parkinson diease

Question 1

what is the main risk factor for parkinson diease?

Answer 1

The etiology of neuron degeneration in PD remains unknown, but the main risk factor is believed to be aging.

Question 2

Name two conditions that contribute to oxidative stress in PD.

Answer 2

Conditions that may promote oxidative stress include:
1. increased MAO-B metabolism
2. decreased glutathione clearance of free radicals

Question 3

what are the causes of neuron degenration?

Answer 3

1. oxidative stress
2. mitochondrial disfunction
3. increased conc. of excitotoxic aa and inflammatory cytokines
4. immune system disorder
5. trophic factor defiency
6. signal mediated apoptosis
7. envirmomental toxin
8. mutation in some gene( LRRK2)

Question 4

Which part of the brainstem is affected in PD?
and what are the cells effected?

Answer 4

Dopaminergic Neurons
in susbtantia nigra –> in midbrain

Question 5

What happens when dopaminergic neurons die in PD?

Answer 5

As dopaminergic neurons die, dopamine messages cannot be transmitted to other motor centers of the brain, and patients develop motor symptoms.

Question 6

other neurotransmitters and their non motor symtoms example:

Answer 6

As dopaminergic neurons degenerate, other neurotransmitters in the brain also decrease with non motor symtoms like:

anxiety and depression: due to loss of dopamine and norepinephrine in limbic system

cognitive impairment: due to acetylcholine and serotonin in limbic system

Question 7

Disease Progression of PD which areas of brain

Answer 7

PD can begin in the autonomic nervous system (ANS), olfactory system, or vagus nerve (lower brainstem).

It then spreads to the upper brainstem and cerebral hemisphere, affecting dopamine pathways as the disease progresses.

Question 8

drug induced pseudoparkinsonism drugs

Answer 8

also called (Extra-pyramidal symptoms).
drugs:
1. antipsychotics: prochlorperazine
2. antiemetic: metoclopramide

removing drug – resolve probelm

Question 9

What are the initial sensory symptoms in PD?

Answer 9

Sensory symptoms:
Pain, olfactory disturbances (smell issues), visual dysfunction.

Question 10

Classic Features (Motor Symptoms): of PD

Answer 10

1. Resting tremor: most commonly in the hands
2. Muscular rigidity
3. Akinesia or bradykinesia
4. Postural instability that may lead to falls

Question 11

other non montor symtoms

Answer 11

• sleep, nausea, anxiety, speech problem, urinary problem
• intellectual deterioation – resemble with alziemer diease
• immobility seen in most– within 10-20 years

Question 12

Name a medication used in a therapeutic trial for PD diagnosis.

Answer 12

levadopa can confirm diagnosis of PD

Question 13

what are non pharmacological option and surgical for pd

Answer 13

most common: good nutrition, physical condition and social interactions
surgical: deep brain stimulation –> consider when drugs unresponsive
moa: This procedure involves electrical stimulation of the subthalamic nucleus or globus pallidus interna.
benefits: reduce motor symtoms, and improve QOL

Question 14

drugs used in PD are

Answer 14

• Anticholinergics
• Amantadine
• MAO-B inhibitors
• Dopamine agonists
• Levodopa / carbidopa combination
• Catechol-O-methyltransferase (COMT) inhibitors

Question 15

levadopa should initialy used for?

Answer 15

Levodopa results in greater motor improvement and should be used as initial therapy in:
1. the elderly (greater than 75 years)
2. those with cognitive impairment.

Question 16

antichlonergic is avoided in which patients? and why?

Answer 16

They should be used cautiously or avoided in patients older than 70 years because of an increased risk of
1. cognitive impairment,
2. urinary dysfunction
3. glaucoma.

Question 17

antichlonergic might lead to alziemer why?

Answer 17

anticholinergics might lead to an increased risk of Alzheimer disease in PD patients due to:
increased incidence of amyloid plaques and neurofibrillary tangles

Question 18

selegine not used at night why?

Answer 18

Selegiline should not be dosed in the late afternoon or evening because one of its metabolites is amphetamine-like, so may cause insomnia.

Question 19

moa-b benefits when combined with levadopa

Answer 19

Might be combined with levodopa to achieve the following benefits:
* May reduce off time.
* Can extend the on time of levodopa up to 1 hour
* Permit reduction of levodopa dose by as much as half
* If combined with levodopa in early treatment may delay motor complications.

Question 20

compt benefits:

Answer 20

• Increase levodopa concentration allowing decrease in its daily dose,
• extend its t1/2 with decrease in off time & increase on time by 1 – 2 hrs.
• Dyskinesias should improve with a decrease in the levodopa dose.