Mehl. Parkinson and like diseases + drugs Flashcards
M. Loss of dopamine-secreting neurons in the pars compacta of the midbrain, with deposition of alpha-synuclein on biopsy. Dx?
Parkinson disease
M. Presents with classic features of bradykinesia/akinesia, resting tremor, shuffling, short-steppage gait, micrographia, and cogwheel rigidity. Disease?
Parkinson disease
M. Parkinson CP?
Presents with classic features of bradykinesia/akinesia, resting tremor, shuffling, short-steppage gait, micrographia, and cogwheel rigidity.
M. Parkinson gene mutation?
Alpha-synuclein gene mutation most common; many genes implicated.
M. Parkinson. Combo commonly used for Tx?
Carbidopa-levodopa
M. Parkinson. what does levodopa?
Levodopa crosses the BBB to be converted to dopamine centrally. However, levodopa is subject to fast metabolism when administered alone.
M. Parkinson. function of carbidopa?
The addition of carbidopa to levodopa functions as a competitive inhibitor of breakdown enzymes, resulting in increased levodopa availability for passage across the BBB.
Do not confuse this mechanism with direct COMT inhibitors (tolcapone, entacapone), which prevent breakdown of L-dopa.
M. Parkinson. if levodopa- carbidopa administered to high doses, what CP?
can cause psychosis if administered in too-high a dose.
M. This is assessed on 2CK Psych forms, where if patient gets psychotic episodes following recent addition of C-L to regimen, or following an increase in dose, the answer is simply “decrease dose of carbidopa-levodopa.” “Discontinue carbidopa-levodopa is the wrong answer.”
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M. Parkinson. mechanism of amantadine?
Amantadine increases presynaptic release of dopamine
M. Parkinson. drug that increases presynaptic release of dopamine?
Amantadine
M. Parkinson. Be aware of D2 agonist names – i.e., ropinirole, pramipexole, cabergoline, pergolide, and bromocriptine, which can all in theory be used as treatments.
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M. Parkinson. Ropinirole, group?
D2 agonist
M. Parkinson. pramipexole, group?
D2 agonist
M. Parkinson. cabergoline, group?
D2 agonist
M. Parkinson. pergolide, group?
D2 agonist
M. Parkinson. Bromocriptine, group?
D2 agonist
M. Parkinson. Selegiline inhibits monoamine oxidase B, which is an enzyme that preferentially breaks down dopamine. USMLE wants you to know this can cause serotonin syndrome, either alone, or in combo with drugs like St John Wort or SSRIs.
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M. Parkinson. Selegiline, mechanism?
Selegiline inhibits monoamine oxidase B, which is an enzyme that preferentially breaks down dopamine.
M. Parkinson. Selegiline - what complication?
Selegiline inhibits monoamine oxidase B, which is an enzyme that preferentially breaks down dopamine. USMLE wants you to know this can cause serotonin syndrome, either alone, or in combo with drugs like St John Wort or SSRIs.
M. Restless leg syndrome. CP?
Idiopathic, irresistible urge to move legs while in bed/sleeping
Idiopathic, irresistible urge to move legs while in bed/sleeping.
M. Restless leg syndrome.
M. Restless leg syndrome. MCC?
Most common cause is iron deficiency anemia. First step is checking the patient’s serum iron and ferritin.
M. Restless leg syndrome. First thing to do = check iron levels. if normal, next step???
If iron studies are normal, gabapentin and D2 agonists (ropinirole, pramipexole) can be used.
M. Restless leg syndrome.
USMLE wants you to know that patients with RLS have increased risk of developing Parkinson disease, which makes sense since D2 agonists help, indicating a potential problem with dopamine signaling or production in some patients.
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M. Normal pressure hydrocephalus, CP?
“wet, wobbly, wacky” +/- Parkinsonism.
The parkinsonism is the most overlooked detail by students, who will usually only know the wet, wobbly, wacky part.
“wet, wobbly, wacky” +/- Parkinsonism?
M. Normal pressure hydrocephalus
M. Normal pressure hydrocephalus.
What the USMLE will do is give you an older male who has WWW triad + they give you 2-3 more sentences describing what sounds like Parkinson disease, where you’re like “What the hell? Is this Parkinson disease?” No. It’s just NPH, which is a Parkinson-plus disorder, where it can look like Parkinson disease but it ain’t.
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M. Normal pressure hydrocephalus. Mechanism of urinary incontinence?
Once again, due to impingement on the corona radiata, and the mechanism they want for urinary incontinence = “failure to inhibit the voiding reflex.”
M. Wilson disease. Cp, in what patients?
Parkinsonism in a young patient is Wilson disease till proven otherwise.
M. Wilson disease. mechanism?
Excessive copper accumulation in tissues, including the basal ganglia and liver, due
to inability to excrete it into bile.
M. Lewy body dementia. CP?
The patient will have dementia + visual hallucinations + Parkinsonism.
M. The patient will have dementia + visual hallucinations + Parkinsonism. Dx?
Lewy body dementia
M. Progressive supranuclear palsy. Obscure condition that gets asked on 2CK.
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M. Progressive supranuclear palsy.
You just need to know that 100% of questions will say what CP?
axial dystonia + Parkinsonism
they’ll just ask for diagnosis straight-up.
M. Progressive supranuclear palsy. what is axial dystonia?
Axial dystonia is a type of muscle condition resulting in abnormal posture and movement of the spine and torso.
M. type of muscle condition resulting in abnormal posture and movement of the spine and torso.?
Axial dystonia which is a part of Progressive supranuclear palsy (axial dystonia + parkinsonism)
M. MPTP = synthetic heroin.
- Just know it is a cause of Parkinsonism.
- Shows up on a 2CK Psych form. Students are like wtf?
M. drugs. Bromocriptine - group, also in what condition can be used?
D2 receptor agonist
Bromocriptine classic agent used for prolactinoma (dopamine agonism ̄ prolactin).
M. drugs. Ropinirole + pramipexole classically show up as …. Tx for what?
as restless leg syndrome treatment
M. drugs. Ropinirole + pramipexole classically show up as restless leg syndrome treatment.
First step - check iron. is normal, then Tx with these drugs.
New literature suggests gabapentin is first-line over D2 agonists now for RLS, but USMLE won’t play trivia. They will give patient with RLS + say, “In addition to ropinirole, what else could be added?” And gabapentin will be the only answer listed that works.
M. drugs. Ropinirole + pramipexole. What could be added for RLS Tx?
New literature suggests gabapentin is first-line over D2 agonists now for RLS, but USMLE won’t play trivia. They will give patient with RLS + say, “In addition to ropinirole, what else could be added?” And gabapentin will be the only answer listed that works.
M. Selegiline - irgi for Parkinson disease
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