OME - Tremor

Question 1

Pathophysiology Parkinson’s?

Answer 1

Loss of dopaminergic neurons in substantia nigra

Question 2

How does dopamine signalling work?

Answer 2

1. Dopamine released binding to D2 receptor
2. This inhibits GABA (GABA is an inhibitory NT) - increasing movement
3. AchR stimulate GABA - movement stop

Question 3

Things that can happen to Levodopa on ingestion?

Answer 3

1. Break into Dopamine - cannot cross BBB

2. Cross BBB - converted to De in brain

Question 4

What does COMT do?

Answer 4

Breaks L-Dopa / into a substance that cant cross BBB

Question 5

What does MAO-B do?

Answer 5

Breaks down dopamine brain

Question 6

What does dopamine do in brain?

Answer 6

Increases movement

Question 7

Parkinsons presentation

Answer 7

Hypokinetic disorder:

1. Bradykinesia - can’t get started / masked faces
2. Cogwheel rigidity
3. Pill rolling resting tremor
4. Gait

Question 8

Parkinson’s Diagnosis?

Answer 8

Clinical

- MRI can also show generation in substantia nigra

Question 9

Ways to intervene in parkinson’s?

Answer 9

1. Antagonize Ach (the breaks) Benztropine
2. COMT inhibitors “Apones”
3. MAOB inhibitors - Selegiline
4. L-Dopa / Carbidopa
5. De Agonists - Ropinirole / Pramipexole

Question 10

Who to use benztropine in?

Answer 10

Young patient with only milk parkinson only having tremor

Question 11

How to use amantadine in Parkinson’s?

Answer 11

DONT

Question 12

What does carbidopa do?

Answer 12

Stops breakdown of L Dopa into dopamine

- This is important as L-Dopa can cross BBB but dopamine cannot

Question 13

What are Ropinirole / Pramipexole?

Answer 13

De agonists that can be used to treat parkinsons

Question 14

Rx parkinsons if less than 70 and functional?

Answer 14

1. Dopamine agonists

Question 15

Rx parkinson’s over 70 or Not functional?1

Answer 15

1. L-Dopa / Carbidopa

2. COMT / MAOB inhibitors once #1 wears off

Question 16

What to do in parkinson’s when medicines fail?

Answer 16

Deep brain stimulation

Question 17

Presentation essential tremor?

Answer 17

1. Family history
2. No tremor at rest
3. Intentional tremor (does not worsen as you get closer to target)
4. Usually middle aged man

Question 18

Dx essential tremor?

Answer 18

Clinical

Question 19

Rx essential tremor?

Answer 19

Low does propranolol

Question 20

What causes intentional tremor?

Answer 20

Cerebellar dysfunction: stroke / alcohol

Question 21

Presentation intentional tremor?

Answer 21

1. No tremor at rest
2. Tremor on movement
   - Worse as it gets close to target

Question 22

How is huntington’s transmitted?

Answer 22

With anticipation: worse/and younger in each generation

• Trinucleotide repeat
• Autosomal dominant

Question 23

What is chorea?

Answer 23

1. Purposeless movements

2. Uncontrollable ballistic movement

Question 24

Rx huntington’s?

Answer 24

None