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Flashcards in Parkinson's + Movement Disorders Deck (19):
1

Parkinson's disease px

-resting tremor
-shuffling gait
-cogwheeling
-micrographia
-orthostatic (due to autonomic instability)

-dec dopamine, inc ACh

2

Parkinson's dx

no diagnostic tests

3

Shy-Drager syndrome px, tx

Parkinsonism + prominent orthostatic hypotension

-autonomic dysfunction (postural hypotension, abnormal sweating, bladder/bowel disturbance, salivation, lacrimation, impotence, gastroparesis)

-tx: intravascular volume expansion (fludrocortisone, salt supplementation, alpha agonists, stockings)
-dopamine agonists do NOT work

4

Supranuclear palsy px

Parkinsonism + vertical gaze palsy

-cannot voluntarily look downwards

5

Olivopontocerebellar atrophy px

Parkinsonism + prominent ataxia

6

Parkinson's tx: class options

-dopamine agonists
-anticholinergics

7

dopamine agonist drugs

-carbidopa/levodopa
-pramiprexole, bromocriptine, pergolide, ropinirole
-COMT inhibitors (tolcapsone, entacapone)
-selegiline, amantadine

8

anticholinergic drugs

-benztropine
-trihexyphenidyl

9

tx for: <60 YO + mild functional impairment

-anticholinergics: benztropine

-SE: urinary retention, constipation, dry mouth

10

tx for: >60 YO Parkinson's + mild impairment

-amantadine

-don't use anticholinergics ---due to SLUDGE loss side effects

11

tx, SE for: severe Parkinson's

-levodopa/carbidopa = strongest choice --bc directly replaces dopamine

-SE: on/off phenomenon = drug is never a smooth even level of dopamine (sometimes too much or too little)

-carbidopa prevents peripheral conversion of levodopa, so that it can reach brain

12

ropinorole & pramipexole MOA, SE

-directly stimulates dopamine receptors

-less adverse effects (less on/off)
-less potency --> good initial tx

13

amantadine MOA

inc dopamine release from substantia nigra

14

bromocriptine & pergilide SE

-cause vasoconstriction

15

COMT inhibitors MOA

-tolcapone, entacapone
-prevents degradation of dopamine
-adjunct: must be combined with levidopa/carbidopa

16

MAO inhibitor

-selegiline
-adjunctive therapy to prevent symptoms
-dec degradation of dopamine

17

benign essential tremor px, drugs that affect it, tx?

-px: resting & intention tremor

-alcohol will steady the tremor
(don't confuse for alcoholism)
-beta agonists, caffeine make it worse

-tx: beta blocker --> propanolol
-anticonvulsants: primidone, topiramate

18

restless leg syndrome px, tx

-unable to control legs at night
(movement helps it feel better)

-tx: ropinorole, pramipexole (dopamine agonists)
-gabapentin

19

restless leg syndrome causes

-Fe-deficiency anemia
-uremia (ESRD)
-DB
-MS, Parkinson's
-pregnancy
-drugs (antidepressant, metoclopramide)