parkinson's

Question 1

what

Answer 1

progressive reduction of dopamine in basal ganglia leading to disorders of movement

symptoms characteristically asymetrical

Question 2

classic triad

Answer 2

resting tremor
rigidity
bradykinesia

Question 3

basal ganglia

Answer 3

responsible for coordinating habitual movements, controlling voluntary movements and learning specific movement patterns

Question 4

pathophysiology

Answer 4

substansia nigra produces dopamina

dopamine is essential for basal ganglia function

parkinsons - graduall but progressive fall in dopamine production

Question 5

typical patient

Answer 5

older man ~70yrs

stooped posture
forward tilt
reduced arm swing
shufflig gait

Question 6

features

Answer 6

unilateral tremor
cogwheel rigidity
bradykinesia

depression 
sleep disturbance, insomnia
asomina
postural instability 
cog impairment, memory problems

Question 7

features - unilateral tremor

Answer 7

frequency 4-6hz
pill rolling tremor
worse at rest

Question 8

features - cogwheel rigidity

Answer 8

resitance to passive movement - inc tone

Question 9

features - bradykinesia

Answer 9

handwriting gets smaller and smaller
shuffling gait
difficulty initiating movements
hypomimia

Question 10

Parkinson’s tremor vs benign essential tremor: symmetry

Answer 10

P = assymetrical

BET = symmetrical

Question 11

Parkinson’s tremor vs benign essential tremor: frequency

Answer 11

P = 4-6Hz

BET= 5-8Hz

Question 12

Parkinson’s tremor vs benign essential tremor: when resting

Answer 12

P = worse at rest

BET = improves at rest

Question 13

Parkinson’s tremor vs benign essential tremor: effect of intentional movement

Answer 13

P = improves with intentional movement

BET = worse w intentional movement

Question 14

Parkinson’s tremor vs benign essential tremor: effect of alcohol

Answer 14

P = no change w alcohol

BET = improves w alcohol

Question 15

parkinson’s plus syndromes - multiple system atrophy

Answer 15

neurones of multiple brain systems degenerate
affects basal ganglia plus other areas

basal ganglia destruction –> parkinson presentation

other areas destructin –>autonomal dysfunction + cerebellar dysfunction

Question 16

parkinson’s plus syndromes - Lewy Body dementia

Answer 16

type of dementia assoc w features of parkinsonism

progressive cog decline
visual hallucinations
delusions
disorders of REM sleep 
fluctuating consciosness

Question 17

Mangement - levodopa

Answer 17

synthetic dopamine
given orally

usually combined with another drug that stops levodopa being broken down in body before enters brain

Question 18

Levodopa - what is it usually given in combination with

Answer 18

peripheral decarboxylase inhibitors

ex carbidopa, benseradize

Question 19

levodopa - example of combination drugs

Answer 19

co-benyldopa (levodopa + benserazide)

co-careldopa (levodopa + carcbidopa)

Question 20

when is levodopa used

Answer 20

it is most effective treatment for symptoms but becomes less effectve overtime

often reserved when other treatments are not managing to control symptoms

Question 21

dopamine side effects

Answer 21

dyskinesias

• dystonia
• chorea
• athetosis

Question 22

COMT inhibitors

Answer 22

inhibitors of catechol-o-methyltransferase

metabolises levodopa in body and brain

taken with levodopa (+ decarboxylase inhibitor) to slow breakdown of levodopa in brain

extends effective duration of levodopa

Question 23

COMT inhibitor example

Answer 23

entacapone

Question 24

dopamine agonists

Answer 24

mimic dopamine in basal ganglia and stimulates dopamine receptors

usually used to delay use of levadopa and then used in combination of levodopa to reduce dose of levadopa needed

Question 25

dopamine agonists S/E

Answer 25

pulmonary fibrosis with prolonged use

Question 26

dopamine agonists examples

Answer 26

bromocryptine
pergolide
carbergoline

Question 27

Monoamine Oxidase-B Inhibitors

Answer 27

blocks monoamine-oxidase B enzyme from breaking down dopamine
increase circulating dopamine

used to delay use of levodopa and then in combo with levodopa to reduce reuquired dose

Question 28

Monoamine Oxidase-B Inhibitors examples

Answer 28

selegiline

rasagiline