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Parkinson’s Disease And Drug Therapy Flashcards

(46 cards)

1
Q

Disturbance of planning?

A

Apraxia

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2
Q

Ballismus?

A

High amplitude flailing of the limbs on one side of the body

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3
Q

Hemiballismus pathophysiology?

A

Disruption of indirect pathway at STN

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4
Q

What causes hemiballismus?

A

Stroke

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5
Q

Tic disorder?

A

Brief repetitive stereotype movements with a premonitory urge (uncomfortable feeling)

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6
Q

Coprolalia?

A

Swearing

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7
Q

Chorea?

A

Jerky, brief, not repetitive, flowing contracting

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8
Q

Chorea pathophysiology?

A

problem in STN in indirect pathway

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9
Q

What causes chorea?

A

Huntington’s and neuroleptics

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10
Q

Huntington’s chorea genetics?

A

Trinucleotide repeat chromosome 4

Autosomal dominant

Longer the repeat sequence the earlier the disease presents

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11
Q

Myoclonus?

A

Brief movement, rapid onset and offset. Positive and negative

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12
Q

Causes of myoclonus

A

Prion
Juvenile myoclonus epilepsy
Brain hypoxia

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13
Q

Dystonia?

A

Abnormal twisting posture, may be associated with jerking movement

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14
Q

Possible pathophysiology for dystonia?

A

Abnormal dopaminergic activity in basal ganglia: blocking dopamine receptors and treatment with levodopa

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15
Q

Dystonia causes?

A

Huntington’s, Parkinson’s, encephalitis, stroke, brain injury

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16
Q

Kinetic tremor?

A

Nose finger

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17
Q

Essential tremors

A

Predominantly postural

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18
Q

Essential tremor is due to?

A

Gabaergic dysfunction in cerebellum

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19
Q

Problems with dopamine blocking agents?

A

Oculogyric crisis (spasmodic movements of eye usually upwards), neuroleptic malignant syndrome

Subacute: drug induced Parkinsonism

Long term: tardive dyskinesia

20
Q

Parkinsonism triad of symptoms?

A

Bradykinesia, rigidity and shaking (resting tremor)

21
Q

Parkinson’s: REM parasomnia?

A

Sleep disorders, unusual movement, emotion, behaviour and dreams between different stages of sleep

22
Q

Pathophysiology of PD?

A

Lack of dopamine from substantia nigra

23
Q

Percentage cell loss of dopaminergic cells of substantia nigra?

24
Q

Causes of Parkinsonism?

A

Idiopathic over 80, diffuse levy body, drugs, hydrocephalus, Wilson’s disease, rare familial, cerebri vascular disease

25
Break-down of levodopa?
Dopa decarboxylase
26
MAO inhibitors: type A and B:
A: serotonin, adrenaline, noradrenaline and dopamine B: dopamine We use B because selective e.g selegiline and rasagiline
27
COMT inhibitor?
Entacapone/tolcapone. Makes dyskinesia worse, diarrhoea, liver disease
28
Dopamine agonists?
Work on dopamine receptors Cons, Dopamine dysregulation syndrome E.g apomorphine s/c infusion but skin nodules
29
Disturbance of coordination is called?
Ataxia
30
Example of tic disorders?
Simple- coughing blinking Complex- twirling jumping Plus motor disorder and coprolalia
31
How do you reduce tic disorder?
Distraction and concentration
32
What is the more sever expression of spectrum of tic disorders?
Tourette syndrome
33
Tic disorder causes?
``` Complex genetic inheritance Post infectious immune Often associate with other co-morbid conditions 50%- ADHD 33.3% - OCD And up to 50% with anxiety ```
34
What is the clinical presentation of Huntington’s?
Cognitive- inability to make decisions multitask and slowness of thought Behavioural- irritability, depression apathy anxiety delusions Physical- chorea, motor persistence dystonia and eye movements
35
What can myoclonus be treated by?
Antiepilieptics
36
What is th pathophysiology of tremor?
Increased activity in the cerebellothalamocortical circuit
37
PD is due to?
Dopamine dysfunction in the pallidus
38
Drugs to treat hyperkinetic movement disorders?
Dopamine receptor blocking agents (eg haloperidol, chlorpromazine, pimozide, risperidone) Dopamine depleting agents (eg Tetrabenazine, Reserpine) Atypical anti-psychotics (eg Clozapine, Olanzapine, Aripiprazole)
39
Oculogyric crisis?
``` Very characteristic acute response to certain drugs Fixed stare, upward deviation of eyes Neck extension Trunk extension Jaw spasms +/- tongue protrusion ‘Acute dystonic’ reaction ```
40
Neuroleptic malignant syndrome?
Rigidity/ muscle breakdown – raised CPK. ●Fever ●Autonomic instability (volatile BP/PR) ●Confusion
41
Tardive dyskinesia?
Choreic oral-facial movements (video), dystonic trunk posturing ●Exact mechanism unclear – likely dopamine supersensitvity of basal ganglia –ie secondary receptor/ plastic changes ●Treatment -gradual withdrawal of offending agent, substitution with an atypical anti-psychotic ; use of a dopamine depleting agent (tetrabenazine); use of a benzodiazepine (clonazepam) if distressing
42
No motor symptoms of Parkinson’s?
``` Depression anxiety Dementia: slowed thoughts Postural hypotension, hypersalivation Restless legs rem parasomnia Reduced sense of smell ```
43
PD pathophysiology?
Decreased dopamine input leads to reduced activation of direct pathway and reduced inhibition of indirect pathway, leading to reduced movements
44
What else do you find in Parkinson’s?
Lewy bodies and intraneuronal protein inclusion
45
Early drug therapies for Parkinson’s?
Amantadine – Initially anti-flu agent Glutamate agonist Anti-cholinergics – Procyclidine, Benzhexol May help with tremor Limited by side effects (confusion, urinary retention, dry mouth…) Mono-amine oxidase inhibitors
46
Non drug therapies?
Not clear how it works (but it does!) Probably high freq stimulation causing ‘jamming’(inhibition of neurons by depolarising block) Also disrupts abnormally synchronous basal ganglia rhythms ``` Favoured target subthalamic nucleus (STN) for PD Also pallidum (for dystonia) and thalamus (for tremor) ``` ``` Disease will still progress and no effect on non-motor -dementia, -dysautonomia, -postural instability….. ``` - Future – neurorestorative (stem cells) - Neuroprotective (growth factors)