Brain 6

Question 1

Which factors contribute to the pathophysiology of Parkinson’s disease?
a. decreased dopamine in the basal ganglia
b. increased glutamate in the substantia nigra
c. decreased acetylcholine in basal ganglia
d. increased GABA in the thalamus

Answer 1

A. decreased dopamine in the basal ganglia
D. increased GABA in the thalamus

Question 2

Parkinson’s disease is a

Answer 2

chronic neurodegenerative disorder of the basal ganglia

Question 3

With Parkinson’s disease there is an imbalance between

Answer 3

dopamine (not enough) and acetylcholine (too much)

Question 4

When given together ___ & ___ increase the concentration of dopamine in the basal ganglia

Answer 4

cabidopa & levodopa

Question 5

Patients with Parkinson’s disease are at risk for

Answer 5

autonomic instability, orthostatic hypotension, dysrhythmias, and aspiration

Question 6

_________ may be used to treat acute exacerbation of Parkinsonian symptoms

Answer 6

Anticholinergics

Question 7

_____________________ can be used to treat the s/sx. of Parkinson’s disease.

Answer 7

A deep brain stimulator can be implanted

Question 8

Procedure-related considerations for the insertion of a deep brain stimulator include

Answer 8

lack of airway access during the procedure and risk of venous air embolism

Question 9

____________________ may exacerbate extrapyramidal s/sx and are contraindicated

Answer 9

Antidopaminergic drugs & phenothiazines

Question 10

An example of a phenothiazine is

Answer 10

promethazine

Question 11

Examples of antidopaminergic drugs include

Answer 11

metoclopramide
butyrophenones (haloperidol & droperidol)

Question 12

Diagnosis of Parkinson’s disease requires 2 of the 4 cardinal signs:

Answer 12

1. resting “pill-rolling” tremor
2. skeletal muscle rigidity
3. postural instability -loss of balance with an altered gait
4. bradykinesia- very slow movement and reflexes

Question 13

Risk factors for the development of Parkinson’s disease include

Answer 13

old age- greatest risk factor
exposure to manganese in welders as well as herbicides, pesticides, and possibly genetics

Question 14

Levodopa is a precursor to

Answer 14

dopamine

Question 15

Carbidopa is a

Answer 15

decarboxylase inhibitor

Question 16

By preventing levodopa metabolism in the blood, more

Answer 16

levodopa can enter the CNS

Question 17

In the circulation, levodopa is metabolized to

Answer 17

dopamine and DA in the blood does not penetrate the CNS

Question 18

Cardiovascular effects of levodopa and carbidopa include

Answer 18

increased inotropy, tachycardia and orthostatic hypotension

Question 19

Other side effects of levodopa & carbidopa include

Answer 19

dyskinesia, nausea and vomiting

Question 20

Selegiline is a

Answer 20

MAO-B inhibitor

Question 21

MAO-inhibitors restore

Answer 21

dopamine concentration by reducing dopamine metabolism in the CNS

Question 22

Unlike non-selective MAOIs, selegiline does not increase the risk of

Answer 22

tyramine-induced hypertensive crisis

Question 23

Other treatments for Parkinson’s disease include

Answer 23

dopamine agonists
anticholinergics
amantadine
hormonal replacement
catechol-o-methyltransferase inhibitors

Question 24

Patients with Parkinson’s disease are at risk for

Answer 24

autonomic instability, orthostatic hypotension, dysrhythmias and aspiration

Question 25

___________ has anticholinergic properties and is useful for sedation and reduction of tremors

Answer 25

diphenhydramine

Question 26

Hypotension with patients with Parkinson’s should be treated with

Answer 26

intravascular volume expansion and direct acting agents such as phenylephrine

Question 27

_______________ can cause an acute dystonic reaction due to the interruption of central dopaminergic neurotransmission.

Answer 27

Alfentanil

Question 28

________ is controversial to give due to its effects on the SNS

Answer 28

Ketamine

Question 29

It is important to monitor for __________ postoperatively for Parkinson’s patients.

Answer 29

postoperative ventilatory failure

Question 30

Can you give neuromuscular blockers to Parkinson’s patients?

Answer 30

yes, no contraindications

Question 31

Levodopa has a half-life of

Answer 31

6-2 hours; it must be given the morning of surgery to prevent worsening of symptoms such as rigidity which can impact ventilation

Question 32

For longer surgeries for Parkinson’s patients,

Answer 32

levodopa should be administered via an orogastric tube

Question 33

With deep brain stimulation surgery, seizures can be treated with

Answer 33

small dose of propofol, barbiturate or benzodiazepine

Question 34

To minimize the risk of intracranial hemorrhage for deep brain stimulation surgery, SBP should not exceed

Answer 34

140 mmHg

Question 35

The sitting position increases the risk of

Answer 35

VAE; a precordial doppler aids in diagnosis

Question 36

If deep brain stimulation is planned, it may be helpful to withhold

Answer 36

levodopa; it causes symptoms to worsen which facilitates optimal electrode placement

Question 37

Deep brain stimulation requires a ________

Answer 37

burr hole to insert electrodes into the subthalamic nucleus, globuc pallidus, and ventralis intermedius; this is done under stereotactic guidance

Question 38

With deep brain stimulation, the patient’s head is placed in a

Answer 38

rigid frame. this can complicate airway management so avoid oversedation and respiratory depression

Question 39

To determine optimal electrode placement, the patient must be

Answer 39

awake but can be lightly sedated with opioids or dexmedetomidine

Question 40

Because of the crucial role of GABA in the thalamus,

Answer 40

GABA agonists such as propofol or benzodiazepines are avoided as they can interfere with electrophysiologic brain monitoring