Week 10 - Parkinson's Disease Flashcards
(80 cards)
1
Q
what is parkinson’s disease
A
- a progressive & neurodegenerative & movement disorder that involves degeneration of dopaminergic neurons in the substantia nigra
2
Q
what two nt does parkinson’s disease effect? how?
A
- causes an imbalance in nt dopamine & ach secreted in the basal nuclei
= excessive Ach, dopamine deficiency
3
Q
what is the fnxn of dopamine (3)
A
- trunk support
- voluntary motion
- posture
4
Q
what are movement programs from the motor cortex typically inhibited by
A
- GABA secreted from the basal nuclei onto the thalamus
5
Q
what effect does ach have on GABA? dopamine?
A
- ach = excitatory hormone = increased secretion of GABA
- dopamine = inhibitory = decreased secretion of GABA
6
Q
what effect does excessive ach have
A
- excessive ach stimulated inhibition of the motor cortex = inhibition of movements
( why we get the rigidity, slowed movement, etc.
7
Q
what is the most common cause of PD
A
- most common cause is idiopathic
8
Q
what are other causes of PD (4)
A
- encephalitis
- severe carbon monoxide poisoning
- MPTP
- neurleptic drug toxicity
9
Q
what are risk factors of PD (4)
A
- 60 years or older
- FHx
- history of head trauma
- exposure to herbicides & pesticides
10
Q
what are the 4 main symptoms of PD
A
- tremor
- rigidity
- bradykinesia
- postural instability
11
Q
what other symptom may occur w PD
A
- intellectual deterioration
12
Q
what causes the tremor during PD to be more pronounced (4)
A
- more pronounced at rest
- enhanced by stress, concentration, or anxiety
13
Q
is the tremor uni or bilateral
A
- usually begins in only one side of the body initially
- but can progress & be bilateral
14
Q
what is the tremor during PD often described as
A
“pill rolling”
- looks like ur trying to roll a pill between the thumb & index finger
15
Q
what affects does the tremor during PD have (2)
A
- affect handwriting
- affect ADLs
16
Q
what is rigidity
A
- increased resistance to passive movement
17
Q
what can rigidity during PD look like?
A
“cogwheel rigidity”
- watch video in notes as it is hard to explain
18
Q
what can rigidity during PD cause
A
- muscle soreness/fatigue due to the constant state of rigidity
19
Q
what is bradykinesia
A
- slow voluntary movements
20
Q
what other effect can PD have on motor function (6)
A
can cause reduction in autonomic extrapyramidial movements –> does not execute involuntary movements such as:
- blinking
- swinging arms while walking
- swallowing saliva = drooling
- facial expressions
- postural adjustments
21
Q
what is meant by “masked face” during PD
A
- way to describe the lack of facial expressions that occur w PD
22
Q
what kind of posture is seen w PD
A
- stooped or flexed posture
23
Q
what is postural instability
A
- flexed posture with “shuffling” steps
24
Q
what can postural instability lead to (2)
A
- instability
- falls
25
what is postural instability complicated by
- slowed voluntary movements
26
describe the onset of PD
- insidious & gradual
27
define akinesia
- the loss of the ability to move muscle voluntarily
| - absence of movement
28
define bradykinesia
- slowness of movement
29
define dyskinesia
- abnormal involuntary movement
30
what happens as PD progresses (6)
complications increase such as:
- motor symptoms
- weakness
- akinesia
- neuro problems
- neuropyschiatric problems (depression, anxiety)
31
what changes in mental status might you see during assessment of PD (5)
- depression
- mood swings
- flat affect
- sleep disturbances
- dementia (memory loss & confusion)
32
what changes in sensation might you see during assessment of PD
- paresthesia
| - loss of smell
33
what changes in balance/corrdination might you see during assessment of PD (5)
- bradykinesia
- shuffling gait
- stooped posture
- difficulty initiating movements
- unable to stop themselves from going forward & backwards
34
what changes in movement might you see during assessment of a pt with PD (7)
- tremors (pill rolling)
- rigidity (cogwheel)
- jerky quality
- muscle fatigure & soreness
- difficulty executing involuntary movements
- drooling
- masked face
35
which cranial nerves might be effected by PD
- CN1
- CN 2,3,4,6
- CN 5, 7
- CN 8
- CN 9,10,12
- CN 11
- all of them
36
what might the change in CN 1 cause
- loss of smell
37
what might the change in CN 2,3,4,6 cause (2)
- visual changes
| - difficulty w eye closure & blinking
38
what changes in CN 5 and 7 might you see (2)
- blank, expressionless face
| - difficulty chewing
39
what changes in CN 8 might you see (2)
- hearing loss
| - balance issue
40
what changes in CN 9,10, 12 might you see (2)
-issues with speech & swallowing
41
what changes in CN 11 might you see
- issues w movement of head & shoulders
42
_____ occurs in 40% of PD pts
- dementia
43
is there a diagnostic test for PD
- no specific diagnostic test
44
describe how diagnosis of PD is completed
based of manifestations & history
| - must have 2/3 classic triad
45
what is the PD traid
- tremor
- rigid
- bradykinesia
46
what can confirm the diagnosis of PD
- positive response to antiparkinson meds
47
what is a type of surgical care for PD
- deep brains stimulation
48
describe how deep brain stimulation works
- involves placing an electrode in the thalamus, globus, pallidus, or subthalamic nucleus
- connected to a generator in the upper chest
- device is programmed to delivery specific current to targeted brain location
49
what is the goal of treatment for PD
- restoring the balance between ach and dopamine
50
what 3 classes of meds are used for PD
- dopaminergic agents
- dopamine agonists
- MAO inhibitors
51
what are 2 types of dopaminergic agents for PD
- levodopa
| - levodopa/carbidopa
52
what is the MOA of levodopa
- crosses the BB and is converted to dopamine in the brain = increased lvls of dopamine
53
what is a challenge w levodopa (2)
- only a small part reaches the brain
- bc most is metabolized in the body
= difficult to achieve optimal dosages
- also loses effectiveness over time
54
what is the most effective drug for parkinsons
- levodopa
55
what are 4 adverse effects of levodopa
- dyskinesias
- postural hypotension
- NV
- psychosis
56
what is dyskinesia
- abnormal, involuntary, erratic movements of the face, arms, legs, or trunk
57
how does levodopa cause dyskinesias
thru the on-off phenoneom:
- too little dopamine = parkinson's disease symptoms worsen
- but too much due to the med = dyskinesia
58
how can we prevent the NV associated levodopa? what is a con to this?
- give w food
| - but it will decrease absorption
59
what needs to be done if levodopa causes psychosis
- dose will need to be reduced
60
what med is often given in combo w levodopa
- carbidopa
61
what is the MOA of carbidopa
- no therapeutic effect on its own
| - but it stops metabolism of levodopa in the body = increased amt of dopamine available to the brain
62
list adverse effects of levodopa/carbidopa
- decreased CVS effects (hypotension)
- decreased NV side effect of levodopa
- increased dyskinesias
63
how does levodopa/carbidopa decrease the CVS and NV side effect associated w levodopa on its own
- by decreasing the lvl of dopamine in the body
64
how does levodopa/carbidopa increase the dyskinesias compared to levodopa on its own
- by increasing the amt of dopamine in the brain
65
what is a type of dopamine agonist used for PD
- pramipexole
66
what is the MOA of pramipexole
- directly activates dopamine receptors
67
describe the use of pramipexole
- for mild to mod PD symptoms
68
what are the effects of pramipexole
- improved motor performance
| - stabilized motor control in later disease when used w levodopa
69
list s/e of pramipexole (6)
- NV
- dizziness
- daytime somnolence
- insomnia
- hallucinations
70
describe dyskinesia during pramipexole
- does not cause dyskinesia
71
what is one s/e associated w pramipexole if used with levodopa
- high likelihood of postural hypotension (more than 50%
72
what is an MAO-B inhibitor used for PD
- selegiline (deprenyl)
73
what is the MOA of selegiline
- inhibits the enzyme monoamine oxidase B, which breaks down dopamine = more dopamine in brain
74
describe the relation between selegiline and levodopa
- prolongs the effects of levodopa bc it prevents the dopamine it is converted into from being inactivated so quickly
75
what is a pro to selegiline
- may delay disease progression
76
what are 2 side effects of selegiline
- insomnia
| - postural hypotension
77
what are 3 types of dyskinesia
- akinesia
- akathisia
- dystonia
78
what is akinesia
- loss of voluntary motor function
79
what is akathisia
```
- having the urge to move, restlessness
ex:
- rocking while standing
- lifting feet as if marching on spot
- crossing & uncrossing legs while sitting
```
80
what is dystonia
- abnormal muscle tone leading to impaired or abnormal movements of head, neck, and tongue
