Parkinson's Disease Flashcards
what is parkinsons
a progressive, degenerative disorder of the basal ganglia function
- characterized by tremor, rigidity, bradykinesia
what is the basal ganglia
function of the cerebellum to make smooth coordinated movements
- part of the basal ganglia is the substantia nigra where dopamine is produced
what is primary parkinson’s disease
idiopathic
- genetic and sporadic
* damage to dopamine producing cells*
what is secondary parkinson’s
acquired
- infection
- intoxication
- trauma
- drug induced (antiemetics/depressions will interfere with dopamine transmission)
alter production of dopamine
what are the risk factors for parkinson’s
age (70s)
more likely men
genetics
anxiety/depression
head trauma
hysterectomy
coffee consumption (protective)
what is dopamine
NT that is both inhibitory and excitatory
- in parkinson’s it is inhibitory
- helps muscles work smoothly, controllably, and without unwanted movements
* inhibits unnecessary movement
what is ACh
an excitatory NT that works in conjunction with the dopamine system
- prevents unwanted movements
- must be balanced, if one goes up then one must come down
what is the pathogenesis of parkinson’s
- destruction of substantia nigra in basal ganglia
- dec levels in dopamine
- imbalance between dopamine and ACh
- relative excess of ACh
- loss of controlled movements and balance
what are the clinical manifestations
- bradykinesia (slowness of movements)
- cog wheel rigidity (stiffness)
- resting tremor
- shuffling gait
- mask like expression
- postural instability
*gradual onset and progression, typically one side of body first *
what is the classic triad of manifestations of parkinson’s
tremor
rigidity
bradykinesia
what are the characteristics of tremors in parkinson’s
- often first sign
- affects handwriting
- more prominent at rest
- aggravated by stress or concentration
- pill roll
what are the two types of tremors
parkinsons
essential
what is an essential tremor
results form faulty neurological impulses w fine motor movements
- occur with motor function
- no other sx of parkinsons
what is the parkinson’s tremor
results from a dopamine def
- occur with rest and improve with movements
- other symptoms of parkinsons
what is rigidity
resistance to passive movements
- cog wheel rigidity –> movements are jerky and slow
- sustained muscle contractions
- too much ACh
- associated complaints are muscle soreness, aches, pain
what is bradykinesia
loss of automatic movements
- no blinks, swinging of arms, swallowing saliva, no self expression with hands and face
–> results in drooling, flat face
overall lack of spontaneous movement
what are complications of parkinson’s
dementia
depression/anxiety
decreased mobility –> malnutrition, aspiration, pneumonia, UTIs, skin breakdown
drug related complications
what are the goals of pharm of parkinsons
maintain independence and dec sx that are associated
how do parkinson’s drug work
correct the imbalance btw dopamine and ACh
- enhance dopamine (dopaminergic) or block ACh (anticholinergic)
what is levodopa/carbidopa
most effective drug for parkinson’s that is a combo drug
what is the moa of levodopa
converts dopamine in the brain and activates dopamine receptors
what is the moa of carbidopa
blocks destruction of levodopa
what is the disadvantage of levodopa/carbidopa
takes several months to see improvement
does not work long term
- dose eventually wears off so may need shorter dose intervals
- abrupt loss of effect calles the on off phenomenon that can occur at anytime (off periods will inc over time) (can be reduced w drugs and avoid high protein meals)
what are the adverse effects of levadopa
N/V (give low doses, take w food)
dyskinesias (range from annoying to disabling)
postural hypotension
dysrhythmias
psychosis: hallucinations, nightmares, paranoia
darken sweat and urine
activate malignant melanoma
