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Aging and Complex medicine > Parkinson's disease > Flashcards

Parkinson's disease Flashcards

1
Q

what is the mean age for Parkinson’s disease

A

65 years old

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2
Q

what is Parkinson’s disease

A

neurodegenerative condition caused by degeneration of dopaminergic neurones in the substantia nigra

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3
Q

what is the classic triad of symptoms in Parkinson’s disease

A
  • bradykinesia
  • resting, pill rolling tremor
  • cogwheel rigidity
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4
Q

name 3 psychiatric features of Parkinson’s disease

A
  • psychosis
  • dementia
  • depression
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5
Q

what are the facial, voice and hand writing changes that can occur in Parkinson’s disease

A
  • mask like facial expression
  • micrographia
  • hypophonia
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6
Q

why does blood pressure need to be monitored in Parkinson’s disease?

A

postural hypotension can develop

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7
Q

describe a Parkinsonian gait

A
  • stooped posture
  • difficulty initiating movement + turning
  • small shuffling steps
  • reduced arm swing
  • freezing is common
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8
Q

name a differential diagnosis of Parkinson’s disease

A

Essential tremor

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9
Q

inheritance pattern of Essential tremor

A

autosomal dominant

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10
Q

type of tremor in Essential tremor?

A

postural tremor, that usually affects both sides

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11
Q

what is the tremor in essential tremor made better and worse by?

A

better by: alcohol + rest

worse by: movement such as eating and drinking

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12
Q

how is Essential tremor managed

A

Propranolol is 1st line, Primidone

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13
Q

Pathophysiology of Idiopathic Parkinson’s disease?

A

Neurodegeneration of the pre-synaptic neurones in the substantia nigra, loss of dopamine delivery to the basal ganglia

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14
Q

what is the triad of Dementia w/ Lewy bodies

A

Parkinsonism, Dementia, Visual hallucinations

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15
Q

management of vascular dementia?

A

50% respond to Levadopa

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16
Q

management of Dementia w/ lewy bodies?

A

shared care bwtween;

  • psychiatry
  • neurology
  • geriatrics
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17
Q

name 4 medications that can cause drug induced Parkinson’s disease

A
  • prochloroperazine
  • haloperidol
  • metoclopramide
  • cyclizine
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18
Q

name conditions that have symmetrical Parkinsonism

A
  • Drug induced Parkinsonism
  • Multiple system atrophy
  • Progressive supranuclear palsy
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19
Q

name 2 Parkinsonian plus syndromes

A

Progressive supranuclear palsy
+
Multi-system atrophy

20
Q

What is multi-system atrophy characterised by?

A

autonomic features + cerebellar signs

21
Q

autonomic features in multisystem atrophy?

A
  • erectile dysfunction
  • balance + breathing problems
  • atonic bladder
22
Q

management of Mutli-system atrophy?

A

Levadopa + supportive treatment

23
Q

what is progressive supranuclear palsy characterised by?

A

gradual deterioration of brain cells in areas of the brain including the substantia nigra

24
Q

clinical features of progressive supranuclear palsy? (3)

A

1) early falls
2) speech slurring
3) vertical gaze impairment

25
Q

normal pressure hydrocephalus is due to ___

A

build up of CSF in the ventricles

26
Q

triad of normal pressure hydrocephalus?

A
  • dementia
  • gait disorder
  • bladder instability
27
Q

what is cortico-basal degeneration due to?

A

abnormal tau cells accumulate in certain areas of the brain e.g. basal ganglia and eventually cause deterioration

28
Q

management of normal pressure hydrocephalus?

A

diagnostic LP –> CSF removal –> insert VP shunt

29
Q

medication to give to a patient is the motor symptoms are affecting their QoL?

A

levadopa

30
Q

what is Ropinirole?

A

oral agent: dopamine receptor agonist

31
Q

safe anti-sickness medication to give in Parkinson’s disease?

A

Domperidone

32
Q

adverse effects of dopamine receptor agonists

A
  • excessive sleepiness
  • hallucinations
  • impulse control disorders
33
Q

Rasagaline + Selegiline are part of what group of medications?

A

MAO-B

- Inhibit the breakdown of dopamine secreted by dopaminergic neurones

34
Q

what is the duration of effectiveness of Levadopa?

A

2 years

35
Q

name 4 side effects of Levadopa

A
  • dry mouth
  • postural hypotension
  • palpitations
  • drowsiness
36
Q

Enatcapone is a ___ inhibitor

A

COMT inhibitor

37
Q

type of medication used to treat drug induced Parkinsonism

A

anticholinergics

38
Q

non - medical management of PD?

A
  • physiotherapy
  • occupational therapy
  • speech + language therapists (inc. swallowing)
39
Q

how to explain to a patient how Levadopa works?

A

your body converts levadopa into dopamine. it already occurs naturally in our bodies, and taking it as a drug treatment boosts the supply, meaning nerve cells can make more dopamine

40
Q

what is controlled release Levadopa and what are the benefits of it?

A

Allow Levadopa to enter your body slowly instead of all at once. particularly helpful if they are taken before going to bed to reduce stiffness during the night

41
Q

what are dispersible Levadopa tablets?

A

can be mixed with water to make a drink, takes effect more quickly than capsules, can be used if you have difficulty swallowing tablets or capsules.

42
Q

What is Duodopa?

A

intestinal gel; reduce involuntary movements side effects and drug wearing off

43
Q

when to take Levadopa in relation to eating?

A

30-60 minutes prior to eating

44
Q

what type of food can cause patients taking Levadopa to feel nauseous or interfere with the absorption>

A

protein

found in; meat, eggs, fish, cheese

45
Q

common side effects of Levadopa?

A
  • nausea + vomiting
  • hypotension
  • apetite loss
  • sleep problems
46
Q

adverse effects of Levadopa?

A
  • dyskinesia (with long term use)

- impulsive and compulsive behaviour

Aging and Complex medicine (9 decks)

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