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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
name two MAO-B inhibitors
rasagiline | selegiline
26
which drug for parkinson's carries the highest risk of adverse effects?
dopamine agonists
27
what are the possible adverse effects of drugs for parkinson's?
excessive sleepiness psychosis - hallucinations/delusions impulse control disorders
28
what is the drug of choice for drug induced parkinson's?
central anti-cholinergic drugs
29
name some examples of central anti-cholinergic drugs
orphenadrine benzotropine procyclidine trihexiphenidyl
30
when should caution be taken with the use of central anti-cholinergic drugs?
in patients with dementia and BPH
31
how does drug induced parkinson's present?
``` bradykinesia expressionless face slow initiation of movement symmetrical symptoms speech difficulties ```
32
how is drug induced parkinson's managed?
50% of cases reversible when causative drug stopped
33
what is tardive dyskinesia and what causes this?
delayed drug induced movement disorder neuroleptic drugs
34
why is drug induced parkinson's not treated with levodopa?
receptors are blocked so it would not work
35
how is neuroleptic induced parkinsonism managed?
procyclidine
36
what investigation can be used to distinguish parkinsonism from dystonia?
DAT scans
37
what is a tremor?
a rhythmic sinusoidal oscillation of a body part
38
name four different types of tremor
essential drug induced rest/parkinsonian orthostatic
39
what body parts are affected by an essential tremor?
usually upper limbs head, voice and other body parts less commonly
40
which tremor type is usually associated with a positive family history of tremor?
essential tremor
41
what is the frequency of an essential tremor?
6-12 Hz
42
what can suppress an essential tremor?
alcohol | beta blockers
43
what type of tremor is an essential tremor?
action or postural
44
what type of tremor is a drug induced tremor?
action or postural
45
what body parts are usually affected by a drug induced tremor?
upper limbs
46
when does a parkinsonian tremor tend to occur?
when the body part is at rest hence why it is also known as a rest tremor
47
what body parts are usually affected by a rest tremor?
hands, legs and jaw
48
what is the frequency of a rest tremor?
4-6Hz
49
when does an orthostatic tremor occur?
when the patient is standing still
50
what body parts are affected by an orthostatic tremor?
lower limbs results in unsteadiness
51
what is the frequency of an orthostatic tremor?
14-16 Hz
52
what is it called when myoclonus occurs during movement?
action myoclonus
53
what is it called when myoclonus is provoked by a stimulus?
stimulus sensitive or reflex myoclonus
54
what is chorea?
a movement disorder characterised by a continuous and random flow of muscle contractions
55
what can cause chorea?
``` genetics drugs vascular infections immune conditions endocrine problems ```

Y3 Neurology (31 decks)

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