Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

neurology/psychiatry > parkinson's > Flashcards

parkinson's Flashcards

1
Q

what are some risk factors for parkinson’s disease (PD)

A

rural living
well water
pesticides
heavy metal exposure
fungus (mushroom alcohol)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

what are some protective risk factors for parkinson’s disease

A

cigarette smoking
caffeine consumption

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

describe the pathophysiology of PD

A

decreased dopamine in the brain (SUBSTANTIA NIGRA)

symptoms appear when 70-80% of SN neurons are depleted

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

what are the roles of dopamine in the brain?

A

smooth, controlled muscle movement
cognition and frontal cortex function
pleasure and motivation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

what acronym describes the cardinal symptoms of PD?

A

TRAP:
Tremor
Rigidity
Akinesia/bradykinesia
Postural instability

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

the onset of cardinal signs in PD is usually _____ and ______

A

unilateral and asymmetric!!

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

describe the tremor in PD

A

usually occurs at rest and disappears with voluntary movement or sleep
initially affects upper extremities
can manifest as pill rolling

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

describe rigidity in PD

A

manifests as cogwheeling or hypomimia (blank face)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

describe akinesia/bradykinesia in PD

A

slow throughout an intended action, difficulty initiating movement, microglia (letters get smaller as you write), shuffling, freezing

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

what may be some differential diagnoses to rule out for PD?

A

insult: TBI, stroke, pugilism, supranuclear palsy
infection: encephalitis, meningitis, HIV/AIDS
intoxication: carbon monoxide, mercury, Wilson’s disease (copper accumulation), drugs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

which drugs may induce parkinsonian symptoms

A

antipsychotics except clozapine
antiemetics like prochlorperazine
methyldopa
anesthesia
opioid overdose
MPTP (contaminant in street drugs)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

how can dopamine cross the blood brain barrier?

A

peripherally administered dopamine CANNOT cross the BBB (it is hydrophilic and there is no DA transporter)
but L-DOPA, the immediate precursor, can cross

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

why is carbidopa added to L-dopa

A

to block the decarboxylation of L-dopa to dopamine in the periphery so it can cross into the brain as L-DOPA

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

what is the gold standard drug for symptomatic PD initial therapy if rigidity or bradykinesia is the chief complain

A

L-DOPA/carbidopa

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

which age group is L-DOPA preferred

A

older adults 65+
safest side effect profile
younger patients report L-DOPA dyskinesias

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

how long is L-DOPA effective for?

A

a finite period of time ~10-15 years

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

how to convert to controlled release/extended release L-DOPA

A

increase the IR dose by 30%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

dosing for L-dopa/carbidopa

A

initial 25 mg/100 mg daily: start low and go slow- increase by 1 tablet every other day– max dose determined by patient tolerability (~1500 mg/day). after IR stable, can switch to long acting

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

likely need at least _____ of carbidopa to adequately inhibit peripheral conversion of L-DOPA and prevent nausea/vomiting

A

75 mg/day

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

what are the adverse effects of L-DOPA

A

nausea/vomiting
postural hypotension
dyskinesias, psychiatric disturbances

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

patient counseling for L-DOPA/carbidopa

A

IR onset of action may take up to 1 hr; longer for CR
ER: do not crush, can open and sprinkle on applesauce
L-DOPA competes with protein for absorption: counsel on diet
must taper when discontinuing

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

when are DA agonists the preferred agent

A

in younger patients (can cause psychiatric disturbance in older patients) as initial therapy option if rigidity or bradykinesia is chief complaint
may be considered early monotherapy in L-DOPA sparing strategy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

DA agonist drug names

A

ergot derivatives: bromocriptine
non ergot derivatives: pramipexole, ropinirole, rotigotine patch

24
Q

DA agonist dose adjustments

A

for renal

25
Q

patient counseling for DA agonists

A

ropinirole/pramipexole: sleep attacks, a serious problem when driving
rotigotine: application site reactions
MUST taper when discontinuing
adverse effects: hallucinations and impulse control disorders (gambling and shopping)

26
Q

why do we have to taper DA agonists?

A

abrupt cessation can lead to physiologic withdrawal including anxiety, panic attacks, n/v/d, depression, etc.
it can also exacerbate underlying PD causing diaphragm rigidity (asphyxiation) and immobility (clots)

27
Q

how long should tapering last?

A

as long (if not longer) than the titration period

28
Q

what are complications from L-DOPA?

A

wearing off effect when an adequate dose of L-DOPA does not last and symptoms return before the next dose

dyskinesias such as chorea, dystonia

29
Q

prevalence of L-DOPA complications

A

more than half of patients develop complications after 5-10 years. more common in younger patients <60 years

30
Q

what are options when L-DOPA is wearing off

A

change L-DOPA administration by either decreasing the dose and increasing the frequency, or give a combination of IR and CR formulations

or can augment L-DOPA with other therapies such as COMT inhibitors, MAO-B inhibitors, apomorphine

31
Q

COMT inhibitor mechanism

A

selective & reversible inhibition of COMT (catecyl-o-methyl-transferase) inhibits degradation of DA

32
Q

why are COMT inhibitors used?

A

to extend the life of L-DOPA in patients with motor fluctuations: it is ineffective when given as monotherapy so must administer simultaneously with L-DOPA

33
Q

what drugs are the COMT inhibitors?

A

entacapone, tolcapone, opicapone

34
Q

dosing considerations for COMT inhibitors

A

decrease L-DOPA dose by 25% when starting COMT

35
Q

ADEs of COMT inhibitors

A

dopaminergic ADRs, urine discoloration

36
Q

mechanism of MAO-B inhibitors

A

selective & irreversible inhibition of MAO-B in brain interferes with degradation of DA

37
Q

which drugs are the MAO-B inhibitors

A

rasagiline, selegiline (PO only– patch not used in parkinson’s), safinamide

38
Q

dosing considerations for MAO-B inhibitors

A

decrease L-DOPA dose by 10% when starting MAO-B

39
Q

patient counseling for MAO-B inhibitors

A

drug interactions: contraindicated with opioids and serotonin drugs, even after stopped (x2 weeks)
interaction with foods containing tyramine (wine, beer, aged cheese, overripe food)

40
Q

describe the use of apomorphine in PD?

A

DA agonist used in L-DOPA off episodes

41
Q

apomorphine requires _____ due to risk of _____

A

test dose under medical supervision due to risk of severe hypotension

42
Q

start _____ 3 days prior to apomorphine

A

trimethobenzamide

43
Q

what new special formulations can be used for L-DOPA off episodes

A

CD/LD intestinal gel that is administered via external pump & jejunal tube (morning bolus, continuous dose, on-demand doses)

levodopa inhalation powder that can be used up to 5x/day as an on demand rescue for “off episodes”– 10 minute onset and lasts an hour but not recommended for asthma/COPD

44
Q

when is istradefylline used

A

once daily for “off periods” as an add-on to CD/LD

45
Q

considerations for istradefylline

A

special dosing (smokers, strong CYP3A4 inhibitors and inducers)
side effects are dyskinesias, hallucinations, insomnia

but does not cause orthostatic hypotension as other dopaminergic agents do

46
Q

when might anticholinergics be used for PD?

A

as monotherapy in patients <65 if only tremor
or as adjunct therapy if persistent tremor despite DA therapy

47
Q

which anticholinergics may be used for tremor in PD

A

benztropine or trihexyphenidyl

48
Q

what factor limits the use of anticholinergics for PD

A

adverse effects– dry mouth, blurred vision, urinary retention, constipation, confusion, sedation

49
Q

what is the role of amantadine in PD

A

adjunct therapy to decrease the intensity of L-DOPA dyskinesias

50
Q

what is the mechanism of amantadine

A

it is an antiviral with mild and transient antiparkinsonian activity by increasing DA release, preventing reuptake, and directly stimulating the DA receptors

51
Q

adverse effects of amantadine

A

hallucinations, confusion, dizziness, edema
older adults especially susceptible to CNS effects

52
Q

what are the most common nonmotor symptoms of PD

A

depression
psychosis
constipation
genitourinary symptoms (sexual dysfunction, urinary incontinence)

53
Q

treating depression in PD?

A

most common
SSRI/SNRI first line

54
Q

psychosis in PD is characterized by ___ and treated by ___

A

characterized by hallucinations & delusions
treatment:
1. discontinue offending agents (anticholinergics, amantadine, MAO-B inhibitors, COMT inhibitors, DA agonists) but unlikely to d/c L-DOPA
2. consider low dose atypical antipsychotics (quetiapine>clozapine)

55
Q

treatment of constipation in PD

A

try non pharm with increasing water and fiber
may consider PEG
AVOID PSYLLIUM

neurology/psychiatry (22 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions