Parkinsonism

Question 1

What is the cause of Parkinsonism?

Answer 1

Loss of cells in the substantia nigra resulting in a decrease in dopamine: leads to significant movement disorder

Question 2

What neutrotransmitter change leads to the presentation of Parkinsons?

Answer 2

Decreased Dopamine

Question 3

How is Parkinson’s Diagnosed?

Answer 3

Clinical Presentation

Question 4

How does Parkinson’s typically present?

Answer 4

Age >50-60: tremor, muscular rigiditiy, bradykinesia and a shuffling gait with unsteadiness to turning and a tendency to fall

Question 5

What is Cogwheel Rigidity?

Answer 5

Slowing of movement on passive flexion or extension of an extremity

Question 6

What happens to the size of writing in patients with Parkinsons?

Answer 6

Small: Microgarphia

Question 7

What happens to BP in patients with Parkinson’s?

Answer 7

They get Orthostatic Hypotension

Question 8

Why is Orthostatic Hypotension associated with Parkinson’s?

Answer 8

Inability of pulse and blood pressure to reset appropriately

Question 9

What muscular presentation is associated with Parkinson’s?

Answer 9

Spasticity: Painful contracted muscles from CNS damage

Question 10

What other disorder is associated with Spasticity?

Answer 10

MS

Question 11

What is the TRAP Pneumonic for Parkinson’s?

Answer 11

Tremor
Rigidity
Akinesia
Postural Instability

Question 12

What treatments are used for Mild Parkinson’s?

Answer 12

Anticholinergics: relieve tremor and rigidity

Amantadine: increase dopamine release

Question 13

How do Anticholinergics help treat Mild Parkinson’s?

Answer 13

Relieve tremor and rigidity

Question 14

What are common adverse effects of Anticholinegics used to treat mild Parkinson’s?

Answer 14

Dry mouth
worsening prostate hypertrophy
Constipation

Question 15

What are common anticholinergic drugs used for mild parkinson’s?

Answer 15

Benztropine and Trihexyphenidyl

Question 16

How does Amantadine help treat mild parkinson’s?

Answer 16

Increases the release of Dopamine from the substantia Nigra

Question 17

What adverse effect is associated with Amantadine?

Answer 17

Livedo Reticularis

Question 18

What classifies as Severe Parkinson’s?

Answer 18

Inability to care for themselves, or Orthostasis

Question 19

What drug classes are used to treat severe parkinson’s?

Answer 19

Dopamine Agonists

Levodopa/Carbidopa

COMT inhibitors

Istradefylline

MAO-Inhibitors

Deep Brain stimulation

Question 20

What are common Dopamine Agonists used to treat severe parkinson’s?

Answer 20

Pramipexole and Ropinirole

Apomorpohine or Rotigotine

Question 21

What is the best initial therapy for Severe Parkinson’s?

Answer 21

Pramipexole and Ropinirole

Question 22

What is the most effective medication for Severe Parkinson’s?

Answer 22

Levodopa/Carbidopa

Question 23

What is Levodopa/Carbidopa associated with?

Answer 23

On/Off episodes
-Off: insufficient dopmanine: Bradykinesia
-On: excessive dopamine: Dyskinesia

Question 24

What are common COMT Inhibitors used for severe Parkinson’s?

Answer 24

Tolcapone and Entacope

Question 25

How do COMT inhibitors help treat severe parkinson's?

Answer 25

Extend the duration of Levodopa/Carbidops by blocking Dopamine metabolism

Question 26

What is the mechanism of Istradefylline?

Answer 26

Adenosine a-2 antagonist

Question 27

How does Istradefylline help treat severe parkinson's?

Answer 27

Decreases the "off" Phenomenon

Question 28

How do MAO-I help treat severe Parkinson's?

Answer 28

Block metabolism of dopamine

Question 29

What is Deep brain stimulation highly effective for in severe parkinson's?

Answer 29

Tremors and rigidity

Question 30

Which migraine drugs worsen Parkinson Disease?

Answer 30

Prochlorperazine Metoclopramide Chlorpromazine They are all anti-dopaminergic

Question 31

What is Lewy body dementia?

Answer 31

Parkonsonism with dementia

Question 32

What is Shy-Drager Syndrome?

Answer 32

Parkinsonism predominantly with orthostasis

Question 33

How does Progressive Supranuclear Palsy present?

Answer 33

Same features as Parkinson disease along with -Vertical supranuclear gaze palsy: can't look up or down easily -postural instability with unexplained falls -Cognitive dysfunction

Question 34

How do you treat Progressive Supranuclear Palsy?

Answer 34

Same treatments as Parkinson Disease

Question 35

What is an Essential Tremor?

Answer 35

Tremor that is activated by voluntary movement or when arms are held in a fixed posture against gravity

Question 36

What makes an essential tremor worse?

Answer 36

Caffeine

Question 37

What improves an essential tremor?

Answer 37

Alcohol

Question 38

What is the best initial treatment for an essential tremor?

Answer 38

Propranolol

Question 39

What can be added to treatment for an Essential Tremor that is not controlled with Propranolol?

Answer 39

Primidone: antiepileptic Topiramate or Gapapentin: 3rd line or if asthmatic Thalamotomy: ablates thymus with MRUS or u/l thalamotomy with local heat

Question 40

What is restless leg syndrome?

Answer 40

Uncomfortably sensation in the legs "Creepy and Crawly" at night

Question 41

What makes restless leg syndrome worse?

Answer 41

Caffine

Question 42

What relieves restless leg syndrome?

Answer 42

Moving the leg

Question 43

What is Restless Leg Syndrome associated with?

Answer 43

Iron Deficiency

Question 44

How do you treat Restless Leg Syndrome?

Answer 44

Gapapentin or Pregabalin dopamine agonists: Pramipexole Iron Replacement