Parkinson's disease Flashcards
What is the pathophysiology of parkinson’s disease?
Progressive reduction of dopamine production in the basal ganglia of the brain - causing a movement disorder.
What is the classic triad of parkinson’s disease presentation?
- resting tremor
- rigidity of movement (leadpipe)
- bradykinesia (slowness of movements)
This are typically assymetrical.
Describe the features of a parkinson’s tremor?
- 4-6hz frequency (meaning it happens 4-6 times a second)
- describes are ‘pill rolling’
- more pronounced when resting
- improves on voluntary movement
- worse when the patient is distracted
How is the rigidity in parkinson’s disease described?
- cogwheel like rigidity
- resistance to passive movement of a joint
- upon arm movement - you feel a tension that gives way in small little jerk movements
Describe the bradykinesia features in parkinson’s disease?
- slower, smaller movements
- shuffling gait with a reduced arm swing
- difficulty initiating movements - e.g. standing still to walking
- reduced facial movements and expressions (hypomima)
Describe the gait seen in parkinson’s disease?
- shuffling gait
- reduced arm swing
What features (outside of the classic triad) may be seen in parkinson’s disease?
- depression
- cognitive impairment and memory problems
- sleep disturbance and insomnia
- postural instability - stopped with a forward tilt
How is parkinson’s disease managed?
Medications such as
- levodopa (synthetic dopamine)
- COMT inhibitors - e.g. entacapone
- dopamine agonsts - bromocryptine
- monoamine oxidase B inhibitors - rasagiline
What happens over time as co-careldopa is used to treat parkinson’s disease?
It’s effectiveness decreases over time ( complete loss is often after 2-5years)
Why is levodopa given as co-careldopa?
Levodopa is combined with carbidopa to prevent early breakdown of dopamine ( stops breakdown in the peripheral NS so that it enters the central nervous system)
How do COMT inhibitors work for parkinson’s disease?
Inhibits the COMT enzyme - which normally metabolises levodopa. Hence slows the breakdown of levodopa.
What class of drug is entacapone?
COMT inhibitor
What condition can be managed with co-careldopa, entacapone, bromocryptine or rasagiline?
Parkinson’s disease
What is entacapone used to manage?
Parkinsons disease
What class of medication is bromocryptine?
dopamine agonist
