Parkinsonism and Parkinson's Disease Flashcards Preview

724: Medical Lectures > Parkinsonism and Parkinson's Disease > Flashcards

Flashcards in Parkinsonism and Parkinson's Disease Deck (77)
1

What can be defined as any combination of tremor, rigidity, bradykinesia, and progressive postural instability?

Parkinsonism

2

What is the gender and ethnic distribution among patients with Parkinsonism?

Occurs in all ethnic groups, with an approximately equal sex distribution

3

Idipathic Parkinson disease begins most often between the ages of __-__.

45-65

4

Parkinsonism may result form mutation of hat 5 genes?

- Alpha-synuclein
- Parkin
- LRRK2
- DJ1
- PINK1

5

Mutations in what gene account for some cases of sporadic Parkinson disease?

LRRK2

6

What environmental factors may lead to Parkinsonism?

- Exposure to certain toxins (maganese dust, carbon disulfide)
- Severe cases of carbon monoxide poisoning

7

Reversible parkinsonism is sometimes seen in what type of patients?

patients receiving neuroleptic drugs, reserpine, or metoclopramide

8

What is the main cause of idiopathic parkinsonism?

Dopamine depletion which leads to an imbalance of dopamine and acetylcholine

9

Because dopamine depletion is often the cause what is the focus of treatment?

Blocking the effect of acetylcholine

10

Serum urate levels are a prognostic factor in that the rate of progression declines as the urate level _____.

increases

11

What are 5 risk factors for developing Parkinson's disease?

- Age
- Family history
- Male sex
- Ongoing herbicide/pesticide exposure
- Significant prior head trauma

12

What are 4 protective factors against Parkinson's disease?

- previous ibuprofen use
- smoking
- caffeine
- coffee

13

A disruption in the direct pathway leads to what?

Akinesia/bradykinesia

14

A disruption in the indirect pathway leads to what?

Resting tremor

15

What are the 4 cardinal signs of parkinsonism?

- Tremor
- Rigidity
- Bradykinesia
- Postural instability

16

Describe tremors associated with parkinsonism

- they can occur in all limbs
- a tremor of 4-6 cycles is conspicuous at rest

17

What increases tremors?

emotional stress

18

What produces less severe tremors?

voluntary activities

19

What is responsible for the characteristically flexes posture?

rigidity

20

Define rigidity

an increase in resistance to passive movement

21

What is the most disabling symptom of parkinsonism?

bradykinesia

22

Define bradykinesia

A slowness in voluntary movement and a reduction of automatic movements such as swing of the arms while walking

23

What are 10 other characteristics of parkinsonism?

- relatively immobile face
- decreased or infrequent blinking
- lack of facial expression
- saliva drooling from the mouth
- seborrhea of the scalp and face
- mild blepharoclonus
- tremor around the mouth and lips
- tremor around the mouth and lips
- impaired swallowing
- soft and poorly modulated voice

24

Do people with parkinsonism exhibit with muscle weakness or decreased DTRs?

No

25

How is parkinsonism diagnosed?

If bradykinesia is present with either a tremor or rigidity

26

What 2 common diagnoses may be mistaken for mild parkinsonism?

- old age (hypokinesia and resting tremor)
- depression (absent facial expressions)

27

What is the major difference between an essential tremor and parkinsonism?

Essential tremors are typically more of an action tremor than resting type tremor

28

What movements do essential tremors affect?

head movements

29

What type of tremors are associated with parkinsonism?

tremors of the jaw or lips

30

What are 6 differential diagnoses to Parkinson's disease?

- Wilson disease
- Huntington disease
- multiple system atrophy
- progressive supranuclear palsy
- Jakob-Creutzfeldt disease
- corticobasilar degeneration
- drug induced parkinsonism

31

How can Wilson's disease be distinguished from PD?

- early age onset
- Kayser-Fleischer rings (iris)
- chronic hepatitis
- increased copper concentrations in the tissues

32

How can Huntington's disease be distinguished from PD?

- early age onset
- chorea like movements
- athetosis

33

How can multisystem atrophy be distinguished from PD?

- autonomic insufficiency (postural hypotension, anhidrosis, disturbances of sphincter control, ED)
- pyramidal deficits
- lower motor signs
- cerebellar dysfunction

34

How can progressive supranuclear palsy be distinguished from PD?

- eye movements (downward gaze)
- postural instability (ataxia)
- axial dystonia
- pseudobulbar palsy (dysarthria/dysphagia)
- pseudo-emotional liability

35

What is Jakob-Creutzfeldt disease due to?

infection

36

How can Jakob-Creutzfeldt disease be distinguished from PD?

- Dementia: memory loss, hallucination, psychosis
- Myoclonic jerking
- Ataxia
- Pyramidal signs
- MRI and electroencephalograph findings

37

How can corticobasal degeneration be distinguished from PD?

- absence of tremor
- lack of L-dopa response

38

What are the distinctive features of corticobasal degeneration?

- ideomotor apraxia
- alien limb phenomenon
- aphasia
- loss of cortical sensory function

39

How can drug induced parkinsonism be distinguished from PD?

it is reversible

40

What patient population is vulnerable to drug induce parkinsonism?

AIDS

41

Symptoms of drug induced parkinsonism should subside _-_ weeks after medication

4-6

42

Because there is no cure for PD, treatment is focused on what?

controlling the symptoms associated with PD

43

What are the 7 medical measures taken to treat PD?

- amantadine
- anticholinergic drugs
- levodopa
- dopamine agonists
- selective monoamine oxidase inhibitors
- COMT inhibitors
- atypical antipsychotics

44

What type of patients may be helped with amantadine?

those with mild symptoms but no disability

45

The side effects of amantadine are uncommon with the typical dosage of ___mg given twice a day orally

100

46

What are anticholinergic drugs beneficial in relieving?

tremors and rigidity (no so much bradykinesia)

47

What are 5 examples of anticholinergic drugs?

Benzotropine mesylate (Cogentin)
- Biperiden (Akineton)
- Orphenadrine (Disipal, Norflex)
- Procyclidine (Kemadrin)
- Trihexyphenidyl (Artane)

48

What is the most effective drug for treating PD?

Levodopa (L-DOPA)

49

How does L-dopa function to treat PD?

It is converted into dopamine in the body which increases overall dopamine levels in the brain

50

What symptoms of PD are improved through the use of L-dopa?

All major aspects of parkinsonism

However, it does not decrease progression of the disease

51

The __-__ phenomenon is a late complication of L-dopa. Describe this phenomenon

on-off

Abrupt but transient fluctuations in the severity of parkinsonism occur unpredictably but frequently during the day

52

What is the "off" period of the on-off phenomenon marked by?

bradykinesia

53

What is the "on" period of the on-off phenomenon marked by?

increased mobility

54

How does L-dopa cross the blood brain barrier?

An enzyme (DDC) converts L-dopa into dopamine which can then cross the barrier

55

What DDC inhibitor is oftentimes given in combination with L-dopa in order to reduce the associated side effects?

Carbidopa

56

Does the combination of Carbidopa and L-dopa prevent the "on-off" phenomenon?

No

57

What medication provides an already prepared combination of carbidopa and L-dopa in either a 1:10 or 1:4 ratio?

Sinemet

58

Precautions to taking L-dopa should be considered in what type of patients?

Those with active peptic ulcers or malignant melanomas

59

How do dopamine agonists help in treating PD?

They act directly on dopamine receptors, and their use in parkinsonism is associated with a lower incidence of the response fluctuations and dyskinesias that occur with long-term L-dopa therapy

60

When are dopamine agonists best administered?

before L-dopa or with a low dose of Sinemet

61

What are 2 dopamine agents that are effective at the early and advanced stages of Parkinson disease?

- Pramipexole
- Ropinirole

62

Pramipexole – most individuals require __-__ mg 3x daily taken orally

0.5 - 1.5

63

Ropinirole – most individuals require _-_ mg 3x daily

2 to 8

64

What are 2 examples of selective monoamine oxidase inhibitors (MAOIs)?

- Rasagiline
- Selegiline

65

How do MAOIs function in treating PD?

They inhibiting the metabolic breakdown of dopamine which improves the fluctuations or declining response to L-dopa

66

Why should high tyramine foods be avoided while taking MAOIs?

They may cause hypertension

67

What foods are high in tyramine?

- cheese
- cured meats (pepperoni, summer sausage, salami)

68

What are 2 examples of Catecholamine-O-Methyltransferase inhibitors (COMT inhibitors)?

- Tolcapone
- Entacapone

69

How do COMT inhibitors function in treating PD?

They reduce the metabolism of levadopa to 3-O-methyldopa which thereby alters the plasma pharmacokinetics of L-dopa, leading to more sustained plasma levels and more constant dopaminergic stimulation of the brain

70

What does treatment with COMT inhibitors do?

Reduces the response fluctuations and increases period of responsiveness to levodopa. However, it does not delay levodopa-induced dyskinesia

71

Which COMT inhibitor is used more frequently and why?

Entacapone, because Tolcapone may cause liver toxicity

72

What drug is the commercial preparation of levodopa combined with carbidopa and entracapone?

Stalevo

73

What are confusion and psychotic symptoms associated with dopaminergic therapy treated with?

atypical antipsychotics agents

74

What are 4 examples of atypical antipsychotics used?

- clozapine (most effective)
- olanzapine
- quetiapine
- risperidone

75

What types of therapy may benefit patients with parkinsonism?

- PT
- OT
- Speech

76

What 2 surgical procedures can be used for patients who become unresponsive to medical treatment or have intolerable side effects?

- Thalamotomy: destruction of part of the thalamus with a liquid nitrogen frozen probe
- Pallidotomy: destruction of the globus pallidus on one side of the body

77

Describe what a deep brain stimulator does

Provides high frequency electrical stimulation of the subthalamic nuclei or globus pallidus