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3a neurology > Parkinson's > Flashcards

Parkinson's Flashcards

1
Q

What is Parkinson’s disease

A

progressive neurodegenerative condition caused by degeneration of dopaminergic neurons in the substantia nigra

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2
Q

What is the classical triad of classical features for Parkinson’s disease?

A
  • bradykinesia
  • tremor
  • rigidity
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3
Q

Are symptoms of Parkinson’s characteristically symmetrical or asymmetrical

A

asymmetrical

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4
Q

Describe the epidemiology of Parkinson’s disease

A
  • around twice as common in men
  • mean age of diagnosis is 65 years
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5
Q

Describe bradykinesia in the context of Parkinson’s disease?

A
  • poverty of movement also seen, sometimes referred to as hypokinesia
  • short, shuffling steps with reduced arm swinging
  • difficulty in initiating movement
  • difficulty in turning around when standing
  • handwriting gets smaller
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6
Q

Describe the tremor seen in Parkinson’s disease

A
  • most marked at rest, 4-6 Hz
  • worse when stressed or tired, improves with voluntary movement
  • generally asymmetrical
  • typically ‘pill-rolling’, i.e. in the thumb and index finger
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7
Q

Describe the rigidity seen in Parkinson’s disease

A
  • resistance to passive movement of the joint
  • lead pipe
  • cogwheel
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8
Q

Apart from the classical triad, what are some other characteristic features of Parkinson’s disease?

A
  • depression
  • postural instability
  • masked facies
  • stooped posture
  • dementia, psychosis
  • sleep disturbances and fatigue
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9
Q

Describe the features of drug-induced parkinsonism

A
  • motor symptoms are generally rapid onset and bilateral
  • rigidity and rest tremor are uncommon
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10
Q

What are Parkinson’s-plus syndromes

A

rare condition where neurones of various systems in the brain degenerate, including the basal ganglia

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11
Q

How is Parkinson’s disease diagnosed

A
  • clinical - history and exam
  • should only be diagnosed and managed by a specialist with expertise in movement disorders
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12
Q

How is Parkinson’s disease managed

A
  • Levodopa usually combined with a decarboxylase inhibitor (e.g. carbidopa or benserazide)
  • Dopamine agonists
  • Monoamine oxidase B inhibitors
  • catechol-O-methyl transferase inhibitor
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13
Q

Why is levodopa the most effective treatment of Parkinson’s

A

of the antiparkinson drugs, Levodopa is associated with the greatest improvement in symptoms and activities of daily life

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14
Q

Why is levodopa nearly always combined with a decarboxylase inhibitor

A

this prevents the peripheral metabolism of levodopa to dopamine outside of the brain and hence can reduce side effects

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15
Q

Give some common side effects of levodopa

A
  • dry mouth
  • anorexia
  • palpitations
  • postural hypotension
  • psychosis
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16
Q

Give some adverse effects associated with difficulty in achieving a steady dose of levodopa

A
  • end-of-dose wearing off: symptoms often worsen towards the end of dosage interval -> decline in motor activity
  • ‘on-off’ phenomenon: large variations in motor performance, with normal function during the ‘on’ period, and weakness and restricted mobility during the ‘off’ period
  • dyskinesias at peak dose: dystonia, chorea and athetosis
  • these effects may worsen over time - clinicians therefore may limit doses until necessary
17
Q

What drug may be used to manage dyskinesia associated with levodopa

A

amantadine

18
Q

Which antiparkinson drug is associated with the highest chance of impulse control disorders

A

dopamine receptor agonists

19
Q

Why is it important not to acutely stop levodopa, and what can be used if a Parkinson’s patient can’t take it orally?

A
  • Stopping levodopa suddenly can cause withdrawal symptoms
  • If a patient can’t take levodopa orally, a dopamine agonist patch can be used as rescue medication to prevent acute dystonia.
20
Q

Give 4 examples of dopamine receptor agonists

A
  • bromocriptine (ergot-derived)
  • cabergoline (ergot-derived)
  • ropinirole
  • apomorphine
21
Q

Give 2 adverse effects of dopamine receptor agonists

A
  • pulmonary fibrosis (ergot-derived)
  • impulse control disorders
22
Q

Give an example of a MAO-B (Monoamine Oxidase-B) inhibitor

A

selegiline

23
Q

Describe the mechanism of action of MAO-B

A

inhibits the breakdown of dopamine secreted by the dopaminergic neurons

24
Q

Give an example of a COMT inhibitor

A

entacapone

25
Q

How are COMT inhibitors used in the treatment of Parkinson’s

A

taken with levodopa (and a decarboxylase inhibitor) to slow down the breakdown of levodopa in the brain

26
Q

Give 5 causes of parkinsonism

A
  • drug-induced e.g. antipsychotics, metoclopramide (excluding domperidone)
  • progressive supranuclear palsy
  • multiple system atrophy
  • Wilson’s disease
  • post-encephalitis
27
Q

Describe the features of multi system atrophy

A
  • Parkinsonism
  • autonomic dysfunction: postural hypotension, constipation, erectile dysfunction
  • cerebellar dysfunction: ataxia

3a neurology (16 decks)

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