Parkinson's Disease Flashcards
Parkinson’s Disease: What are the four clinical features? (TRAP)
- Tremor
- Rigidity
- Akinesia
- Postural instability
Parkinson’s Disease: Define Tremor
Trembling, shaking of one hand, pill-rolling
Parkinson’s Disease: Describe Rigidity
Cogwheel -> rigid and jerky movements
Parkinson’s Disease: Describe Akinesia
Impaired movement, altered gait
Parkinson’s Disease: Describe postural instability
Stooped posture
Parkinson’s Disease: Where does pill rolling tremor occur?
Fingers and thumb but other muscle groups of the neck, jaw, lips, tongue, eyelids, arm and foot may be affected.
Parkinson’s Disease: What is the first sign in 70% of untreated patients?
Resting Tremor
Parkinson’s Disease: What occurs with rigidity and hypertonicity
- Gait is slow and short stepped; eventually a shuffle
- Cogwheeling (rigid/jerky movement)
- Arm swing is lost
- Bradykinesia
- Hypophonia (Soft speech)
- Balance is easily lost with continuing declines of postural reflexes
- Handwriting become illegible
- Initiation of movement difficult
- Weight loss
- Fatigue
Parkinson’s Disease: Signs and symptoms of head and neck area
- Seborrhea of the face and scalp
- Lack of facial expression
- Diminished blink
- Loss of decline in sense of smell
- Slowness and softness of speech
- Drooling becomes an issue
Parkinson’s Disease: Three psychologic symptoms
Depression, anxiety, dementia (50%)
Parkinson’s Disease:
Look at slide (8)
Parkinson’s Disease: Function of Dopamine Precursors
Metabolized to dopamine
Parkinson’s Disease: Dopamine precursors drugs
-Levadopa (L-dopa) and carbidopa (Sinemet, Madopar)
Parkinson’s Disease: Function of Dopamine Agonists
Mimics dopamine at receptor level
Parkinson’s Disease: Dopamine Agonist Drugs
Bromocriptine (Parlodel), Ropinirole (requip), pramipexole (Mirapex)
Parkinson’s Disease: Function of Dopamine Releasing Agent
Anticholinergic properties enhancing dopamine transmisison
Parkinson’s Disease: Dopamine Releasing Agent Drug
Amantadine (symmetrel)
Parkinson’s Disease: MAO-B Inhibitor Function
Prevents metabolism of dopamine in the brain
Parkinson’s Disease: MAO-B Inhibitor Drug
Selegiline (Eldepryl)
Parkinson’s Disease: Anticholinergic Drug Function
Blocks effects of ACH to rebalance levels with dopamine
Parkinson’s Disease: Anticholinergic Drugs
-Trihexyphenidyl (Artane), Beztropine mesylate (Cogentin), levodopa, carbidopa, and entacapone (Stalevo)
Parkinson’s Disease: Catechol-O Methyltransferase Inhibitor Function
Blocks an enzyme which prevents levodopa from breaking down
Parkinson’s Disease: Catechol-O-Methyltransferase Inhibitor Drugs
Tolacapone (Tasmar) and Entacapone (Camtan)
Parkinson’s Disease: Epinephrine consideration
Limit to 0.04 mg
Parkinson’s Disease: Effectiveness of Drugs over time
After 5 years, 50-70% of patients will become partially unresponsive to meds
Parkinson’s Disease: What can occur while the disease progresses?
Reduction in responsivenss to L-dopa and narrowing therapeutic window leading to fluctuations, dyskinesias, and drug failure
Parkinson’s Disease: Function of implantable electrode
-Emits electrical impulses at higher frequencies than the physiological normal
Parkinson’s Disease: What does the implantable electrode disrupt?
-Disrupts the normal functioning of the target area in the brain.
Parkinson’s Disease: What does the implantable electrode block?
Neural circuits
Parkinson’s Disease: What does the implantable electrode inhibit?
The overactivity of the thalamus which is cause of tremors
Parkinson’s Disease: Describe how cell implants are used as therapy
- Implantation of fetal nigral cells
- The cells survive and replace dopamine
Parkinson’s Disease: What should clinicans be prepared for when it comes to patient’s ability?
- To care for self
- To understand others caring for oral needs
Parkinson’s Disease: What events may make it difficult for patients to receive dental care?
- Can’t get into the office/clinic
- Physical opening and providing access to treatment may be difficult
- Inability to put head back
Parkinson’s Disease: What tools can be used to help with opening and providing dental care?
- Mouth pop
- Provide protection for airway
- After treatment, incline chair slowly
- Allow patient to sit upright and remain sitting for 3 to 5 minutes
- Oral or IV sedation helpful to reduce tremors or dyskinesias to provide treatment
Parkinson’s Disease: What motor strength problems can these patients face?
- Chewing
- Drooling
- Oral hygiene
- Swallowing
- Reflexes
Parkinson’s Disease: What drugs should we be aware of when treating these patients?
Antiparkinsonian drugs can be CNS depressants -> additive effect with sedation
Parkinson’s Disease: What are some oral treatment guidelines we should keep in mind as clinicans?
- Frequent recalls: 3-6 months
- Customized oral home care regimen w/power brushes, portable suction
- Evaluate and integrate a caregiver into oral hygiene care methods
- Maintain esthetics to enhance self-esteem
- Plan for decline
