Parkinson's Flashcards
What is the classic triad of Parkinson’s?
Bradykinesia
Resting tremor
Rigidity
What is the pathophysiology of Parkinson’s?
A reduction in the amount of dopaminergic neurons in the substantia nigra
What are some other common symptoms of Parkinson’s?
Stooped posture
Facial masking
Reduced arm swing
Shuffling gait
Small handwriting
Difficulty initiating movement
What kind of tremor can be seen in Parkinson’s?
Pill rolling tremor
What is the difference between Parkinson’s and benign essential tremor?
Parkinson’s
- Worsens with rest
- Asymmetrical
- Improves with intentional movement
- No change with alcohol
Benign essential tremor
- Improves with rest
- Symmetrical
- Worsens with intentional movement
- Improves with alcohol
What are the differential diagnoses of Parkinson’s?
Lewy body dementia
Benign essential tremor
Drug-induced Parkinsonism
Progressive supranuclear palsy
Multiple system atrophy
What is the first line treatment of Parkinson’s?
Levodopa/carbidopa
What is levodopa?
L-dopa is a precursor to dopamine
What is carbidopa?
Carbidopa prevents levodopa from being broken down before reaching the brain - leads to a lower dose of levodopa needed, and fewer side effects
What is the second line treatment of Parkinson’s?
Dopamine agonists, COMT inhibitors, MAO-B inhibitors
When might a dopamine agonist be considered for initial therapy?
To delay starting levodopa, as levodopa’s effectiveness reduces overtime
What are the signs of multiple system atrophy?
Parkinsonism
Autonomic dysfunction
Cerebellar signs
What is multiple system atrophy?
A rare neurodegenerative disorder that causes gradual damage to neurons
What are the common side effects of levodopa?
Dry mouth
Palpitations
Psychosis
Anorexia
Postural hypotension
Give an example of a dopamine receptor antagonist.
Cabergoline
What medications are contraindicated in Parkinson’s?
Haloperidol - it promotes dopamine blockade
Dopamine antagonists such as olanzapine
What medication can be used to sedate Parkinson’s patients?
Lorazepam
What is the most important side effect of dopamine agonists?
Impulsivity
What is cortico-basal degeneration?
A parkinson-plus syndrome where there is spontaneous uncontrolled movements of the affected limbs (in addition to the Parkinsonian triad)
What is progressive supranuclear palsy?
A parkinson-plus syndrome characterised by the parkinsonian triad + a vertical gaze palsy
What is multiple system atrophy?
A parkinson-plus syndrome characterised by Parkinsonianism and early autonomic features - postural hypotension, impotence and incontinence
Give examples of MAO-B inhibitors.
Rasagiline
Selegiline
Give examples of COMT inhibitors.
Entacapone
Tolcapone
What are the differences between idiopathic and drug induced parkinson’s?
Drug induced parkinsons tends to be symmetrical
Rigidity and resting tremor are uncommon in drug induced parkinsonism
