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D and P - EXAM > Parkinson's > Flashcards

Parkinson's Flashcards

1
Q

What are the deposits in parkinson’s?

A

Lewy body proteins which are made up tangles of alpha sinuclein

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2
Q

3 main feature that happen in the brain in Parkinson’s

A
  1. lewy body protein deposits of alpha-synuclein
  2. loss of dopaminergic neurons form pars compacta of substantia nigra of the midbrain
  3. degeneration also occurs in other basal ganglia nuclei
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3
Q

How is Parkinson’s diagnosed?

A
  1. clinical diagnosis by recognizing physical signs and symptoms
  2. DAT imaging to assess extent of neuron loss
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4
Q

Name two genes associated with early onset Parkinson’s

A

PARK 1 gene - codes for alpha synuclein protein

  • inherited AD
  • rare but major lewy body protein
  1. PARK 2 - codes for Parkin protein
    - Autosomal recessive
    - responsible for most cases of juvenile PD
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5
Q

What does PARK 1 gene code for and inheritance?

A

for alpha synuclein protein

  • inherited AD
  • rare but major lewy body protein
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6
Q

What does PARK 2 gene code for and inheritance?

A

PARK 2 - codes for Parkin protein

- Autosomal recessive

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7
Q

Genes responsible for juvenile PD

A

PARK 2

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8
Q

Triad of parkinsons

A

bradykinesia, tremor and rigidity

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9
Q

Facial features seen in Parkinson’s

A

facial immobility : mask like

-Serpentine stare - reduced frequency of spontaneous blinking

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10
Q

2 features of bradykinesia

A
  1. slowing down of movements - progressive fatiguing and reduced amplitude
  2. Short shuffling steps with reduced arm movements
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11
Q

Features of tremor

A
  1. Unilateral
  2. Resting
  3. Pin rolling between thumb and index
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12
Q

Features of rigidity

A
  1. lead pipe - stiffness seen passive limb movements

2. cogwheel rigidity - stiffness occurs with tremor

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13
Q

Features of posture

A
  1. stooped posture is characteristic
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14
Q

Features of speech and swallowing

A
  1. quiet, indistinct flat voice
  2. drooling
  3. swallowing difficulty - increased risk of aspirayion pneumonia
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15
Q

Cognitive and psychiatric changes

A
  1. Dementia can develop
  2. Visual hallucinations and psychosis
  3. Depression and anxiety are common
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16
Q

Drug-induced parkinsonism

A
  • motor symptoms are generally rapid onset and bilateral

- rigidity and rest tremor are uncommon

17
Q

Levodopa ( mechanism of action )

A
  1. a precursor of dopamine which is used as a dopamine supplement
  2. precursor needs to be used because dopamine itself cannot cross the blood-brain barrier
  3. Administered alongside ‘decarboxylase inhibitor’ ( carbidopa) to inhibit decaboxylase enzyme from converting Ldopa into dopaine peripherally
18
Q

MOAB inibitors ( mechanism of actions )

A
  1. inhibits monoamine oxidase enzyme which breaks down dopamine
19
Q

Drawback of Levodopa

A

Effectiveness reduces over time

20
Q

Name a MAO

A

Selegiline

21
Q

Dopamine receptor agonists

A
  1. Used as primary Tx before Levodopa
22
Q

Example of Dopamine receptor agonist

A

Ropinirole

23
Q

Catechol-O-Methyl Transferase inhibitor - mechanism of action

A

COMT is an enzyme which transfers methyl group onto dopamine and inactivates it

  1. this enzyme is inhibited and so more dopamine is avaliable
24
Q

Catechol-O-Methyl Transferase inhibitor - indication

A
  • Tx patients when effectiveness of Levodopa is staring to wear off
  • Increase duration effect of Levodopa
25
Q

Catechol-O-Methyl Transferase inhibitor- EXAMPLE

A

Tolcapone

26
Q

Anti muscarinics

A
  1. block cholinergic receptors
  2. now used more to treat drug-induced parkinsonism rather than idiopathic Parkinson’s disease
  3. help tremor and rigidity
    e. g. procyclidine, benzotropine
27
Q

First line - if motor symptoms are affecting the patient’s quality of life:

A

Levodopa

28
Q

First line - if motor symptoms are not affecting the patient’s quality of life:

A

dopamine agonist (non-ergot derived),

29
Q

Symptoms despite optimal Levodopa - Mx

A

If a patient continues to have symptoms despite optimal levodopa treatment or has developed dyskinesia then NICE recommend the addition of a

  • dopamine agonist,
  • MAO‑B inhibitor
  • catechol‑O‑methyl transferase (COMT) inhibitor as an adjunct

D and P - EXAM (19 decks)

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