Parkinson's disease Flashcards
What is PD?
Condition where there is a progressive reduction of dopamine in the basal ganglia of the brain, leading to disorders of movement
1) What is the pathophysiology responsible for PD?
2) Why is correct function of the basal ganglia important (3)?
1) Gradual but progressive fall in the production of dopaminergic neurons from the substantia nigra, which is important for the function of the basal ganglia
2) Coordinating habitual movements such as walking or looking around, controlling voluntary movements and learning specific movement patterns
1) What are the classic triad of features in Parkinson’s disease?
2) Are the symptoms of PD typically symmetrical or asymmetrical?
1) Resting tremor, rigidity, bradykinesia
2) Asymmetrical
Describe 3 ways the classic Parkinson’s patient presents
- Older male
- Shuffling gait
- Reduced arm swing
- Forward tilt
- Stooped posture
- Facial masking
PD presentation (1)
1) How is the tremor in PD often described?
2) When is the tremor at its worst and when is it less clear?
3) If the patient is distracted, how does this affect the tremor
4) How is the rigidity on PD decribed?
5) What is rigidity?
1) Pill rolling tremor
2) More pronounced when resting and improves on voluntary movement
3) Makes it worse
4) Cogwheel rigidity
5) Resistance to passive movement of a joint
PD presentation (2)
1) What does bradykinesia mean?
2) Name 2 ways this can present
3) Name 2 other features of PD
1) Slower and smaller movements
2) Smaller handwriting, small steps when walking (shuffling gait), difficulty initiating movement i.e. from standing still to walking, difficulty in turning around when standing - having to take lots of little steps, reduced facial movements and facial expressions (hypomimia).
3) Depression, sleep disturbance and insomnia, autonomic dysfunction, anosmia, postural instability, cognitive impairment and memory problems
How is PD diagnosed?
Clinically based on symptoms and examination
Management of PD (1)
1) What is levodopa, and why is it given?
2) What is levodopa given with and why?
3) Give an example of one of these drugs
4) What are the 2 main combination drugs called?
5) Even though Levodopa is the most effective treatment for symptoms, what is it’s downside?
6) Name 2 other side effects of Levodopa
1) Synthetic dopamine, to increase dopamine levels
2) Peripheral decarboxylase inhibitor (PDI), to stop levodopa being broken down in the body before it gets the chance to enter the brain
3) Carbidopa, benserazide
4) Co-careldopa and co-beneldopa
5) It’s effectiveness wears off over time
6) Abnormal movements associated with excessive motor activity, postural hypotension, restlessness, GI upset, on off effect, end of dose effect
Management of PD (2)
1) What is the main side effect of dopamine when the dose is too high?
2) What does this mean?
3) COMT inhibitors can also be used in PD, how do they work?
4) Name an example of a COMT inhibitor
5) Why is a COMT inhibitor taken with levodopa and a PDI?
1) Dyskinesia
2) Abnormal movements associated with excessive motor activity
3) Inhibit COMT which breaks down levodopa in the periphery and the brain
4) Entacapone
5) To slow breakdown of the levodopa in the brain and extend the effective duration of the levodopa
Management of PD (3)
1) How do dopamine agonists work?
2) Why are they used with levodopa?
3) What is a notable side effect of prolonged use of dopamine agonists?
4) Name one of these
1) Mimic dopamine in the basal ganglia and stimulate the dopamine receptors
2) Reduce the dose of levodopa that is required to control symptoms
3) Pulmonary fibrosis
4) Bromocriptine, pergolide, cabergoline, ropinirole
Management of PD (4)
1) How do MAO-B inhibitors work?
2) Why is the MAO-B subtype targeted?
3) Name one of these drugs
4) These drugs are used in the same way as what other class of drugs used in PD?
1) Inhibit MAO (monoamine oxidase) which are enzymes that break down dopamine, serotonin and adrenaline
2) They’re specific to dopamine and don’t act on serotonin and adrenaline as much
3) Selegiline, rasagiline
4) Dopamine agonists
Parkinson’s-plus Syndromes
1) What are Parkinson’s-plus Syndromes?
2) What are the 4 main syndromes?
3) Name 1 difference between PD and Multiple system atrophy
1) Neurodegenerative diseases featuring the classical motor features of Parkinson’s disease but with additional features that distinguish them from PD
2) Multiple system atrophy, dementia with Lewy Bodies, progressive supranuclear palsy, corticobasal Degeneration
3) Autonomic dysfunction leading to symptoms such as postural hypotension, constipation, abnormal sweating and sexual dysfunction. Cerebellar dysfunction causing ataxia
Drug induced parkinsons
1) Name a drug that can cause DIP
2) How is it managed?
1) Anti-emetics i.e. promethazine, metoclopramide, antipsychotics, antidepressants, CCBs, anticonvulsants (drugs that decrease dompamine)
2) Antimuscarinics i.e. benzotropine, procyclidine
Why does Parkinson’s cause postural hypotension?
Autonomic dysfunction (can also be a side effect of co-careldopa in high doses)
