Parkinson's

Question 1

What is Parkinson’s?

Answer 1

Progressive reduction of dopamine in the basal ganglia leading to dysfunction of the basal ganglia

Question 2

How does Parkinson’s present?

Answer 2

• Resting Tremor- ‘Pin-roll’(thumb and index finger)
• Bradykinesia
• Rigidity- Cog-wheel rigidity
• D’s: Depression, Dementia, disturbed sleep, drooling,
• Mask like face
• Postural hypotension

Question 3

What improves the resting tremor?

Answer 3

Intentional movement

Worse at rest

Question 4

What do you get with Bradykinesia?

Answer 4

Short, shuffling steps with reduced arm movements

Difficulty in initiating movement

Question 5

What is cog wheel rigidity due to?

Answer 5

Superimposed tremor

Question 6

How is Parkinon’s diagnosed?

Answer 6

Clinically

Question 7

What is the management of Parkinson’s?

Answer 7

Levodopa (synthetic dopamine) with a peripheral decarboxylase inhibitor

Question 8

What are the 2 Levodopa medications that can be used in the management of Parkinson’s?

Answer 8

• Co-benyldopa- Benserazide

* Co-careldopa- Carbidopa

Question 9

What other medications can be used in the management of Parkison’s?

Answer 9

COMT inhibitor

Dopamine antagonist

Question 10

Which COMT inhibitor can be used in the management of Parkinson’s?

Answer 10

Entacapone

Question 11

What is the function of a COMT inhibitor?

Answer 11

Extends the duration of dopamine

Question 12

What dopamine receptor agonists can be used in the management of Parkinson’s?

Answer 12

Bromocriptine
Cabergoline

Question 13

What are possible bad effects that Levodopa can cause?

Answer 13

Dystonia (unintentional sustained muscle contractions)
Palpitations
Postural hypotension
Chorea (rapid, jerky involuntary body movements.)
Athetosis (slow, involuntary, convoluted, writhing movements of the fingers, hands, toes, and feet)

Question 14

What can occur when levodopa wears off?

Answer 14

Dyskinesia
Hallucinations
Balance problems

Question 15

What is Parkinson’s syndrome plus?

Answer 15

Dementia with Lewy bodies

Multiple System Atrophy

Question 16

How does dementia with lewy bodies present?

Answer 16

Fluctuating cognition
Parkinsonism
Visual hallucinations

Question 17

How does multiple system atrophy present?

Answer 17

Postural hypotension
Sexual dysfunction
Atonic bladder
Ataxia

Question 18

3How do the symptoms of parkinson’s typically present?

Answer 18

Asymmetrically

Question 19

When would you typically give levadopa in the management of parkinson’s?

Answer 19

When the motor symptoms of parkinsons are affecting the quality of the patients’ life

Question 20

What are the potential side effects of dopamine receptor agonists?

Answer 20

pulmonary, retroperitoneal and cardiac fibrosis.

Question 21

What tests need to be carried out prior to the administration of dopamine receptor agonists?

Answer 21

Echocardiogram, ESR, creatinine and chest x-ray

Question 22

Why can levadopa not be acutely stopped?

Answer 22

Can cause acute dystonia (sustained involuntary muscle contraction)

Question 23

What are the common adverse effects of levadopa?

Answer 23

dyskinesia- involuntary withering movement
dry mouth
anorexia
palpitations
postural hypotension
psychosis

Question 24

What two situations can occur if Parkinson’s medication is not absorbed (due to vomiting) or taken?

Answer 24

Neuroleptic malignant syndrome
Acute akinesia

Question 25

What is the difference in presentation with drug-induced Parkinson’s and idiopathic Parkinson’s?

Answer 25

In drug-induced Parkinson’s
–motor symptoms are generally rapid onset and bilateral
–rigidity and rest tremor are uncommon

Question 26

What can be used in the diagnosis of Parkinson’s if there is difficulty differentiating between essential tremor and Parkinson’s disease?

Answer 26

SPECT

Question 27

What are possible causes of drug induced parkinsons?

Answer 27

• chlorpromazine
• haloperidol
• flupentixol
• sulpiride
• metoclopramide