Parkinson's Disease Flashcards
What is Parkinson’s disease?
A progressive, degenerative disorder of basal ganglia function
What is parkinson’s characterized by?
Tremor, rigidity, and bradykinesia (slowness of speed and movement)
What is the function of the basal ganglia?
Function in the cerebellum to make smooth, coordinated movements
What does the substantia nigra in the basal ganglia make?
Dopamine
What is primary parkinsonism?
Idiopathic (this is what is called parkinson’s disease)
Can be genetic or sporadic
This is the most common type
What is secondary parkinsonism?
Acquired from infection, intoxication, trauma, or drug induced events
What are the drugs that cause secondary parkinsonism?
Some antidepressants - this is most common, but this is reversible once stopped
What are the risk factors for parkinsonism?
Age (peaks in the 70s)
Men more than women
Genetics (can be attached with dominant / recessive)
Could potentially be tied to: anxiety / depression, head trauma, hysterectomy
What is a protective factor against parkinsonism?
Coffee consumption
What is dopamine, what does it do?
Inhibitory neurotransmitter
Function = message tranmission
Controls movement and balance
Helps muscles work smooth, controllably, and without unwanted movement
What is acetylcholine, what does it do?
Excitatory neurotransmitter
Works in conjunction with dopamine system
Balance is crucial between the two
Works best in balance with dopamine
How are the levels of dopamine and acetylcholine changed with parkinsonism?
Too much acetylcholine in relation to dopamine = loss of coordinated movements
What is the patho behind primary parkinsonism?
Destruction of the substantia nigra in the basal ganglia
Dopamine levels decrease
Imbalance is formed between dopamine and ACh
Relative excess of ACh
Loss of controlled movement and balance
What are the clinical manifestations of parkinsonism?
Bradykinesia
Cogwheel rigidity
Resting tremor (pill rolling)
Shuffling gait
Mask-like expression
Postural instability
May involve one side of the body at first
What is the classic triad of manifestations for parkinsonism?
Tremor
Rigidity
Bradykinesia
What is usually the first sign of parkinsonism?
Tremor
Why does rigidity happen with parkinsonism?
Sustained muscle contraction because of too much ACh in relation to dopamine
What complaints are usually associated with rigidity?
Pain, aches, muscle soreness
What happens with bradykinesia?
Loss of automatic movement - no blinking, swinging of the arms, swallowing of saliva (drooling), or self expression with hands / face
Overall lack of spontaneous movement
What is the difference between an essential tremor and a parkinson’s tremor?
Essential: Results from faulty neurological impulses, tremors occur with motor function, no other manifestations of parkinson’s
Parkinson’s: Results from a dopamine deficiency, tremor occur with rest and improves with movement, presents with other manifestations of parkinson’s
What are the complications from parkinsonism?
Dementia (due to spread of lewy bodies)
Depression / anxiety
Decreased mobility (aspiration, malnutrition, pneumonia, UTI, skin breakdown)
Drug related complications
What is the goal of parkinsonism pharmacology?
Help individuals maintain motor function for as long as possible and try to correct the imbalance between dopamine and ACh
What is the MOA of Levodopa / Carbidopa?
Levodopa = converts to dopamine in the brain and activates the dopamine receptors
Carbidopa = blocks the destruction of Levodopa
What are the side effects of levodopa / carbidopa?
N/V (can give with food but it does decrease the absorption)
Dyskinesias (involuntary, erratic, writhing movements of the face, arms, legs, or trunk)
Cardiovascular (hypotension, dysrhythmias)
Psychosis (hallucinations, nightmares, paranoia)
Dark sweat / urine
Can activate malignant melanoma
