Parkinsonism and Parkinson's Disease Flashcards
(77 cards)
1
Q
What can be defined as any combination of tremor, rigidity, bradykinesia, and progressive postural instability?
A
Parkinsonism
2
Q
What is the gender and ethnic distribution among patients with Parkinsonism?
A
Occurs in all ethnic groups, with an approximately equal sex distribution
3
Q
Idipathic Parkinson disease begins most often between the ages of __-__.
A
45-65
4
Q
Parkinsonism may result form mutation of hat 5 genes?
A
- Alpha-synuclein
- Parkin
- LRRK2
- DJ1
- PINK1
5
Q
Mutations in what gene account for some cases of sporadic Parkinson disease?
A
LRRK2
6
Q
What environmental factors may lead to Parkinsonism?
A
- Exposure to certain toxins (maganese dust, carbon disulfide)
- Severe cases of carbon monoxide poisoning
7
Q
Reversible parkinsonism is sometimes seen in what type of patients?
A
patients receiving neuroleptic drugs, reserpine, or metoclopramide
8
Q
What is the main cause of idiopathic parkinsonism?
A
Dopamine depletion which leads to an imbalance of dopamine and acetylcholine
9
Q
Because dopamine depletion is often the cause what is the focus of treatment?
A
Blocking the effect of acetylcholine
10
Q
Serum urate levels are a prognostic factor in that the rate of progression declines as the urate level _____.
A
increases
11
Q
What are 5 risk factors for developing Parkinson’s disease?
A
- Age
- Family history
- Male sex
- Ongoing herbicide/pesticide exposure
- Significant prior head trauma
12
Q
What are 4 protective factors against Parkinson’s disease?
A
- previous ibuprofen use
- smoking
- caffeine
- coffee
13
Q
A disruption in the direct pathway leads to what?
A
Akinesia/bradykinesia
14
Q
A disruption in the indirect pathway leads to what?
A
Resting tremor
15
Q
What are the 4 cardinal signs of parkinsonism?
A
- Tremor
- Rigidity
- Bradykinesia
- Postural instability
16
Q
Describe tremors associated with parkinsonism
A
- they can occur in all limbs
- a tremor of 4-6 cycles is conspicuous at rest
17
Q
What increases tremors?
A
emotional stress
18
Q
What produces less severe tremors?
A
voluntary activities
19
Q
What is responsible for the characteristically flexes posture?
A
rigidity
20
Q
Define rigidity
A
an increase in resistance to passive movement
21
Q
What is the most disabling symptom of parkinsonism?
A
bradykinesia
22
Q
Define bradykinesia
A
A slowness in voluntary movement and a reduction of automatic movements such as swing of the arms while walking
23
Q
What are 10 other characteristics of parkinsonism?
A
- 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
Q
Do people with parkinsonism exhibit with muscle weakness or decreased DTRs?
A
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
