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Patho 2 > Parkinson's > Flashcards

Parkinson's Flashcards

1
Q

Parkinson’s

A

Progressive degeneration of the basal ganglion function

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2
Q

Basal ganglia fxn

A

slow coordinated mvts

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3
Q

Which cells are affected with parkinson’s

A

substantia nigra - cells in the basal ganglia that make dopamine

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4
Q

CM of Parkinson’s

A
  • BIG 3–rest tremor, rigidity, bradykinesia with nonmotor CM
  • upper tremor (pill roll), shuffling gait, flat affect, postural instability (fall risk)
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5
Q

Primary Parkinson’s

A
  • idiopathic Parkinson’s disease
  • genetic or sporadic
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6
Q

Secondary Parkinson’s

A

Parkinsonism but not the disease
- acquired–infx, drug tox, trauma
- most often drug-induced (antiemetic and antidepressive)

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7
Q

How to fix drug-induced parkinsonism

A

stop the drug and it usually resolves

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8
Q

Risk fx for Parkinson’s

A
  • avg onset 60s, peak in 70s
  • more men than women
  • dom or recessive family (10%)
  • enviro exposure to agricultures and pests
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9
Q

2nd fx that bring Parkinson’s out more

A

depression, head trauma, hysterectomy

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10
Q

Protective fx for Parkinson’s

A

coffee!

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11
Q

Dopamine in Parkinson’s

A
  • inhibitory and excitatory NTs
  • causes smooth motion w/o extra mvt normally
  • lack inhibitory Dp receptors so unnecessary mvts aren’t inhibitory
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12
Q

ACh in Parkinson’s

A
  • excitatory NT that causes uncoordinated mvts
  • muscle fxn and balances with Dp so if Dp is wrong and ACh is right, still fxn well
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13
Q

Patho of Parkinson’s

A
  • excess ACh with Dp –lose coordination
  • don’t balance each other out
  • primary–damage to sub nigra causes dec DP and dp/ACh imbalance, inc ACh and lose coordination
  • secondary–altered Dp production
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14
Q

How do Parkinson’s sx progress

A

Gradual to prog–develop alone or in combo
- begin with 1 side and move to both

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15
Q

First sign of Parkinson’s often

A

resting tremor
- handwriting affected
- worse with stress and concentration

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16
Q

Parkinson’s vs essential tremor

A

Parkinson’s–DP deficit and ACh inc
- occur with rest and fixed with mvt
Essential–from faulty neuro impulses with motor fxn
- no other CM of parks

17
Q

Rigidity

A

resistance to passive mvt
- “cogwheel rigidity”
- inc ACh causes continuous ctx with muscle soreness, aches, and pains
- often bilat but can be unilat

18
Q

Bradykinesia

A

loss of automated mvt
- no blinking, no swing arms/balance, drool (no swallow), no self-expression with hands and feet

19
Q

Major cause of disability with Parkinson’s

A

Bradykinesia

20
Q

Comps of Parkinson’s

A

dementia (Lewy bodies form and cause memory, cog, hallucinations), sleep probs, fatigue, anx/dep, dec mobility (PNA, asp, malnut, UTIs (urine retention)), skin b/d)

21
Q

Goals of Parkinson’s pharm

A

Maintain motor fxn best you can
- inc Dp or stim of Dp receptors
- block ACh with anticholinergic drugs

22
Q

Levodopa/carbidopa (Sinemet) class and MOA

A

Dopaminergic
- Levodopa converts to Dp in brain and activates DP rec; carbidopa blocks destruction of levodopa–keep Dp in sys for longer

23
Q

Levodopa/carbidopa (Sinemet) SE

A
  • All r/t levodopa; N/V, dyskinesias (annoying to disabling uncontrolled mvts), CV postural hypotension and dysrhythmias, psychosis (hallucinate, nightmare, paranoia), dark sweat and urine, can activate malignant melanoma
24
Q

Levodopa/carbidopa NC

A
  • takes several months to work
  • doesn’t work long-term–dose wears off
  • may need shorter dose intervals
  • abrupt loss of effect “on-off” phenomenon–can occur anytime w/ dosing and can’t predict (“off” pd inc with time)
  • take with small food to dec GI (does dec drug abs tho)
  • vit B6, antipsychotics, and pro can dec effect
  • carbidopa, antiACh, MAOIs can inc fx (tox)–psychosis
25
Q

Duopa class and MOA

A

Same as Levidopa/Carbidopa

26
Q

Duopa SE

A

Fall asleep w/o warning (watch with driving), orthostatic hypotension, hallucination, unusual urges (compulsive), dep, dyskinesia; g tube-assoc sx and surg (infx risk, dislodge, body image)

27
Q

Duopa NC

A
  • infusion thru feeding tube or g tube into sm int
  • gel-like
  • cont up to 16h/d for cont blood level (can do at night)
  • response fluctuates
  • don’t take w/i 2W MAOIs, antiHTN, antipsychotic, metoclopramide, isonazid, iron, vitamins (B6)
  • don’t take with high pro
28
Q

When is Duopa used instead of Levidopa

A

When you don’t respond well to oral PD drugs or want to dec the “on-off”

29
Q

Pramipexole (Mirapex) class and MOA

A
  • DP receptor agonist
  • Bind with D2 receptors to stim inhib Dp rec
30
Q

Pramipexole (Mirapex) SE and NC

A
  • Nausea, sleep attack, pathologic gambling and compulsive behaviors
  • With levodopa, ortho hypo, dyskinesias, and hallucination risk doubles
31
Q

When is Pramipexole used

A

Monotherapy in early PD and combo in advanced PD, RLS

32
Q

Ropinirole (Requip) class and MOA

A
  • Dp rec agonist
  • MOA unknown–may inc nerv impulses w/i substantia nigra
33
Q

What is ropinirole for

A

Idiopathic PD

34
Q

Ropinirole (Requip) SE and NC

A
  • sim to other drugs
  • long term inc risk of DM and acromegaly (excess growth hor)
35
Q

Rigotine (Neupro)

A

Dp agonist
- once daily patch for Parkinson’s

36
Q

Apomorphine

A

Dp agonist
- fast sx relief
- short acting SQ ij
- often used in “off” phase

Patho 2 (15 decks)

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