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Patho 2 - Exam 2 > Parkinson's Disease > Flashcards

Parkinson's Disease Flashcards

1
Q

What is Parkinson’s disease?

A

A progressive, degenerative disorder of basal ganglia function

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2
Q

What is parkinson’s characterized by?

A

Tremor, rigidity, and bradykinesia (slowness of speed and movement)

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3
Q

What is the function of the basal ganglia?

A

Function in the cerebellum to make smooth, coordinated movements

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4
Q

What does the substantia nigra in the basal ganglia make?

A

Dopamine

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5
Q

What is primary parkinsonism?

A

Idiopathic (this is what is called parkinson’s disease)
Can be genetic or sporadic
This is the most common type

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6
Q

What is secondary parkinsonism?

A

Acquired from infection, intoxication, trauma, or drug induced events

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7
Q

What are the drugs that cause secondary parkinsonism?

A

Some antidepressants - this is most common, but this is reversible once stopped

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8
Q

What are the risk factors for parkinsonism?

A

Age (peaks in the 70s)
Men more than women
Genetics (can be attached with dominant / recessive)
Could potentially be tied to: anxiety / depression, head trauma, hysterectomy

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9
Q

What is a protective factor against parkinsonism?

A

Coffee consumption

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10
Q

What is dopamine, what does it do?

A

Inhibitory neurotransmitter
Function = message tranmission
Controls movement and balance
Helps muscles work smooth, controllably, and without unwanted movement

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11
Q

What is acetylcholine, what does it do?

A

Excitatory neurotransmitter
Works in conjunction with dopamine system
Balance is crucial between the two
Works best in balance with dopamine

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12
Q

How are the levels of dopamine and acetylcholine changed with parkinsonism?

A

Too much acetylcholine in relation to dopamine = loss of coordinated movements

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13
Q

What is the patho behind primary parkinsonism?

A

Destruction of the substantia nigra in the basal ganglia
Dopamine levels decrease
Imbalance is formed between dopamine and ACh
Relative excess of ACh
Loss of controlled movement and balance

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14
Q

What are the clinical manifestations of parkinsonism?

A

Bradykinesia
Cogwheel rigidity
Resting tremor (pill rolling)
Shuffling gait
Mask-like expression
Postural instability
May involve one side of the body at first

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15
Q

What is the classic triad of manifestations for parkinsonism?

A

Tremor
Rigidity
Bradykinesia

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16
Q

What is usually the first sign of parkinsonism?

A

Tremor

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17
Q

Why does rigidity happen with parkinsonism?

A

Sustained muscle contraction because of too much ACh in relation to dopamine

18
Q

What complaints are usually associated with rigidity?

A

Pain, aches, muscle soreness

19
Q

What happens with bradykinesia?

A

Loss of automatic movement - no blinking, swinging of the arms, swallowing of saliva (drooling), or self expression with hands / face
Overall lack of spontaneous movement

20
Q

What is the difference between an essential tremor and a parkinson’s tremor?

A

Essential: Results from faulty neurological impulses, tremors occur with motor function, no other manifestations of parkinson’s

Parkinson’s: Results from a dopamine deficiency, tremor occur with rest and improves with movement, presents with other manifestations of parkinson’s

21
Q

What are the complications from parkinsonism?

A

Dementia (due to spread of lewy bodies)
Depression / anxiety
Decreased mobility (aspiration, malnutrition, pneumonia, UTI, skin breakdown)
Drug related complications

22
Q

What is the goal of parkinsonism pharmacology?

A

Help individuals maintain motor function for as long as possible and try to correct the imbalance between dopamine and ACh

23
Q

What is the MOA of Levodopa / Carbidopa?

A

Levodopa = converts to dopamine in the brain and activates the dopamine receptors

Carbidopa = blocks the destruction of Levodopa

24
Q

What are the side effects of levodopa / carbidopa?

A

N/V (can give with food but it does decrease the absorption)
Dyskinesias (involuntary, erratic, writhing movements of the face, arms, legs, or trunk)
Cardiovascular (hypotension, dysrhythmias)
Psychosis (hallucinations, nightmares, paranoia)
Dark sweat / urine
Can activate malignant melanoma

25
Q

How long does it take to see levodopa / carbidopa work?

A

Several months

26
Q

Does levodopa / carbidopa work long term? Why or why not?

A

No, there is a gradual loss of drug effect where the dose wears off and the patient may need shorter dosing intervals

27
Q

What is the off-on phenomenon with levodopa / carbidopa?

A

Abrupt loss of effect of the medication - this can occur anytime during the dosing interval
Off periods increase over time and can be reduced with drugs and avoiding high protein meals

28
Q

What medications increase and decrease the effects of levodopa / carbidopa?

A

Increase = carbidopa, anticholinergics, MAOI
Decrease = Vitamin B6, antipsychotics, protein

29
Q

How is Duopa given?

A

Instilled via feeding tube into small intestines as a gel form (suspension)

30
Q

What medications interact with duopa?

A

Anti-HTN, MAOI, antipsychotics, metoclopramide, isoniazid, iron, other vitamins

31
Q

What are the side effects of duopa?

A

Falling asleep without warning, orthostatic hypotension, hallucinations, unusual urges, depression, dyskinesia, SE with tube insertion

32
Q

What class of medication is pramipexole?

A

Dopamine receptor agonist

33
Q

What is the MOA of pramipexole?

A

Binds with D2 receptors

34
Q

What is the indication for pramipexole?

A

Early manifestations of parkinson’s (in younger patients)
Restless leg

35
Q

What are the side effects of pramipexole (monotherapy)?

A

Nausea, sleep attacks, pathologic gambling, and other compulsive behaviors

36
Q

What are the side effects of pramipexole when taken with levodopa?

A

Orthostatic hypotension, dyskinesia, hallucination risk doubles

37
Q

What class of medication is ropinirole?

A

Dopamine receptor agonist

38
Q

What is the indication for ropinirole?

A

Parkinson’s

39
Q

What are the side effects of long term ropinirole use?

A

Increased risk of DM and acromegaly

40
Q

What is the class of rotigotine?

A

Dopamine receptor agonist

41
Q

How is rotigotine administered?

A

In a once daily patch

42
Q

What is the class of neostigmine?

A

Dopamine receptor agonist

Patho 2 - Exam 2 (9 decks)

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