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Disease and Therapeutics > Degenerative Disorders > Flashcards

Degenerative Disorders Flashcards

1
Q

What are the main manifestations of Degenerative disorders?

A

Movement or Cognitive impairment.

*Usually later in life but has a genetic and environmental aspect

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2
Q

What are the 8 mechanisms through which Degenerative disorders develop?

A 
1-Hypoxia (stroke/GABA issues)
2-Excitatory AA (glutamate on NMDA/AMPA)
3-Ion Fluxes (Ca++ distrib)
4-Free radicals 
5-Immune issues (Autoimmune)
6-Infections (Viral/Bacterial
7-Apoptosis
8-Protein Aggregation (plaque)
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3
Q

What are the 3 main clinical manifestations of Parkinson’s Disease?

A

1-Tremor
2-Rigidity
3-Bradykinesia

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4
Q

What are the two main postural abnormalities in those with Parkinson’s?

A

1-Stooped Posture

2-Shuffling of feet

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5
Q

What are the 3 main Autonomice and neuroendocrine manifestations of Parkinson’s?

A

1-Salivating/drooling
2-Slurred speech (often speak softly as well)
3-Dysphagia/Choking

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6
Q

What are 3 late symptoms of Parkinson’s?

A

1-Depression/reclusiveness
2-Immobilility
3-Loss of bowel function (usually constipation)

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7
Q

Which stage of Parkinsons only affects one side with minimal or no functional impairment?

A

Stage 1 (Mild/Early)

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8
Q

Which stage of Parkinsons affects both sides but has normal posture and balance?

A

Stage II

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9
Q

Which stage of Parkinsons affects both sides with mild imbalance when standing or walking?

A

Stage III (Moderate)

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10
Q

Which stage of Parkinsons affects both sides with instability while standing or walking and needs help/cannot live alone?

A

Stage IV (Advanced)

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11
Q

Which stage of Parkinsons is fully developed and restricts the patient to bed or a wheelchair?

A

Stage V

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12
Q

Though Parkinsons may develop in anyone that lives long enough, ____% over the age of 80 have it, _____% in those 50-60 years old and _____% in those under 50

A

50, 1, 0.01

*Not gender Biased

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13
Q

What pathway is affected in Parkinsons?

A

Dopamine neuron activity in the Nigra striatal neurons between Substantia Nigra and Striatum

*Increased Cholinergic activity results

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14
Q

What are 4 Possible environmental causes of Parkinsons?

A

1-Mg and Hg (welders/dentists)
2-Pesticides (quinones, Farmers)
3-Trauma (Brain Injuries)
4-Dopamine (creates ROS)

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15
Q

What are two possible genetic components of Parkinsons?

A

1-Synuclein (vesicle trafficking)

2-Larkin

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16
Q

L-Dopa is used as a Dopamine precursor to battle the loss of the Nigra-Striatal pathways but must be administered with what to block peripheral metabolism of L-Dopa?

A

Carbidopa

*L-dopa doesn’t cross the BBB really well so high plasma levels are needed. Entacapone can improve the effect as well.

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17
Q

What drug is administered in combination with L-dopa and is a COMT inhibitor to block metabolism of dopamine?

A

Entacapone

*often with Levodopa as well as Carbidopa

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18
Q

What is a typical reaction right after a patient has taken their L-dopa?

A

Clenched jaw, tight/twisted fist. May cause behavior, movement and psychosis issues

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19
Q

Which medication for parkinsons can cause blurred vision, urinary retention, and dry mouth?

A

Benztropine

*anticholinergic

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20
Q

Which drug is used in most parkinsons at some point?

A

Levodopa (L-dopa)

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21
Q

Which parkinsons drug is a D2 agonist and may cause orthostatic hypotension, nausea, confusion and hallucinations?

A

Pramipexole

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22
Q

Which parkinsons drug is a MAO inhibitor?

A

Selegiline

*slows DA metabolism. Only drug to not cause xerostomia

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23
Q

What surgical technique is sometimes used to help control balance and tremor symptoms of parkinsons?

A

Deep Brain Stimulation. Enhances DA release. Best in early onset parkinsons

24
Q

Besides xerostomia, what oral side effects might Combination Levodopa drugs cause?

A
  • Glossitis
  • Trismus (from clenching)
  • pigmentation/dark saliva
25
Q

Though it does not cause xerostomia, what oral side effects might Selegiline cause?

A
  • Sublingual ulcerations

- Burning mouth/lips

26
Q

What should be kept in mind when treatment planning for a parkinsons patient?

A

Major dental interventions would be done early in PD if possible

27
Q

What is the ideal treatment schedule for a parkinsons patient?

A

Short, morning appointments 90 minutes after PD meds, after emptying bladder

28
Q

If a patient is taking levodopa and/or entacapone how should your use of local anesthetic change?

A

Limit to 2-3 cartridges of Epi containing anesthetic

29
Q

The uncontrolled jerky movements of Huntington’s disease (chorea) is related to what?

A

Too much dopamine in the striatum

30
Q

What are the three main stages of progressive intellectual dysfunction in Huntingtons?

A

1-Early: Deterioration of judgement
2-Depression
3-Psychotic and compulsive

31
Q

Huntingtons is found in ____% of the pop. Last __ -__ years and is _____ aggressive in males and when the gene comes from the ______

A

0.01
5-10 years
More
Father

32
Q

In parkinsons the cell bodies of the Substantia Nigra deteriorate whereas in Huntingtons, the deterioration is in the?

A

Striatum Cell bodies

*too much dopamine. Enlarged ventricles due to lose of caudate

33
Q

The huntington gene seems to be related to glutamate and causes what?

A

NMDA receptors to be more sensitive, resulting in loss of GABA regulation

34
Q

What two kinds of drugs are the best to treat huntingtons?

A

1-DA antagonists

2-D2 antagonists

35
Q

What are 3 drugs used to treat Huntingtons?

A

1-Haloperidol (D2 antagonist, antipsychotic)
2-Citalopram (SSRI, antidepressant)
3-Baclofen (GABA agonist, relieves muscle rigidity for comfort)

36
Q

What disease is caused by cholinergic depletion, causes neuronal symptoms, and can last 15+ years?

A

Alzheimer’s disease

*3-4 million/ 1% of pop. have it. 50% of 80+ yr old have it

37
Q

What are the 3 basic stages of alzheimers?

A

1-Early: still work and function but forget things. Recent memories slip
2-Moderate: difficulty with common tasks, forget location
3-Late stage: Don’t remember people or things motor functions deteriorate

38
Q

What three areas of the brain are mainly effected in Alzheimers?

A

1-Hippocampus (memory)
2-Cortex
3-Nucleus Basalis- connects to hippocampus with Ach projections

39
Q

What are the two histological effects of Alzheimers on the brain?

A

1-Senile Plaques

2-Neurofibrillary tangles

40
Q

What type of histological alzheimer effect has tau protein aggregates that look like railroad tracks?

A

Neurofibrillary Tangles

*associated with microtubules

41
Q

What type of histological alzheimer effect has B-amyloid protein aggregates?

A

Senile Plaques

*APP not formed correctly

42
Q

Which neurotransmitter decreases in alzheimers?

A

ACh

*Treatments like Aricept increase ACh

43
Q

What are 7 common alzheimer disease medication types?

A 
1-Cholinesterase inhibitor
2-Atypical Antipsychotics
3-Neuroleptic
4-SSRI
5-Tricyclic antidepressant
6-Serotonin and Norepi reuptake inhib
7-Central a2 autoreceptor
44
Q

While disease is more prevalent in females, has relapse cycles with variable symptoms and is due to myelination issues?

A

Multiple Sclerosis

*Oligodendrocyte issues. Heat tends to worsen it

45
Q

Though most complain of fatigue, what are some symptoms of MS?

A 
1-Optic
2-Auditory and other sensory
3-Depression
4-Autonomic system (dangerous)
5-Cognition deficiency
46
Q

What is the epidemiology of MS?

A

1-Scandenavian is more frequent.
2-Genetic based disorder.
3-Adolescents and young adults
4-2:1 female to male ratio

47
Q

What likely triggers MS?

A

Virus which induces an autoimmune response with acute inflammatory episodes

48
Q

What are the 4 classicfications of MS?

A

1-Benign
2-Relapsing remission (on/off)
3-Relapsing progressive (minor remissions)
4-Chronic progression (no remission)

49
Q

What do you need to see on an MRI in order to diagnose MS?

A

2 or more lesions

*Symptoms are based on location

50
Q

What medication is mainly used to manage relapses in ms?

A

Prednisone

51
Q

What is used to manage Bladder dysfunction in MS?

A

Tamsulosin (Flomax)

52
Q

What is used to manage Bowel dysfunction in MS?

A

metamucil (psyllium)

53
Q

What is used to manage depression in MS?

A

Prozac

54
Q

What is used to manage fatigue in MS?

A

modafinil

*also used for ADHD

55
Q

What is used to manage pain in MS?

A

gabapentin (Neurotin)

*enhance GABA selectively

56
Q

What is used to manage tremors in MS?

A

clonazepam (klonopin)

Disease and Therapeutics (39 decks)

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