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STEP 5: NEURO SHELF > MovementD/o_PretestStepup > Flashcards

MovementD/o_PretestStepup Flashcards

1
Q

What is the Tx of a YOUNG PARKINSON’S Pt only with PD TREMOR? Why not OLD pts?

A

BENZTROPINE or TRIHEXPHENIDYL - anti-cholinergic

Dis-inhibition: Inhibit Ach-mediated GABA activation

NOT used in elder or demented pts due to ANTI-CHOLINERGIC TOXICITY and POLYPHARMACY (BEER’S CRITERIA)

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2
Q

Describe the PARKINSONIAN TREMOR.

A

4-6Hz. Unilateral.
(+) Exacerbates with distractability
(-) Improves with movement and comes again with ending of mvmt = re-emergence
UNILATERAL, Starts in the hand -> spreads to part of the face (entire face is NOT involved unlike cerebellar and essential tremors)

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3
Q

CLASS 1: What is the first line Tx for PARKINSON’s? Describe the mechanism.

A

LEVODOPA-CARBIDOPA

Periphery: L-Dopa will NOT be converted to DOPAMINE in periphery bec carbidopa will inhibit the conversion. LESS PERIPHERAL DOPAMINE = LESS SIDE EFFECTS

Central: L-Dopa WILL be converted to DOPAMINE since carbidopa can NOT cross the BBB, where dopamine is actually needed.

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4
Q

Which substances will cross the BBB out of L-DOPA, CARBIDOPA, DOPAMINE?

A

ONLY L-DOPA

Carbidopa and Dopamine do NOT cross BBB

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5
Q

CLASS 2: What may be used in addition to LEVODOPA-CARBIDOPA in Parkinson’s pts?

A

DOPAMINE AGONISTS - PRAMIPEXOLE/ ROPINOROLE/ BROMOCRIPTINE

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6
Q

CLASS 2: Which is the most commonly used DOPAMINE AGONIST for parkinson’s pts? Which is the least used and why?

A 
PRAMIPEXOLE = most commonly used
BROMOCRIPTINE = ergot compound, least commonly used due to side effect profile
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7
Q

If parkinson’s pt is <70yo and has INTACT FUNCTION, what PD drug is prescribed?

A

DOPAMINE AGONIST - PRAMIPEXOLE or ROPINOROLE

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8
Q

If parkinson’s pt is >70yo OR does NOT have intact function, what PD drug is prescribed?

A

LEVODOPA-CARBIDOPA

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9
Q

What is the purpose of other CLASSES OF PD DRUGS in addition to LEVODOPA-CARBIDOPA?

A

Levodopa-carbidopa effects wear off with long-time usage. Need other classes - COMT inhibitors, MAOB inhibitors to augment

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10
Q

Other than Levodopa-carbidopa and dopamine agonists, what are the 2 other classes of PD drugs?

A

1) COMT inhibitors - Inhibits L-DOPA conversion into 3-OMD

2) MAOB inhibitors - Inhibits degradation of dopamine into DOPA-C

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11
Q

When ALL medications fail for PARKINSON’S, what is the next resort of treatment?

A

DEEP BRAIN STIMULATION of GPi or STN

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12
Q

Which nerve cells are damaged in PARKINSON DISEASE?

A

SUBSTANTIA NIGRA + LOCUS CERULEUS (midbrain)

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13
Q

PROGRESSIVE SUPRANUCLEAR PALSY (PSP) is similar to which movement disorder? What is affected in PSP?

A

Similar to PARKINSON’S - BG + Brainstem + cerebellum

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14
Q

Who is mostly affected by PROGRESSIVE SUPRANUCLEAR PALSY?

A

MIDDLE-AGED and ELDERLY men

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15
Q

How are PSP and PARKINSON similar? (4)

A

1-2) RA - rigidity + akinesia

3) PROGRESSIVE course
4) Cognitive decline

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16
Q

How do PSP and PARKINSON differ? (2)

A

1) PSP - Does NOT cause tremor (T)

2) PSP - DOES cause ophthalmoplegia

17
Q

How does one test for COGWHEEL RIGIDITY in a PARKINSON’S Pt ?

A

RATCHET-LIKE JERKING - Test the tone of one limb (jerks) while the pt clenches or activates the other limb/fist

18
Q

How does POSTURAL INSTABILITY look in a PARKINSON’S Pt?

A

SHUFFLING GAIT, STOOPED POSTURE, difficulty initiating the first step

19
Q

What syndrome is PARKINSONIAN SX + AUTONOMIC INSUFFICIENCY?

A

MULTIPLE SYSTEM ATROPHY (SHY-DRAGER) = Movement parkinsonian Sx + Orthostatic hypotension/increased sweating/oily skin/constipation/dry mouth/dry skin/impotence/incontinence

20
Q

What is the most common side effect after 5-7 years of CARBIDOPA-LEVIDOPA (SINEMET) therapy?

A

DYSKINESIAS (Involuntary, often CHOREIC movements) - Thus SINEMET should be delayed as long as possible

21
Q

What is the LEVODOPA ON-OFF PHENOMENON?

A

ADVANCED PARKINSON’S: Over the course of the day, L-dopa has an off course -> Fluctuations in Sx (wears off)

22
Q

Which medications can cause PARKINSONIAN Sx?

A

FIRST GEN ANTI-PSYCHOTICS (NEUROLEPTICS): Chlorpromazine, haloperidol, perphenazine) = anti-D2R

METOCLOPRAMIDE (REGLAN): anti-D2R, anti-5HT3, 5-HT4 agonist

RESERPINE - Blocks vesicular monoamine transport (NE, E, and DA) in presynaptic nerve terminal to synaptic vesicles for exocytosis

23
Q

Which receptor action are EXTRAPYRAMIDAL, PARKINSONIAN-LIKE SX?

A

ANTI-DOPAMINE2 RECEPTOR ACTIVITY

24
Q

Which predominant sx of parkinson’s has the better diagnosis? PD with predominant TREMOR or BRADYKINESIA/?

A

TREMOR as predominant = BETTER PROGNOSIS

BRADYKINESIA as predominant = WORST PROGOSIS

25
Q

What is the most likely age group affected by PARKINSONS? affected by HUNTINGTON’S?

A

PARKINSONS >50YO

HUNTINGTON 30-50YO

26
Q

INHERITED cause of ATAXIA + Nystagmus + Impaired vibratory/proprioception first presenting in YOUNG ADULTHOOD = ? What is the inheritance pattern?

A

FRIEDRICH ATAXIA - Autosomal recessive

Onset by young ADULTHOOD

27
Q

INHERITED cause of ATAXIA + Nystagmus + Impaired vibration/proprioception (Friedrich) + TELANGIECTASES = ? What is the inheritance pattern?

A

ATAXIA TELANGIECTASIA - Autosomal recessive

Onset by CHILDHOOD

Increased incidence of cancer

28
Q

What is the requirement of TOURETTE SYNDROME?

A

MULTIPEL MOTOR TICS + AT LEAST ONE PHONIC TIC

MOTOR = facial grimace, blinking, head jerking, shoulder shrugging

PHONIC = sniffling, grunting, clearing throat, involuntary sweating, repeating words

29
Q

What inheritance pattern is associated with TOURETTE SYNDROME? What psych disorder is it most associated with?

A

AUTOSOMAL DOMINANT

Association with Obsessive-compulsive disorder

30
Q

Who is the most commonly affected age group of TOURETTE SYNDROME?

A

<21yo

31
Q

What are the 3 possible pharmacological options for TOURETTE SYNDROME?

A 
CLONIDINE = centrally-acting alpha2 agonist
HALOPERIDOL = anti-pscyhotic
PIMOZIDE = anti-psychotic
32
Q

What is the approved Tx of ALS and what is its mechanism?

A

RILUZOLE - Glu inhibitor

STEP 5: NEURO SHELF (9 decks)

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