Parkinson's disease Flashcards

1
Q

Parkinson’s disease (PD) characteristics

A

Bradykinesia
Resting Intention Tremor
increased tone (rigidity)

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2
Q

Risk factors of PD

A

age and gender (over 80 1.5M:1F)
Environmental factors (pesticide exposure)
Genetic factors

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3
Q

other clinical features of PD

A
Depression
Anxiety
Cognitive impairment - develops in 1/3 of patients as disease progresses
Speech
Swallowing
dribbling drooling of saliva mouth
constipation
bladder emptying
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4
Q

Indications of investigation for PD

A

Diagnosis is usually clinical

If pyramidal, cerebellar, or autonomic involvment is suspected request CT

of <50yrs rule out Willson’s and Huntington’s disease

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5
Q

Drug management of PD

A

Levodopa (Sinemet and Madopar) - main Rx, mainly improves bradykinesia and rigidity

Decarboxylase inhibitors (Carbidopa and benserazide) - reduce peripheral side effects. (Do not pass BBB)

dopamine receptor agonists - less powerful than levodopa

Monoamine oxidase type B (MAOIB) inhibitors - facilitates breakdown of dopamine in the synapse. (Not used anymore)

catechol-O-methyl-transferase (COMT) - when used with levodopa helps with to prolong effect of each dose and thus lower dose of levodopa

amantadine - useful in early presentation for bradykinesia

anticholinergics - not as useful anymore, could help in improving tone but meh

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6
Q

what is the difficulty with levodopa

A

late detoriaration - this occurs after 3-5 years of treatment with levodopa in 50% patients.

simplest form is end of dose detoriaration

improved by using smaller more frequent doses or slow release preparations

more severe forms have periods of bradykinesia or agitation “on-off effect”

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7
Q

non pharmacological Rx of PD

A

Surgery: deep brain stimulation

physiotherapy and speech therapy

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8
Q

commonest parkinsonism syndromes other than PD

A

cerebrovascular disease and drug induced parkinsonism

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9
Q

other parkinsonism syndromes

A

these are degenerative causes of parkinsonism that develop rapidly and are resistant to levodopa

multiple system atrophy
progressive supranuclear palsy
huntington’s disease - gradually progressive chorea and behavioural symptoms are earliest.

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10
Q

Is PD familial

A

Yes

having a first degree relative puts u at 2-3 times increased risk

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11
Q

Other Drug Rx in PD

A

Rotigotine patch - Levodopa patch in Px with difficulty swallowing, conversion chart for dosage.

Levodopa and dopamine in combination is used in younger Px before

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12
Q

Role of antiemetics in PD

A

sometimes used to control Sx of N/V+D
problem with them is they can cause parkinsonism - domperidone and stemetil are very bad.
Cyclizine isnt so bad

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13
Q

What are the features of bradykinesia

A
Difficulty initiating movement
Mask Face
Shufling gait
speech slow and of low volume
scribbled Handwriting
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14
Q

What tricks can be used to asses Rx effectiveness

A

Handwriting before and after Rx

if no improvement cause of parkinsonism should be reassessed

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15
Q

What are the features of Tone in PD

A

lead-pipe and cog-wheeling

Ask to tap with other hand and asses tone on non-tapng hand

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16
Q

Vascular vs Idiopathic PD

A

Vascular is a stroke causing damage to substantia nigra
symmetrical with shufling gait early on and leaning backwards

Idiopathic develops over years while vascular is rapid.

17
Q

Drugs Causing PD

A

Haloperidol - antipsychotic