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Neurology > Parkinson Dse > Flashcards

Parkinson Dse Flashcards

1
Q

Peak age of onset of PD

A

6th decade

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2
Q

Tetradof PD

A

Hypokinesia, Bradykinesia
Resting tremor
Postural instabilility
Rigidity

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3
Q

CF of PD

A

Expressionless face (hypomimia), stooped posture, festinating gait

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4
Q

Speech in PD

A

Monotomous soft cluttered

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5
Q

early sign of PD

A

Infrequency of blinking

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6
Q

initial sign of PD

A

Tremor - 4 per sec pill rolling tremor of thumb and fingers

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7
Q

Aborts tremor in PD

A

Complete relaxation

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8
Q

Rigidity

A

Cogwheel rigidity

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9
Q

Graphia in PD

A

Micrographia

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10
Q

Speech do in PD

A

Hypokinetic dysarthria

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11
Q

Gait in PD

A

Festinating gait - rapid but short steps

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12
Q

Walking in PD

A

Reduced to shuffle

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13
Q

Spine in PD

A

Extreme forward flexion

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14
Q

Tremors in PD

A

begin in 1 limb spread to one side -> both limb

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15
Q

Inability to resist blinking in response to taapping bridge of nose or glabella

A

Myerson sign

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16
Q

DDx of Parkisonism

A 
PD
Progressive supranucleur palsy
Dysautonomia
Lewy body dse 
NPH
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17
Q

indicates PD

A

Sustained response to Levodopa

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18
Q

Rapid onset of Parkinsonism

A

Neuroleptic meds, Metoclopramide

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19
Q

Pathology of PD cells and nuclei

A

Loss of pigmented cells in substantia nigra and other pigmented nuclei

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20
Q

Pathology of PD, what appears pale

A

Substantia nigra appears pale

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21
Q

Histopath of PD

A

Eosinophilic cytoplasmic inclusions surr by faint halo (Lewy bodies)

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22
Q

Other regions ofn euronal loss in PD

A

Mesencephalic reticular formation, sympathetic ganglia

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23
Q

Causes destruction of dopaminergic neurons

A

MPP+

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24
Q

MPTP converted to what which produces irreversible Parkinsonism

A

MPP+

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25
Q

This mutatation is the mc genetic abn in EARLY ONSET PD

A

Park2 (parkin)

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26
Q

early onsent PD

A

parkin, alpha synuclein

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27
Q

normal component of synapse but in high concentration, aggregates and is a main constituent of Lewy Body

A

Alpha synuclein

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28
Q

Other constituents of LB

A

Ubiquitin and tau

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29
Q

Ubiquitin protein ligase that functions in removal of unnecessary proteins from cells

A

Parkin

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30
Q

Mutation of parkin leads to

A

Misfolding of synuclein

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31
Q

In PD, what cells are lost? What NT is loss?

A

Substantia nigra cells loss

Dopamine input loss

32
Q

With lost of DOPAMINE in PD, 2 nuclei become overactive

A

Subthalamic nucleus

Globus pallidus interna

33
Q

2 anatomic targets in Deep brain stimulation

A

Subthalamic nucleus

Globus pallidus interna

34
Q

Tx of PD most effective

A

L Dopa and L Dopa modifying drugs

35
Q

Crosses BBB

A

L Dopa

36
Q

Does not cross BBB

A

Dopamine

37
Q

Motor complications

A

Fluctuations (“on-off)
Dyskinesias
Wearing off effect
Delayed on

38
Q

Decarboxylase inhibitor

A

Carbidopa

39
Q

Moa of Carbidopa

A

inhibits L dopa decarboxylation –> More of L dopa available –> crosses BBB

40
Q

Dose L Dopa-Carbidopa

A

Levodopa/Carbidopa 25/100 mg BID titrated to 4 tablets 5 or more times daily

41
Q

Tx of PD extends plasma half life of L dopa

A

COMT Catechol.o.methyltransferase inhibitors

42
Q

COMT Catechol.o.methyltransferase inhibitors MOT

A

extends plasma half life of L Dopa

43
Q

COMT Catechol.o.methyltransferase inhibitors sample

A

Entacapone

44
Q

Directly act on dopamine rc

A

Dopamine agonists

45
Q

Dopamine agonists MOA

A

Directly acts on dopamine rc

46
Q

May be initial tx esp younger individuals

A

Dopamine agonists

47
Q

Less likely to cause DYSKINESIAS

A

Dopamine agonists

48
Q

Donwside of dopamine agonists and AE

A

Less potent

More motor and cognitive SE

49
Q

Dopamine agonists are derivatives of

A

Ergot

50
Q

Dopamine agonists Ergot derivatives

A

Bromocriptine
Pergolide
Cabergoline

51
Q

2nd gen dopamine agonists

A

Ropinirole, pramipexole (minimal ergot)

Rotigotine patch

52
Q

2nd dopamine agonists Minimal ergot like effects

A

Ropinirole and premipexole

53
Q

2nd dopamine agonists patch

A

Rotigotine

54
Q

Adjunctive meds in PD

A

Trihexyphenidyl and benztropine (anticholinergic) for tremors

Amantidine - antiviral

55
Q

adjunctive meds (anticholinergic) for tremors

A

Trihexyphenidyl and benztropine

56
Q

Adjunctive meds antiviral

A

Amantidine

57
Q

Moa of Amantidine (adjunctive meds)

A

NMDA antagonist

Antiviral

58
Q

Mild tremors on tremor hypokinesia postural sx

A

Amantidine

59
Q

Neuroprotective agents

A

MAO B inhibitor reduces oxidative stress (Selegeline, Rasagiline)
Ropinirole, pramipexole
Vitamin antioxidants (Vit E)

60
Q

Mao B inhibitor samples

A

Selegeline and Rasagiline

61
Q

MAO B inhibitor (Selegeline, Rasagiline) moa

A

reduces oxidative stress

62
Q

SE of dopamine tx

A 
nausea
dyskinetic movements
end of dose reduction
on-off phenomenon (motor fluctuations)
psychosis
depression, patho gambling
63
Q

Reduction of tremor and bradykinesia

A

L DOPA Carbidopa-L-dopa

64
Q

May prolong L dopa effects

A

Controlled release Carbidopa-L-dopa

65
Q

Moderate effects on all aspects; reduced motor fluctuations of L dopa, less dyskinesia

A

Dopamine agonists (Ropinerole, Pramipexole)

66
Q

Smoothing of motor fluctuations

A

Glutamate antagonist (Amantidine)

67
Q

Tremor reduction

A

Anticholinergics (Benztropine, Trihexyphenidyl)

68
Q

Prolonged effect on L Dopa

A

COMT inhibitors (Entacapone)

69
Q

Reduced off time, Neuroprotection

A

MAO inhibitors (Rasagiline, Selegline)

70
Q

SE meds
Nausea
DYSKINESIA
Orthostatic hypotension

A

L Dopa Carbidopa-L-dopa, Controlled release Carbidopa-L-dopa

71
Q 
SE meds
Orthostatic hypotension
Excessive sleepiness
CONFUSION
hallucination
A

Dopamine agonists (Ropinirole, Pramipexole)

72
Q 
SE meds
Leg swelling
CHF
Prostatic outlet obstruction
Insomia
A

Glutamate antagonists (Amantidine)

73
Q 
SE Meds
Dry mouth
Urinary outlet obstruction
Confusion
Psychosis
A

Anticholinergics (Benztropine, Trihexyphenidyl)

74
Q

SE Meds
Urine discoloration
diarrhea
dyskinesias

A

COMT inhibitor (Entacapone)

75
Q

SE of meds

Hypertensive crisis with tyramine rich foods and sympathomimetics

A

MAO inhibitors (Rasagiline, Selegiline)

Neurology (4 decks)

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