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Neuro 1 - Exam 4 > Parkinson's DZ - RS > Flashcards

Parkinson's DZ - RS Flashcards

1
Q

pathology

A

refers to a group of disorders producing abnormalities in the BG

excessive cholinergic activity, tremor and rigidity

loss of dopamine –> akinesia, bradykinesia

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2
Q

tremor

A

most common initial clin man (75%)

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3
Q

how does a tremor usually appear

A

unilaterally in a single UE

can progress to bilateral

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4
Q

how are tremors first seen

A

pill-rolling tremor in fingers

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5
Q

which side to symptoms usually start on

A

right side

61%

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6
Q

tremors are present

A

at rest

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7
Q

increase in tremors

A

with exertion or tension

stress test

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8
Q

decrease in tremors

A

or disappear with sleep or action

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9
Q

tremors occur as a result

A

of an imbalance b/w cerebellar actions and BG inhibition

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10
Q

overtime…

A

tremor will spread to other body parts including

-legs

face (blepharospasm)

-shoulder

-neck/trunk (titubation)

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11
Q

how do tremors progress

A

unilateral –> bilateral

appendicular –> axial

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12
Q

reduction in

A

medical efficacy

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13
Q

progression causes

A

increased akinetic rigidity

postural/balance/gait disturbance

motor initiation difficulty (freezing)

speech/swallowing/drooling problems

vocal production dysfunction

non-motor symptoms

medication side effects

complications

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14
Q

common presenting

A

TRAP

shuffling gait

decreased arm swing (w/ gait)

dysphasia

micrographia

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15
Q

TRAP

A

cardinal signs

3/4 required for diagnosis

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16
Q

T-Trap

A

resting tremor

pill rolling

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17
Q

R- trap

A

rigidity

lead pipe, cogwheel

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18
Q

A - trap

A

akinesia

bradykinesia

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19
Q

P -trap

A

postural instability

late stage finding

decrease balance and coordination

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20
Q

Heohn and Yahr scales

A

stages 0-5

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21
Q

stage 0

A

no signs of dz

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22
Q

stage 1

A

unilateral dz

23
Q

stage 1.5

A

unilateral plus axial involvement

24
Q

stage 2

A

BIL dz w/o balance impairments

25
Q

stage 2.5

A

mild bilateral dz with recovery on pull test

26
Q

stage 3

A

mild/moderate BIL dz

some postural instability but physically dependent

27
Q

stage 4

A

severe disability

still able to walk/stand unassisted

28
Q

stage 5

A

w/c bound or bedridden unless aided

29
Q

common medication

A

replace dopamine

block acetylcholine

neuroprotective drugs

30
Q

dopamine replacement therapy

A

aimed at replacing deficient dopamine

Sinemet: L-dopa/Carbidopa combination

amantadine

dopamine agonists

enzyme inhibitors

31
Q

L-dopa

A

precursor to dopamine that crosses BBB

32
Q

carbidopa

A

given with L-dopa

inhibits the release of L-dopa in the peripheral tissue and increases it release into the brain

33
Q

what does the combo do (meds)

A

decrease total amount of L-dopa needed

cutting down on side effects

limits bradykinesia, rigidity, tremor

34
Q

what doesnt the sinemet treat

A

motor planning deficits

postural instability

non-motor symptoms

35
Q

overtime (meds)

A

therapeutic window decreases and toxic window increases

36
Q

side effects sinemet

A

dyskinesia

dystonia

on/off motor fluctuations

37
Q

50-60% of people on L-dopa

A

will have motor complications within 5 yrs

38
Q

dopamine agonists

A

bromocriptine (parlodel)

pergolide (permax)

39
Q

when dopamine agonists are added with sinemet

A

decrease clinical fluctuations

40
Q

what do dopamine agonists

A

boost output of remaining substantia nigra cells

41
Q

block acetylcholine

A

anticholinergics

parsidol

cogentin

akinetin

artane

42
Q

anticholinergics do

A

improve symptoms by restoring the balance of ACh and dopamine

43
Q

when are anticholinergics used

A

less frequently than others

more used early in the dz when tremor is the most prominent problem

44
Q

anticholinergics are affective for

A

tremor only

45
Q

side effects of anticholinergics

A

confusion

memory

hallucinations

dry mouth

constipation

urinary retention

orthostasis

46
Q

neuroprotective drugs

A

monoamine oxidase inhibitors (MAOs)

47
Q

MAOs

A

neuronal degradation can be controlled with antioxidants

which control the synthesis and elimination of free radicals

48
Q

problems with medical management –> sinemet

A

can cause dyskinesia, orthostatic hypotension, behavioral signs (confusions, hallucinations, paranoia, psychosis)

49
Q

problems with medical management –> on/off

A

on/off phenomenon and short duration therapeutic response followed by rapid decrease in symptomatic relief

50
Q

on/off phenomenon and short duration therapeutic response followed by rapid decrease in symptomatic relief

A

d/t the fact that PD meds are toxic to receptor site

grows more dramatic over time

“On” time becomes shorter with “off” time having dyskinesia or severe bradykinesia

“narrowing therapeutic window”

“wearing off” phenomenon

51
Q

when is PT attempted

A

ideally during “on” time

52
Q

how many respond to sinemet for a lifetime

A

1/3

53
Q

how many respond to sinemet for 3-5 yrs

A

1/3

54
Q

how many respond to sinemet for 5-7 yrs

A

1/3

Neuro 1 - Exam 4 (12 decks)

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