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Pathophysiology II > Parkinson's Disease > Flashcards

Parkinson's Disease Flashcards

1
Q

What is Parkinson’s disease?

A

Neurochemical Disorder

Substantia nigra loses dopamine producing ability

Inhibition of cholinergic system (decrease in dopamine = increase in acetylcholine)

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2
Q

Up to ___% loss of dopamine occurs before Parkinsonian symptoms appear.

A

80%

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3
Q

What are 4 causes of Parkinson’s disease?

A
  1. Idiopathic: risk factors and family history (MOST COMMON)
  2. Encephalitis
  3. Toxic encephalopathy
  4. Other degenerative diseases of the BG
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4
Q

What are the 4 most common clinical manifestations of PD? (TRAP)

A
  1. Tremor (resting due to excessive cholinergic activity)
  2. Rigidity (non velocity dependent increase in muscle resistance to stretch)
  3. Akinsiea/bradykinesia (caused by loss of dopamine)
  4. Postural instability
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5
Q

How does a tremor typically first present in patient’s with Parkinson’s disease?

A
  1. Starts unilaterally

2. First in seen in fingers (pill rolling)

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6
Q

5 characteristics of a tremor

A
  1. Is present at rest, and often disappears with limb movement
  2. increases with exertion or tension
  3. Decreases or disappears with sleep
  4. Has a frequency of 4-7 Hz
  5. Typically spreads over time
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7
Q

What is an early sign of rigidity? Does it appear bilaterally or unilaterally first?

A

Appears unilaterally before bilaterally

Early sign: loss of arm swing in gait

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8
Q

What are 2 characteristics of bradykinesia? What movements are most affected by bradykinesia?

A
  1. Characterized by an inability to perform purposeful movements
  2. Difficulty producing accurate, quick/ smooth
    movements leading to over/undershooting of
    movement
  3. Sequential/simultaneous movements most affected
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9
Q

What is akinesia? What causes this? What can make this worse?

A
  1. Difficulty with movement initiation
  2. Caused by co-contraction of agonist and antagonist resulting in no movement
  3. Increased frequency in tight/enclosed spaces
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10
Q

True or False: Bradykinesia and Akinesia are mediated by the same mechanism.

A

FALSE

Both are motor planning deficits, but are mediated
by separate mechanisms and do not correlate with
each other

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11
Q

What posture is most commonly seen in patients with PD?

A

Flexor bound posture

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12
Q

What are 3 reasons patients with PD have an increased risk for falls?

A
  1. Delayed equilibrium reactions
  2. Lack of anticipatory postural control
  3. Inability to adequately respond to perturbations
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13
Q

What are 4 gait impairments associated with PD?

A
  1. Festinating, shuffling gait and retropulsion
  2. ↓ heel strike and loss of heel toe progression
  3. ↓ step length
  4. Loss of trunk rotation (impairs bed mobility)
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14
Q

____ occurs in > 50% of individuals with PD

A

DEPRESSION

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15
Q

What is the difference between primary and secondary depression in PD?

A

Primary: Due to loss of dopamine neurons

Secondary: Reactive or due to sensory deprivation

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16
Q

List 4 other symptoms of PD.

A
  1. Low, whispering monotone voice
  2. Masked face
  3. Lack of autonomic regulation leads to ↑ salivation and sebaceous secretions
  4. Micrographia (progressively small handwriting)
17
Q

What are 4 side effects of dopaminergic drugs? What is a disadvantage of using these drugs?

A
  1. orthostatic hypotension
  2. “on/off” times
  3. dyskinesia
  4. hallucinations

Disadvantage: Less effective overtime (need more and more of the drug to achieve the same effects)

18
Q

What are the effects of dopamine agonists? What are 3 side effects?

A
  1. Brain thinks there is more dopamine
  2. Delays need for Sinemet

Side effects: drowsiness, edema, obsessive problems

19
Q

What are the effects of anticholinergics? What are 4 side effects?

A
  1. Restores acetylcholine/ dopamine balance
  2. Control tremor early on

Side effects: dry mouth, sedation, confusion, urinary
retention

20
Q

What are the effects of MAO-B inhibitors? What are 2 side effects?

A
  1. Slow the breakdown of dopamine
  2. Decrease free radical production from dopamine
    metabolism
  3. Reduce on/off time fluctuations

Side effects: orthostatic hypotension, insomnia

21
Q

What are the effects of COMT inhibitors?

A

Blocks this enzyme that inactivates dopamine,

prolongs effective Sinemet time

22
Q

What are the effects of antivirals? What are 3 side effects?

A
  1. Helps rigidity and bradykinesia
  2. Low doses smooth fluctuations
  3. High does suppress dyskinesias

Side effects: edema, skin blotches, insomnia

23
Q

What is the on/off phenomenon? What causes this phenomenon?

A

Short duration therapeutic response followed by rapid
reduction in that response

Due in fact that PD medications are toxic to the
receptor site

24
Q

What is meant by a ‘narrowing therapeutic window’ relative to drug therapy in PD?

A

Patient needs to fall out of the effects of the drug before we can give them more of the drug, because the additive effects are toxic

25
Q

What are botox injections used to manage in PD?

A

Manage hypertonia

Have been used to manage severe equinovarus or
claw deformities caused by rigidity

26
Q

What surgical approach is used to treat PD?

A

Deep brain stimulation

Pathophysiology II (24 decks)

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