3. MTB Step 3 - Parkinson Disease (PD) Flashcards
Cards Complete:
PARKINSON DISEASE (PD)
PRESENTATION
What are (2) Presenting Signs of Parkinson Disease (PD)?
- Tremulous patient
- Slow, abnormal “Festinating” Gait
PARKINSON DISEASE (PD)
PRESENTATION
What are (6) Physical Finding in Parkinson Disease (PD)?
- “Cogwheel” Rigidity
- Resting Tremor (resolves when the patient moves or reaches for something)
- Hypomimia (masklike, underreactive face)
- Micrographia (small writing)
- Orthostasis
- Intact cognition and memory
PARKINSON DISEASE (PD)
DIAGNOSIS
How is Parkinson Disease (PD) diagnosed?
Clinically
There are NO specific diagnostic tests to prove someone has PD
PARKINSON DISEASE (PD)
SEVERITY
What is defined as “Severe Symptoms” of Parkinson Disease (PD)?
The inability to perform Activities of Daily Living (ADLs):
- Cooking
- Cleaning
- Personal Grooming
- Shopping
PARKINSON DISEASE (PD)
TREATMENT
- What is the treatment for Mild Parkinson Disease (PD) in a patient Age < 60?
- What is the treatment for Mild Parkinson Disease (PD) in a patient Age > 60?
- Anticholinergic agent (Benztropine, Hydroxyzine)
- Amantadine (older patients develop far more AEs from anticholinergics agents. ie, worsens memory)
PARKINSON DISEASE (PD)
TREATMENT
What are the (2) First-Line Treatments for the Severe Symptoms of Parkinson Disease (PD)?
-
Levodopa / Carbidopa
- Advantage: Greatest Efficacy
- Disadvantage: “On-Off” phenomena with uneven Long-Term effects and more Adverse Effects
-
Dopamine Agonists (Pramipexole, Ropinirole, Cabergoline, Rotigotine, Apomorphine)
- Advantage: Fewer Adverse Effects
- Disadvantage: Less Efficacy
PARKINSON DISEASE (PD)
TREATMENT
What are (4) other Therapies that may be used to control the Severe Symptoms of PD if the First-Line medications cannot?
- COMT Inhibitors: Tolcapone, Entacapone (these Block Dopamine metabolism and extend the effect of Dopamine Agonists)
- MAO Inhibitors: Selegiline, Rasagiline, Safinamide
- Pimavanserin: 5HT Inhibitor (antipsychotic that does not worsen PD because its mechanism is NOT dopamine inhibition)
- Deep Brain Stimulation: when medical therapy does not control symptoms
PARKINSON DISEASE (PD)
TREATMENT
What should be added if Levodopa treatment for PD causes psychosis?
Quetiapine
PARKINSON DISEASE (PD)
TREATMENT
What medication used in PD is a Dopamine Agonist deliverable by Skin Patch?
Rotigotine
PARKINSON DISEASE (PD)
TREMOR
What is the definition for an Essential Tremor?
A Tremor that occurs BOTH at Rest and with Action.
- Not associated with any other illness.
- No specific diagnostic test.
PARKINSON DISEASE (PD)
TREMOR
- What is the Best INITIAL Therapy for Essential Tremor?
- What should be added after 1 -2 weeks of initial therapy if the tremor is still present?
- What should you switch to if the Tremor still persists?
- What should be done if the question describes a patient with Multiple failed medical therapies and Severe tremor that interferes with functioning?
- Beta-Blockers (especially Propranolol)
- Primidone (antiepileptic that controls tremor)
- Topiramate or Gabapentin
- Thalamotomy (unilateral) - using MR-focused Ultrasound to Ablate the Thalamus with local heat
MULTIPLE SCLEROSIS (MS)
PRESENTATION
What is the Presentation of Multiple Sclerosis (MS)?
Abnormalities of ANY part of the Central Nervous System (CNS):
- Optic Neuritis - most common abnormality
- Atonic Bladder - motor & sensory problems and defects of the bladder
The CNS abnormalities improve only to have another defect develop several months to years later.
MULTIPLE SCLEROSIS (MS)
PRESENTATION
Besides the eye and bladder defects, what are (4) other Common Features of Multiple Sclerosis (MS)?
- Depression
- Fatigue
- Hyperreflexia
- Spasticity
MULTIPLE SCLEROSIS (MS)
DIAGNOSIS
- What is the Best INITIAL & Most ACCURATE Diagnostic Test for MS?
- What Diagnostic Test should be performed if the most accurate test is Nondiagnostic for MS?
- MRI: no reason for CT scan since it is far less sensitive
- CSF (lumbar tap): Presence of Oligoclonal Bands
MULTIPLE SCLEROSIS (MS)
DIAGNOSIS
What is a rare Adverse Reaction to the Gadolinium contrast used in MRI for MS patients with Renal Insufficiency?
Nephrogenic Systemic Fibrosis
- A systemic overreaction with increased collagen deposition in soft tissues.
- Hardened fibrotic nodules develop in the skin, and in severe cases, the heart, lung, and liver can be involved.
- There is no specific therapy.
MULTIPLE SCLEROSIS (MS)
TREATMENT
What is the Best INITIAL Therapy for Acute Exacerbations of MS to help speed resolution?
STEROIDS
MULTIPLE SCLEROSIS (MS)
TREATMENT
What are (9) Disease-Modifying therapies used in the treatment of MS?
- Dalfampridine
- Ocrelizumab - anti-CD20 drug that decreases progression
- Glatiramer
- Fingolimod
- Alemtuzumab - anti-CD52 drug that inhibits lymphocytes and deters progression
- Natalizumab - causes PML
- Beta Interferon
- Mitoxantrone
- Daclizumab
MULTIPLE SCLEROSIS (MS)
TREATMENT
- Which medication is used to treat the Fatigue associated with MS?
- Which (2) medications are used to treat the Spasticity associated with MS?
- Amantadine
- Baclofen or Tizanidine
MULTIPLE SCLEROSIS (MS)
TREATMENT
What are (3) Oral Therapies for MS?
- Dimethyl Fumarate
- Fingolimod
- Teriflunomide
