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Y3 Neurology > Movement Disorders > Flashcards

Movement Disorders Flashcards

1
Q

what is the aim of pharmacological treatment in parkinson’s?

A

control symptoms

improve the patients quality of life

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2
Q

what are the risk factors for parkinson’s?

A

age - elderly
male sex
rural living

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3
Q

what factor can reduce the risk of parkinson’s?

A

smoking

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4
Q

what are the three clinical hallmarks of parkinson’s?

A

bradykinesia
rigidity
tremor

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5
Q

what is bradykinesia?

A

slowness of movement

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6
Q

when is tremor seen in parkinson’s?

A

usually at rest

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7
Q

what criteria needs to be met for a diagnosis of parkinson’s?

A

inclusion criteria met

three or more of the supporting criteria present

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8
Q

what is the inclusion criteria for parkinson’s?

A

bradykinesia and at least one of:

  • muscle rigidity
  • 4-6Hz rest tremor
  • postural instability not due to an alternate primary cause
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9
Q

what are the supporting criteria for a diagnosis of parkinson’s?

A 
unilateral onset 
rest tremor 
progressive 
asymmetric 
response to L dopa 
clinical course >10 years
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10
Q

describe the tremor seen in parkinson’s

A

4-6Hz rest tremor

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11
Q

what is the pathophysiology behind parkinson’s?

A

loss of dopaminergic neurones from the pars compacta region of the substantia nigra

60% loss is usually when symptoms show

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12
Q

what four types of drugs are used to treat parkinson’s?

A

levodopa
COMT inhibitors
dopamine agonists
MAO-B innhibitors

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13
Q

what is the mechanism of action of levodopa in parkinson’s?

A

replaces dopamine

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14
Q

what is the first line treatment for parkinson’s?

A

levodopa

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15
Q

what is levodopa given in combination with and what are these drugs?

A

carbidopa or benserazide

dopa decarboxylase inhibitors - stop it forming dopamine until it reaches the brain to reduce side effects

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16
Q

what is sinemet?

A

a combination of levodopa and a dopa decarboxylase inhibitor given for parkinson’s

aka co-careldopa

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17
Q

what are some acute adverse effects of levodopa use?

A

N+V
postural hypotension
tachycardia/arrythmias

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18
Q

what anti-emetic is often prescribed for nausea due to levodopa in parkinson’s?

A

domperidone as it does not cross the BBB

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19
Q

what are some slowly developing adverse effects of levodopa?

A

motor complications - response fluctuations and dyskinesias

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20
Q

how do COMT inhibitors work for parkinson’s?

A

preserve levodopa

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21
Q

name a COMT inhibitor

A

entacapone

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22
Q

how do dopamine agonists work to manage parkinson’s?

A

mimic dopamine

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23
Q

name three dopamine agonists

A

pramipexole
ropinirole
rotigotine

24
Q

how do MAO-B inhibitors work in parkinson’s?

A

preserve existing dopamine

25
Q

name two MAO-B inhibitors

A

rasagiline

selegiline

26
Q

which drug for parkinson’s carries the highest risk of adverse effects?

A

dopamine agonists

27
Q

what are the possible adverse effects of drugs for parkinson’s?

A

excessive sleepiness
psychosis - hallucinations/delusions
impulse control disorders

28
Q

what is the drug of choice for drug induced parkinson’s?

A

central anti-cholinergic drugs

29
Q

name some examples of central anti-cholinergic drugs

A

orphenadrine
benzotropine
procyclidine
trihexiphenidyl

30
Q

when should caution be taken with the use of central anti-cholinergic drugs?

A

in patients with dementia and BPH

31
Q

how does drug induced parkinson’s present?

A 
bradykinesia
expressionless face 
slow initiation of movement 
symmetrical symptoms 
speech difficulties
32
Q

how is drug induced parkinson’s managed?

A

50% of cases reversible when causative drug stopped

33
Q

what is tardive dyskinesia and what causes this?

A

delayed drug induced movement disorder

neuroleptic drugs

34
Q

why is drug induced parkinson’s not treated with levodopa?

A

receptors are blocked so it would not work

35
Q

how is neuroleptic induced parkinsonism managed?

A

procyclidine

36
Q

what investigation can be used to distinguish parkinsonism from dystonia?

A

DAT scans

37
Q

what is a tremor?

A

a rhythmic sinusoidal oscillation of a body part

38
Q

name four different types of tremor

A

essential
drug induced
rest/parkinsonian
orthostatic

39
Q

what body parts are affected by an essential tremor?

A

usually upper limbs

head, voice and other body parts less commonly

40
Q

which tremor type is usually associated with a positive family history of tremor?

A

essential tremor

41
Q

what is the frequency of an essential tremor?

A

6-12 Hz

42
Q

what can suppress an essential tremor?

A

alcohol

beta blockers

43
Q

what type of tremor is an essential tremor?

A

action or postural

44
Q

what type of tremor is a drug induced tremor?

A

action or postural

45
Q

what body parts are usually affected by a drug induced tremor?

A

upper limbs

46
Q

when does a parkinsonian tremor tend to occur?

A

when the body part is at rest

hence why it is also known as a rest tremor

47
Q

what body parts are usually affected by a rest tremor?

A

hands, legs and jaw

48
Q

what is the frequency of a rest tremor?

A

4-6Hz

49
Q

when does an orthostatic tremor occur?

A

when the patient is standing still

50
Q

what body parts are affected by an orthostatic tremor?

A

lower limbs

results in unsteadiness

51
Q

what is the frequency of an orthostatic tremor?

A

14-16 Hz

52
Q

what is it called when myoclonus occurs during movement?

A

action myoclonus

53
Q

what is it called when myoclonus is provoked by a stimulus?

A

stimulus sensitive or reflex myoclonus

54
Q

what is chorea?

A

a movement disorder characterised by a continuous and random flow of muscle contractions

55
Q

what can cause chorea?

A 
genetics 
drugs 
vascular 
infections 
immune conditions 
endocrine problems

Y3 Neurology (31 decks)

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