Parkinsonism

Question 1

Parkinsonism is the loss of cells in the______ resulting in a decrease in
_____

Answer 1

substantia nigra

dopamine

Question 2

The most common cause of parkinsonism is

Answer 2

idiopathic.

Question 3

Among etiologies, look for Gait disturbances+ Hx of

Answer 3

repeated head trauma (boxing)
antipsychotic medications (Thorazine)
encephalitis,
reserpine
metoclopramide

Question 4

DX

Answer 4

The diagnosis is based entirely on the clinical presentation. There is no test for parkinsonism.

Question 5

Look for a patient age

Answer 5

50 to 60 or older

Question 6

the 4 cardinal signs are

Answer 6

tremor
bradykinesia
shuffling gait, and
rigidity

Question 7

the gait has unsteadiness
on _____and a tendency to ___. ________ is the slowing of movement
on passive flexion or extension of an extremity.

Answer 7

turning
fall
Cogwheel rigidity

Question 8

Facial expression is ____ and writing is______.

Answer 8

limited (hypomimia)

small (micrographia)

Question 9

Postural instability is
______. This happens because the same slowness that results in bradykinesia results in the inability of the _____ to reset appropriately.

Answer 9

orthostatic hypotension

pulse and blood pressure

Question 10

Treatment is classified by

Answer 10

Mild disease:

Severe disease

Question 11

Mild disease Tx can be sumarized in:

Answer 11

• Anticholinergic medications (benztropine and trihexyphenidyl)
• Amantadine

Question 12

Anticholinergic medications SE

Answer 12

dry mouth,
worsening prostate hypertrophy,
constipation

occur more frequently
in older patients

Question 13

Amantadine may work by _____, Definitely the answer in _______

Answer 13

increasing the release of dopamine from the substantia nigra.

older patients (age >60) intolerant of anticholinergic medications

Question 14

Which migraine drugs worsen Parkinson disease?

Answer 14

Prochlorperazine
Metoclopramide
Chlorpromazine

Question 15

define Severe disease

Answer 15

inability to care for themselves, orthostatic

Question 16

Severe disease treatment can be summarized in

Answer 16

1. • Dopamine agonists
2. • Levodopa/ carbidopa:
3. -COMT inhibitors
4. • MAO inhibitors
5. • Deep brain stimulation

Question 17

Dopamine agonists, who are these people (4)? when to use them?

Answer 17

pramipexole and ropinirole are the best initial therapy in SEVERE

Apomorphine
Rotigotine: patch

AMBOSS: they are the best initial treatment for <65y

Question 18

Levodopa/ carbidopa, is characterized by:

Answer 18

the most effective medication

Associated with
“on/off” phenomena

Amboss: this is the best initial treatment for >65y

Question 19

wtf is “on/off” phenomena?

Answer 19

episodes of insufficient dopamine (“off”) characterized by bradykinesia. The “on” effect is too much dopamine, resulting in dyskinesia.

Question 20

who are the COMT inhibitors

Answer 20

(tolcapone, entacapone)

Question 21

COMT inhibitors (tolcapone, entacapone) extend the duration of ____ by blocking the metabolism of ____. That’s why it’s only used in those _____. And specifically when_____, or when _____.

Answer 21

levodopa/carbidopa
dopamine
treated with evodopa/carbidopa

“on/off” phenomena to even out the dopamine level

the response to therapy
is inadequate.

Question 22

MAO inhibitors. who are they?(2). when to use them? how do they work?

Answer 22

(rasagiline, selegiline) as a single agent or an adjunct to levodopa/carbidopa. They block metabolism of dopamine.

Question 23

Deep brain stimulation: consist of _____. And it’s highly effective for _____

Answer 23

electrical stimulation

tremors and rigidity in some patients.

Question 24

Avoid _____-containing foods (e.g., _____) with MAO inhibitors; they precipitate _____.

Answer 24

tyramine
cheese
hypertension

Question 25

Psychosis and confusion are a known adverse effect of ______ treatment. Treat_____

Answer 25

Use antipsychotic medications with the fewest extrapyramidal (antidopaminergic) effects.

No by stoping Antiparkinsonian Meds!!!!!

Question 26

parkinsonism+ dementia=

Answer 26

Lewy body dementia

Question 27

parkinsonism predominantly with orthostasis=

Answer 27

Shy-Drager syndrome

Question 28

________is an antipsychotic medication that does not worsen Parkinson disease. It works by ________

Answer 28

Pimavanserin

inhibiting 5HT, not through dopamine inhibition.