Parkinson's Disease & Movement Disorders (Exam V) Flashcards
(58 cards)
1
Q
What symptom is the hallmark of Parkinson’s disease?
A
- Tremor at rest (rhythmic movement around a joint)
2
Q
What is Chorea?
A
- Muscle jerking in various areas
3
Q
What is ballismus?
A
- Violent abnormal movements
4
Q
What is essential tremor?
What is this indicative of?
A
- Tremor occurring with movement
- Not Parkinson’s, brain lesion, EtOH, etc.
5
Q
What is Athetosis?
Is this indicative of Parkinson’s disease?
A
- Slow, writhing movement
- Not typical of Parkinson’s
6
Q
What is dystonia?
A
- Abnormal posture w/ no movement.
7
Q
What are Tics?
A
- Single, repetitive movements (especially facial)
8
Q
What is choreathetosis?
A
- Combination of jerking & flowing movements of both chorea & athetosis (dystonia can be present as well)
9
Q
What are possible causes of choreathetosis?
A
- Trauma
- Chore Gravidarum
- Tumors
- Cerebral Palsy
- Huntington’s
- Kernicterus (↑ bilirubin)
- Ataxia Telangectasia
10
Q
What collection of neurons regulates motor activities?
A
- Basal Ganglia/Nuclei
11
Q
Communication from the motor cortex to the thalamus goes through the _____ ______.
A
Basal Ganglia
12
Q
What specific area of the basal ganglia is damaged in Parkinson’s Disease?
A
- Pars Compacta (in Substantia Nigra)
13
Q
What is the normal pathway of motor movement?
A
- Dopamine release from Pars Compacta
- Striatum activated
- Direct pathway with GABA & Sub P
- GABA & Sub P inhibit basal ganglia
- Basal Ganglia → GABA inhibits Thalamus
14
Q
How does Parkinson’s disease differ from the normal pathway of motor movement?
A
- No Dopamine from Pars Compacta
- Dopamine-Striatum pathway bypassed
- Alternate pathway with glutamate activates basal ganglia.
15
Q
What is TRAP in relation to Parkinson’s Disease?
A
- Tremor
- Rigidity
- Akinesia
- Posture
16
Q
Does coginitive decline occur with Parkinson’s disease?
A
Yes, eventually.
17
Q
What environmental factors protect against Parkinson’s Disease?
A
- Cigarettes
- Coffee
- Anti-inflammatories
- Uric Acid
18
Q
What environmental factors increase risk of developing Parkinson’s disease?
A
- Lead & Manganese exposure
- Vitamin D deficiency
19
Q
What genetic component is often present in Parkinson’s patients?
What percentage of Parkinson’s patients have this?
A
- SNCA - α-Synuclein
- 10-15%
20
Q
Do Parkinson’s tremors start all over the body?
A
No, they usually start on one side.
21
Q
What is Akinesia?
A
- Loss or impairment in power of voluntary movement.
22
Q
What drug is given as firstline treatment for Parkinson’s?
Why this drug?
A
- Levo-dopa (dopamine precursor)
- Able to cross BBB unlike dopamine
23
Q
What are Lewy Bodies?
What diseases have these present?
A
- Misfolded proteins
- Mad-Cow, Parkinson’s, Alzheimer’s, Multiple System Atrophy
24
Q
What occupation’s have an increased risk of developing Parkinson’s?
A
- Healthcare
- Teaching
- Farming
25
What non-occupational risk factors exist for Parkinson's Disease?
- >60yo
- Hereditary
- Males
- Herbicides/Pesticides
26
What are the treatments for Parkinson's?
- Exercise
- Levo-Dopa
- CNS antimuscarinics
27
What drugs should be avoided when one has Parkinson's Disease?
- D2 Antagonists (Haldol, etc.)
- MPTP (destroys dopaminergic neurons)
28
Where is MPTP found?
- Illicit synthetic opioids (causes drug-induced Parkinson's)
29
How much of L-Dopa crosses the BBB?
Can this be increased? With what? How much?
- 1-3%
- With Carbidopa (10% uptake of Levo-dopa)
30
How does carbidopa work?
- Inhibits Dopa-Decarboxylase from forming dopamine peripherally (thus saving Levo-dopa for the CNS)
31
Is Levo-dopa a treatment or a cure for Parkinson's?
- Treatment, effective for a period of time before more neurons degrade.
32
What adverse effects can be seen from levodopa?
- **Delusions**
- Dyskinesias - Choreathetosis (too much dopamine)
33
What drug treats delusions associated with levodopa administration?
- Pimavanserin - antipsychotic (inverse agonist of 5-HT2A) suppresses signaling to visual cortex.
34
What is the On-Off Phenomenon with Levo-dopa?
When does it occur?
- Increased mobility followed by marked akinesia.
- Associated with long-term use.
35
What drug interactions exist for Levodopa?
- Vitamin B6 & MAOI's
36
What contraindications exist for Levodopa?
- Psychosis (↑ dopamine signalling)
- Glaucoma
- Melanoma (L-dopa feeds these tumors)
37
How is L-Dopa broken down peripherally?
What drug inhibits this?
- COMT
- Entacapone & Tolcapone
38
What monoamine oxidase is specific for dopamine?
What drug can prevent the breakdown of Dopamine in the CNS by inhibiting MAOB?
- MAO-B
- Selegiline
39
What MAOI's can be paired with Levo-dopa?
- Selegiline
- Rasagiline
40
What dopamine agonist is useful for "off" periods from levodopa & relief of akinesia?
- Apomorphine
41
What antiviral agent has antiparkinson's effects?
- Amantadine
42
What is the most common movement disorder?
What is the treatment?
- Essential tremor (β1 receptor dysfunction) **tremor with movement**
- βblockers
43
What is benign hereditary chorea?
What is the treatment?
- Chorea in childhood with no progression and no dementia.
- Tetrabenazine (↓ Dopamine)
44
What is Tardive Dyskinesia?
What is the most common cause?
- Repetitive, involuntary movements.
- Anti-psychotic drugs.
45
What is Muscular Dystrophy?
What occurs with these disorders?
- Group of muscle disorders of childhood.
- Progessive degeneration of muscle fibers.
46
What is the most common & severe muscular dystrophy disorder?
How is it inherited?
- Duchenne's Muscular Dystrophy (most severe)
- X-linked dystrophin gene absent - passed by mother to sons
47
What sign is seen with children who have Duchenne's MD?
- Gower's Sign - using hands to pushing on legs to stand.
48
What treatment exist for Duchenne's MD?
What is the life expectancy?
- Corticosteroids, β2 agonists, & orthopedic braces.
- 20's
49
What characterizes Cerebral Palsy?
What is the usual cause?
- **Non-progressive** motor disorder of the CNS.
- Birth Trauma (or hemmorhage, anoxia, &/or infection)
50
When does Huntington's disease normally occur?
Is this disease autosomal dominant or recessive?
- age 30 - 40
- Dominant
51
What characterizes the pathophysiology of Huntington's disease?
- GABA reduced in the basal ganglia
- Reduction in ChAT (Choline Acetyltranferase)
- Excess Dopamine
52
What symptoms are seen with Huntington's disease?
- Progressive loss of muscular control
- Chorea
- Dementia
53
What treatments are there for Huntington's disease?
- Tetrabenazine = ↓ excess dopamine
- Dopamine Receptor blockers (ex. Haldol)
54
What characterizes ALS?
When does death occur?
- Loss of motor neurons
- 2-6 years after diagnosis
55
What are the treatments for Lou Gehrig's disease?
- Riluzole - Na⁺ channel blocker (specific for damaged neurons)
- Edaravone - antioxidant.
56
What two anatomical changes are seen in Alzheimer's disease?
- Neurofibrillary tangles inside the neuron
- Amyloid plaques outside the neuron
57
What palliative treatments are available for Alzheimer's disease?
- CNS AChE inhibitors (Tacrine & Rivastigmine) ( ↑ACh at synapse)
- NMDAr Antagonist (Memantine)
58
What are the treatment's for restless leg syndrome?
- Dopamine agonists
- Gabapentin
- Benzodiazepines
- Clonazepam
