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#Phase 2.2: Elderly & Chronic Care > Parkinson's > Flashcards

Parkinson's Flashcards

1
Q

What is the simple pathophysiology of Parkinsons?

A

Progressive reduction of Dopamine in Basal Ganglia –> movement disorders

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2
Q

Where in the Basal Ganglia is Dopamine produced?

A

Substantia nigra

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3
Q

Are the symptoms of Parkinsons symmetrical or asymmetrical?

A

Asymmetrical

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4
Q

What are the classic of Parkinsons symptoms? (4 things)

A
  1. Tremor
  2. Rigidity
  3. Akinesia
  4. Postural instability

TRAP

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5
Q

Who is the typical person to have Parkinsons?

A

70 year old Man

aka Mohammed Ali RIP

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6
Q

When is the Tremor better / worse in Parkinsons?

A
  • Better @ voluntary movement
  • Worse @ distracted
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7
Q

What is the Rigidity in Parkinsons reffered to?

A

Cogwheel rigidity

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8
Q

How do you see Cogwheel rigidity @ examination? (2 steps)

A
  1. Passively flex + extend pt arm
  2. Arm gives way in small increments (little jerks)
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9
Q

What does Akinesia / Bradykinesia in Parkinsons refer to?

A

Movements get Smaller + Slower

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10
Q

How does Bradykinesia present in Parkinsons? (4 things)

A
  1. Handwriting gets smaller (classic exam q)
  2. Can only take small steps (everyday im shuffling)
  3. Difficulty initiating movement (standing à walking)
  4. Reduced facial expressions (hypomimia)
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11
Q

What are the differences between Parkinsons Tremor vs Benign Essential Tremor? (4 things)

A
  1. Parkinsons: Asymmetrical // BET: Symmetrical
  2. Parkinsons: 4-6 per second // BET: 5-8
  3. Parkinsons: Worse @ rest // BET: Better @ rest
  4. Parkinsons: Presents w other symptoms // BET: N/A
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12
Q

How is the Dx of Parkinsons made?

A

Clinically

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13
Q

What does NICE guidelines recommend using to Dx Parkinsons?

A

UK Parkinsons Disease Society Brain Bank Clinical Diagnostic Criteria

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14
Q

Is there a cure for Parkinsons?

A

No :(

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15
Q

What is the aim of Mx of Parkinsons? (2 things)

A
  1. Control symptoms
  2. Minimise side fx
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16
Q

What are the medications available for Parkinsons Mx?

A
  1. Levodopa
  2. COMT inhibitors
  3. Dopamine agonists
  4. Monoamine Oxidase B inhibitors
17
Q

What is Levodopa?

A

Synthetic dopamine to boost dopamine levels

18
Q

What is Levodopa often given with?

A

Peripheral Decarboxylase Inhibitors (e.g Carbidopa)

19
Q

What is the point of Peripheral Decarboxylase Inhibitors (e.g Carbidopa)?

A

Stops Levodopa being broken down peripherally b4 reaches brain

20
Q

Even though Levodopa is the most effective Parkinsons meds, why is it reserved and for who?

A

Reserved bc becomes less effective over time

Reserved for when other meds aren’t controlling symptoms properly

21
Q

What is the main Side effect of too much Dopamine?

A

Dyskinesias (aka excessive motor activity)

22
Q

What are examples of Dyskinesias? (3 things)

A
  1. Dystonia
  2. Chorea
  3. Athetosis
23
Q

What is Dystonia?

A

Excessive muscle contraction –> abn postures / exagg movements

24
Q

What is Chorea?

A

Abn invol movements (e.g jerking)

25
Q

What is Athetosis?

A

Invol twisting / writhing movements (usually in fingers / feet)

26
Q

What is an example of a COMT inhibitor?

A

Entacapone

27
Q

How do COMT inhibitors (e.g Entacapone) work? (3 steps)

A
  1. COMT Enzyme metabolises Levodopa in Body + Brain
  2. COMT Inhibitor slows this down
  3. Extends effective duration of Levodopa
28
Q

What do Dopamine Agonists do?

A

Mimic dopamine –> stimulate dopamine receptors

29
Q

What is the point of Dopamine Agonists? (2 things)

A
  1. To delay use of Levodopa
  2. To reduce dose of Levodopa needed to control symptoms
30
Q

What is a Side fx of prolonged use of Dopamine Agonists?

A

Pulmonary Fibrosis

31
Q

What are examples of Dopamine Agonists? (2 things)

A
  1. Bromocryptine
  2. Cabergoline
32
Q

What is an example of a Monoamine Oxidase B inhibitor?

A

Rasagiline

33
Q

How do Monoamine Oxidase B inhibitors (e.g Rasagiline) work? (3 steps)

A
  1. Monoamine Oxidase B Enzyme metabolises Dopamine
  2. Monoamine Oxidase B Inhibitor slows this down
  3. Delays use of Levodopa + Reduces required dose of Levodopa when it’s used

#Phase 2.2: Elderly & Chronic Care (8 decks)

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