Parkinson's disease Flashcards by cerchia N

which neurotransmitter is implicated?

dopamine

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which pathway is effected?

nigrostriatal pathway

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dopaminergic neurones die in which part of the brain?

the above structure falls under which larger group of structures?

substantia nigra pars compacta

basal ganglia

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what is the aetiology?

idiopathic

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what is seen on histology?

Lewy bodies in substantia nigra

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where does parkinson’s rank in the most common neurodegenerative disorders?

2nd

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what is the most common neurodegenerative disorder?

Alzheimer’s

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which gene is involved?

LRKK-2 gene

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which gender is a RF?

males

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the basal ganglia is mainly responsible for what?

movement

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basal ganglia enables subconscious control of what property in skeletal muscles?

tone

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a person want to move.

Dopamine in the direct pathway does what?

stimulates desired contracting muscle

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a person want to move.

dopamine in the indirect pathway does what?

inhibits antagonistic muscle

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what are the 4 main movement symptoms?

Bradykinesia
Resting Tremor
Rigidity
Postural instability

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what are the non-movement symptoms?

-6

Sleep troubles 
Depression, anxiety, 
dementia
Constipation 
Anosmia

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why is there tremor and rigidity?

Dopamine & ACh balance is thrown off. ( ↓[dopamine] )

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Resting tremor is exacerbated and alleviated by what?

worse when tired

better with movement.

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how many types of rigidity are there in Parkinson’s?

name each?
explain each?

Cogwheel rigidity - arm passively moves and it stops and starts i.e. clunks.

Lead-pipe rigidity - in lower legs do not move at all, a lot of resistance.

what is the must have symptoms to diagnose PD?

Bradykinesia

what type of diagnosis is this?

which speciality must diagnose?

Clinical Diagnosis

neurologist

Bradykinesia will results in what features in their movement?
-4

shuffling steps

mask face

can not stop abruptly

can not resist a push

what is the main feature of their posture?

hunched over

what Ix can you do to check Da levels in basal ganglia?

SPECT (DaT scan)

why would you do a brain MRI?

exclude other causes

what is the 1st line Mx (nutshell mx)?

Levodopa + Carbidopa

which drug used in Parkinson's has a side effect of increased psychosis? why does this SE happen?

Levodopa ↑Dopamine

which drug used in Parkinson's has a side effect involving your heart? what is this side effect specifically? why does this SE happen?

Levodopa arrhythmias Levodopa in periphery --> peripheral DOPA decarboxylase converted it to --> dopamine --> epinephrine --> arrhythmias

the two first line drugs for PD are given together. one of these is used to stop SE of the other. what is this drug called? moa of this drug? does it cross BBB?

Carbidopa dopa decarboxylase inhibitor does not cross the BBB

treatment involves doing essentially what to dopamine levels?

↑dopamine

which group of drugs can be used to help with tremor and rigidity? why does it help?

Antimuscarinic block ACh, ↓ACh so more in balance with Da

which two enzyme inhibitor drugs can be given 2nd line? what effect would the two enzymes have if they were not inhibited? thus, what is effect when you take there two enzyme inhibitors?

MAO-B inhibitor Catechol-O-methyltransferase inhibitor breaks down dopamine ↑dopamine

names of MAO-B inhibitor commonly used in Parkinson's? -2 what is the suffix of this drug class?

rasagiline or selegiline giline

names of COMBT inhibitors commonly used in Parkinson's? -2 what is the suffix of this drug class?

entacapone, tolcapone capone

2 e.g. of antimuscarinics commonly used in Parkinson's?

benztropine, procyclidine

effect of amantadine on Da?

increases it

function of carbidopa?

dopa decarboxylase inhibitor in periphery only

if you do not give carbidopa with levodopa what se can happen? why?

arrhythmia Levodopa in periphery > peripheral DOPA decarboxylase converted it to > dopamine > epinephrine > arrhytmia

Da precursor?

levodopa

levodopa + carbidopa combo together is called what?

sinemet

which enzyme converts levodopa to Dopamine?

DOPA decarboxylase

drug class of prochlorperazine?

anti-sickness/ anti-emetic

prochlorperazine commonly to stop what symptoms? | -2

N&V and dizziness

prochlorperazine effect on Da? thus prochlorperazine effect on Parkinson's symptoms?

Da antagonist makes it worse