Parkinson's Flashcards
What is Parkinson’s?
Progressive reduction of dopamine in the basal ganglia leading to dysfunction of the basal ganglia
How does Parkinson’s present?
- 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
What improves the resting tremor?
Intentional movement
Worse at rest
What do you get with Bradykinesia?
Short, shuffling steps with reduced arm movements
Difficulty in initiating movement
What is cog wheel rigidity due to?
Superimposed tremor
How is Parkinon’s diagnosed?
Clinically
What is the management of Parkinson’s?
Levodopa (synthetic dopamine) with a peripheral decarboxylase inhibitor
What are the 2 Levodopa medications that can be used in the management of Parkinson’s?
- Co-benyldopa- Benserazide
* Co-careldopa- Carbidopa
What other medications can be used in the management of Parkison’s?
COMT inhibitor
Dopamine antagonist
Which COMT inhibitor can be used in the management of Parkinson’s?
Entacapone
What is the function of a COMT inhibitor?
Extends the duration of dopamine
What dopamine receptor agonists can be used in the management of Parkinson’s?
Bromocriptine
Cabergoline
What are possible bad effects that Levodopa can cause?
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)
What can occur when levodopa wears off?
Dyskinesia
Hallucinations
Balance problems
What is Parkinson’s syndrome plus?
Dementia with Lewy bodies
Multiple System Atrophy
How does dementia with lewy bodies present?
Fluctuating cognition
Parkinsonism
Visual hallucinations
How does multiple system atrophy present?
Postural hypotension
Sexual dysfunction
Atonic bladder
Ataxia
3How do the symptoms of parkinson’s typically present?
Asymmetrically
When would you typically give levadopa in the management of parkinson’s?
When the motor symptoms of parkinsons are affecting the quality of the patients’ life
What are the potential side effects of dopamine receptor agonists?
pulmonary, retroperitoneal and cardiac fibrosis.
What tests need to be carried out prior to the administration of dopamine receptor agonists?
Echocardiogram, ESR, creatinine and chest x-ray
Why can levadopa not be acutely stopped?
Can cause acute dystonia (sustained involuntary muscle contraction)
What are the common adverse effects of levadopa?
dyskinesia- involuntary withering movement
dry mouth
anorexia
palpitations
postural hypotension
psychosis
What two situations can occur if Parkinson’s medication is not absorbed (due to vomiting) or taken?
Neuroleptic malignant syndrome
Acute akinesia
What is the difference in presentation with drug-induced Parkinson’s and idiopathic Parkinson’s?
In drug-induced Parkinson’s
–motor symptoms are generally rapid onset and bilateral
–rigidity and rest tremor are uncommon
What can be used in the diagnosis of Parkinson’s if there is difficulty differentiating between essential tremor and Parkinson’s disease?
SPECT
What are possible causes of drug induced parkinsons?
- chlorpromazine
- haloperidol
- flupentixol
- sulpiride
- metoclopramide
