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Flashcards in week 3 prt 2 Deck (22)
1

Parkinson’s is:

A progressive, degenerative neurologic disease characterized by tremor at rest, muscle rigidity and akinesia.
People with PD are faced with multiple problems involving independence in ADLs, emotional well-being, financial security, and relationships with caregivers.

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Pathophysiology Review

A disturbed balance b/w excitatory and inhibitory neurotransmitters causes disorders of voluntary motor function

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In PD:

Neurons in the cerebral cortex atrophy & are lost
Dopaminergic nigrostriatal pathway degenerates.
# of specific dopamine receptors in basal ganglia decreases
Cause decrease in Dopamine (helps regulate nerve impulses involved in motor function)
Usual balance of dopamine (inhibitory neurotransmitter) and acetylcholine (excitatory neurotransmitter) in brain is disrupted & dopamine no longer inhibits acetylcholine

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Cardinal Symptoms

Tremor: Involuntary trembling of the limbs at a rate of 4-6 beats per second

Rigidity: Stiffness of the muscles
Akinesia: Lack of movement or slowness in initiating and maintaining movement
Postural changes: Characteristic bending or flexion of the body, associated with difficulty in balance and disturbances in gait

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Manifestations

Urinary problems or constipation.
improper functioning of ANS (regulates smooth muscle) – incontinent or trouble urinating. Constipation gut slows, poor diet, drinking too little fluid, medications
Skin problems
Face very oily, dandruff, or very dry, +++diaphoresis.
Sleep problems
difficulty staying asleep at night, restless sleep, nightmares & emotional dreams, and drowsiness or sudden sleep onset during the day
Dementia or other cognitive problems.
may develop memory problems & slow thinking
cognitive problems become more severe, leading to a condition called Parkinson's dementia late in the course of the disease (approx 30%)
Orthostatic hypotension
Muscle cramps and dystonia
rigidity and lack of normal movement often causes muscle cramps, especially in the legs and toes.
Dystonia— sustained muscle contractions that cause forced or twisted positions, often caused by fluctuations in the body's level of dopamine
**side effect of too much Levodopa


Anosmia
diminished or loss of sense of smell *early symptom
Pain
aching muscles and joints d/t rigidity & abnormal postures
Treatment and exercises may help

Fatigue and loss of energy
especially late in the day
Associated with depression or sleep disorders, muscle stress, overexertion when well, akinesia

Sexual dysfunction
Erectile dysfunction

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Anosmia

diminished or loss of sense of smell *early symptom

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Dystonia—

sustained muscle contractions that cause forced or twisted positions, often caused by fluctuations in the body's level of dopamine

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Stages of involvement FIVE STAGES:

Five main stages
Initial Stage
Mild Stage
Moderate
Severe Disability
Complete Dependence

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Level 1

No difficulties with day-to-day activities

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Level 2

Mild difficulties with day-to-day activities

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L 3

Moderate difficulties with day-to-day activities
Without some help, have increased difficulty with simple activities such as rising from a chair, washing, dressing, shopping, housework.
May have some difficulties walking and may require assistance.
Difficulties with recreational activities or the ability to drive a car.

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L4

Severe or high levels or interference in activities of daily living
Require much more assistance with activities of daily living such as washing, dressing, housework or feeding.

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L5

Extreme difficulties with day-to-day activities/ total dependency

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Diagnosis

History
Physical exam
No specific diagnostic tests in common use*

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Principles of Treatment

1. Utilize nonpharmacologic therapies
Regular exercise, sound nutrition, & patient & caregiver education are essential for optimal treatment.
2. Individualize medication regimens
Must individualize due to wide variation in the presentation of symptoms between individuals
Based on:
the patient's age and cognitive status
the hours when the need for mobility is greatest
other underlying medical problems
consider cost of medications ($$$) and the patient's ability to pay
3. Recognize Symptom Responsiveness
Medications are most effective at improving mobility, particularly larger limb and body movements
Tremor may not respond well or at all to any medication regimen
Impaired sense of balance generally is not correctable
speech and swallowing symptoms respond poorly or not at all to medications.

4. Recognize Potential Side Effects.
Almost without exception, the meds used to treat PD can cause symptoms that are more troubling than the disease itself.

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3 main types OF PARK MEDS

1. drugs that work directly or indirectly to increase the level of dopamine in the brain.

2.second category of Parkinson's disease drugs affects other neurotransmitters in the body in order to ease some of the symptoms of the disease.
3. help control the non-motor symptoms of the disease, that is, the symptoms that don't affect movement. For example, people with Parkinson's disease-related depression may be prescribed antidepressants.

17

DRUGS TWO TYPES

Gold Standard of Treatment: L-dopa is a precursor of dopamine; modified by brain enzymes to produce dopamine in the brain

Carbidopa is added to prevent breakdown of the L-dopa in the body before it can get to the brain
Effects are decreased by hi-protein meal; often causes nausea

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Dyskinesias *due to too much medication

SHIT WEARS OFF IN 5-10 YEARS

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Adding a COMT inhibitor to a levodopa regimen allows :

More of the l-dopa dose to reach brain
benefit from each dose is prolonged

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Dopamine agonists

Act by directly activating dopamine receptors in brain

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Medications - Amantadine (Symmetrel)

Main role is to reduce choreic movements produced by dopaminergic agents

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Anticholinergics

Block the excitatory action of acetylcholine
Supposed to be good for decreasing tremor, but no better than levodopa
MANY SIDE EFFECTS