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Parkinson's Disease & Movement Disorders Flashcards

End Test 4 (62 cards)

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1
Q

What is a tremor?

A

Slow repetitive/rhythmic movement that a person doesn’t know they’re doing

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2
Q

What is a hallmark symptom of Parkinsons?

A

Tremor AT REST

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3
Q

What is likely the reason for a tremor with movement?

A

Brain lesion
Alcohol/drug toxicity

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4
Q

What is chorea?

A

Quick muscle jerks that can cause impaired movement/coordination

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5
Q

What is ballismus?

A

Wild, violent, abnormal movement

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6
Q

What is ballismus associated with?

A

This wild, violent, abnormal movement is associated with huntington’s disease

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7
Q

What is athetosis?

A

Slow, rotational/twisting movements (writhing)

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8
Q

What is Dystonia?

A

Abnormal posture

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9
Q

What is Tic?

A

Single repetitive movements, esp. in the face

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10
Q

What are tics normally associated with?

A

Antipsychotic drugs

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11
Q

What is Choreathetosis?

A

Combo of Chorea, Athetosis, Dystonia

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12
Q

What causes Choreathetosis?

A

Trauma
Chorea Gravidarum
Turmors
Cerebral Palsy
Huntingtons
Ataxia Telangectasia
Kernicterus

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13
Q

What are most movement issues associated with?

A

Problems with Basal Ganglia cells

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14
Q

Where are Basal Ganglia cells located? What do these areas do? What is the most important area when it comes to movement disorders?

A

Striatum
Substantia nigra
Globus pallidus
Subthalamic nucleus

Regulate motor activity

Substantia nigra

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15
Q

Why is the Substantia nigra the most important area of the Basal Ganglia?

A

it can inhibit the indirect pathway & stimulate the direct pathway.

Both pathways are important in fine muscle tuning & fine control in the thalamus

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16
Q

Movement disorders are related to dysfunction in the _______

A

Basal ganglia

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17
Q

What does the Basal ganglia cells in the substantial nigra secrete? To where?

A

Dopamine

To the striatum

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18
Q

What causes Parkinsons? What predisposes you to this? What decreases/increases symptoms?

A

Genetics: SNCA gene produces Alpha-synuclein
————————-
Environmental: Increases: cigarette smoke, coffee, antiinflammatories, uric acid
Decreases: lead, manganese, Vitamin D

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19
Q

What are symptoms of Parkinsons?

A

Idiopathic, progressive

Cognitive decline

TRAP:
Tremor
Rigidity
Akinesia (impairment in voluntary movement)
Posture

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20
Q

Describe Alpha-Synuclein’s role in movement disorders

A

Protein produced by the gene SNCA
Primary gene associated with parkinsons

Found in CNS neurons specifically in the substantia nigra in areas that can glomerate into Lewy Bodies

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21
Q

What are Lewy bodies?

A

Areas that show up as small white spots in the brain

small areas the brain that are concentrated with protein. Usualy seen in substantia nigra from alpha-synuclein

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22
Q

T/F: Alpha Synuclein should be diffused through the cell

A

T

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23
Q

What is Prion disease?

A

Mad cow disease

another cause of dementia

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24
Q

What neurodegeneration disorders are associated with proteins?

A

Parkinsons: Alpha-synuclein

Alzheimer’s: APP (Amyloid Precursor Protein)

MSA (Multiple system atrophy): Amyloid proteins

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25
Patient's with parkinson's will have ______ upon an autopsy
Lewy bodies
26
What is the only way to confirm parkinsons?
autopsy
27
What is Dementia without parkinson's symptoms, but with Lewy bodies upon autopsy?
Lewy Body disease
28
What are Parkinson's risk factors?
- >60 y/o - hereditary -Men:women 2:1 -Occupation: teaching, healthcare, farming -toxin exposure
29
What drugs do you want to avoid in parkinsons?
Dopamine-R antagonist (antipsychotics) Street drugs
30
What do you want to do to improve QOL with Parkinsons?
Exercise/PT Increase/restore dopamine levels CNS antimuscarinics
31
Drugs: Levodopa/Carbidopa
#1 Treatment for Parkinson MOA: Levodopa: **Prodrug crosses BBB --> Converts to dopamine** -L-isomer of dopamine Carbipoa MOA: COMT inhibitor **Carbidopa prevents the breakdown of L-dopa by increasing reliance in COMT when combined with Levodopa** Racemic mixture **Decreased effectiveness with time** AE: Hallucinations, Delusions -this is increased with carbidopa!!! -Give Pimavanserin to combact this -Dyskinesias- choreathethosis (mild) Drug interactions: MAOIs, Vitamin B6 **Contraindications: Psychosis, Glaucoma, Melanoma** -increase in dopamine -dopanergic pathway produces melanin & produces needed for the eye
32
What is the active form of Levodopa? Inactive?
Active: L-dopa Inactive: D-dopa
33
Drug: Pimavanserin
Class: Antipsychotic MOA: 5-HT(2A) Inverse agonist -visual cortex at thalamus substantia nigra uses: assist with psychotic SE of Levodopa/Carbidopa
34
What is the On-Off Phenomen?
Associated with long term use of levodopa Periods of increased mobility followed by marked akinesia because of this, people woild do drug holidays and stop taking medication for a period of time to prevent this (Prevent the medication from having decreased effects)
35
Drugs: Pramipexole
Class: Dopamine Receptor Agonist Less effective than levadopa but good for early treatment uses: parkinsons (early) Less SE than levadopa
36
Drugs: Selegeline
Class: MAOIs MOA: MAO-B selective: specifically inhibits the dopamine transporter from reuptake -slower breakdown of substantia nigra -increase dopamine **ALL OF THESE FOOD, DRUG, HERB INTERACTIONS & SE!!!!!!!**
37
NE, Epi, and Dopamine are all _____
Catecholeamines
38
F/T: You can take PO catecholamines. Why?
F They are inactivated by COMT
39
Drugs: Tolcapone
Class: COMT inhibitor MOA: inhibits the enzyme that breakdown Dopamine -increasing dopamine circulation
40
What is COMT?
Enzyme that inactivates catecholamines.... **Dopamine is a catecholamine**
41
Drugs: Apomorphine
Class: Dopamine agonist uses: parkinsons during "drug vacation" or off period -relief of akinesia
42
What are Sx treatments for Parkinsons?
Lesion ablation Deep brain stimulation of the basal ganglia Implantation of fetal substantia nigra
43
Describe Essential tremor
Causes: B1 receptor dysfunction Tx: beta blockers that cross the BBB
44
Describe Benign Hereditary Chorea
Jerky movments Autosomal dominant-50% chance child will have it -Chorea in childhood -No progress, no dementia Tx: Tetrabenazine
45
Drugs: Tetrabenazine
Class: Dopamine Receptor blocker Uses: Benign Hereditary Chorea
46
Drugs: Baclofen
Muscle relaxant Uses: Cerebral Palsy
47
Describe Tardive Dyskinesia
Repetitive, involuntary movements in the face caused by antipsychotic drugs
48
What are other drugs used to treat movement disorders?
Levodopa Phenytoin Seizures meds
49
What is Muscular Dystrophy?
Genetic disorder Progressive degenerstion of muscle fibers Characterized by progressive muscle weakness/wasting
50
Describe Duchenne's MD
X-linked recessive: more common in males -Results from gene that encodes Dystrophin -Dystrophin absent in children with Duchenne Muscle wasting (late: decrease muscle in diaphragm -> assisted ventilation) Early onset in childhood Usually do not survive beyond 20s Tx: Improve QOL Corticosteroids Beta-2 agonist: increases blood flow to increase muscle strength
51
Children with Duchenne's _______ have Dystrophin
Dont
52
What is a marked sign of muscle weakness in children?
Gowers Sign When you ask them to stand up, they put their hands on their knees to assist them instead of standinf straight up
53
Describe Cerebral Palsy
Non-progressive motor disorder of the CNS -alterations in movement & posture Caused by some something that happened at birth SE: hyper/hypotonia or reflexes, scissoring of legs, failure to meet milestones seizures Tx: No cure Intrathecal pump -> botox or baclofen
54
Describe Huntington
MOA: GABA reduced in basal ganglia Includes Ballismus which is wild, violent, abnormal movement Tx: Tetrabenazine, Haloperidol Genetic counseling, ST/PT/OT
55
Drugs: Tetrabenazine, Haloperidol
Class: Haloperidol: Dopamine Receptor Blocker/antagonist -Tetrabenazine: Depletes dopamine Uses: Huntington's diseases -decrease dopamine levels
56
Describe Amyotropic Lateral Sclerosis (ALS)
"Lou Gehrig's disease" Loss of motor neurons **Death 2-6 years after diagnosis** More common in men than women Tx: Extend QOL Riluzole, Edaravone
57
Drugs: Riluzole
Class: Na+ channel blocker Uses: "Lou Gehrig's disease"
58
Describe Alzheimer's
Has no definitive cause: hereditary or nonhereditary but more likely to develop if family history Causes: Neurofibrillary tangles d/t hyperphosphorylation of tile-proteins within the cells -Senile plaques caused by A-Beta 42 accumulation around protein S/S: Forgetfulness, emotional, lack of concentration Dx made by ruling out other causes of dementia Death in 4-12 years Prevention: CVS health, NSAIDs, diet/exercise Tx: Palliative -Tacrine, Rivastigmine, Memantine
59
What is the #1 cause of dementia?
Alzheimer disease
60
T/F: You get get Alzheimer's at 30
T
61
Drugs: Tacrine, Memantine
Class: CNS Ach esterase inhibitors MOA: Prevents the breakdown of Ach which increase Ach circulation
62
Describe Restless leg syndrom
Discomfort in legs causing an urge to move Makes it hard to sleep Increased risk of developing in pregnancy Tx: dopamine, agonist, gabapentin, benzodiazepines, opiates (clonazepam)

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