequent recalls: 3-6 months - Customized oral home care regimen w/power brushes, portable suction - Evaluate and integrate a caregiver into oral hygiene care methods - Maintain esthetics to enhance self-esteem - Plan for decline