Parkinsonism Flashcards
Parkinsonism is the loss of cells in the______ resulting in a decrease in
_____
substantia nigra
dopamine
The most common cause of parkinsonism is
idiopathic.
Among etiologies, look for Gait disturbances+ Hx of
repeated head trauma (boxing) antipsychotic medications (Thorazine) encephalitis, reserpine metoclopramide
DX
The diagnosis is based entirely on the clinical presentation. There is no test for parkinsonism.
Look for a patient age
50 to 60 or older
the 4 cardinal signs are
tremor
bradykinesia
shuffling gait, and
rigidity
the gait has unsteadiness
on _____and a tendency to ___. ________ is the slowing of movement
on passive flexion or extension of an extremity.
turning
fall
Cogwheel rigidity
Facial expression is ____ and writing is______.
limited (hypomimia)
small (micrographia)
Postural instability is
______. This happens because the same slowness that results in bradykinesia results in the inability of the _____ to reset appropriately.
orthostatic hypotension
pulse and blood pressure
Treatment is classified by
Mild disease:
Severe disease
Mild disease Tx can be sumarized in:
- Anticholinergic medications (benztropine and trihexyphenidyl)
- Amantadine
Anticholinergic medications SE
dry mouth,
worsening prostate hypertrophy,
constipation
occur more frequently
in older patients
Amantadine may work by _____, Definitely the answer in _______
increasing the release of dopamine from the substantia nigra.
older patients (age >60) intolerant of anticholinergic medications
Which migraine drugs worsen Parkinson disease?
Prochlorperazine
Metoclopramide
Chlorpromazine
define Severe disease
inability to care for themselves, orthostatic
Severe disease treatment can be summarized in
- Dopamine agonists
- Levodopa/ carbidopa:
- -COMT inhibitors
- MAO inhibitors
- Deep brain stimulation
Dopamine agonists, who are these people (4)? when to use them?
pramipexole and ropinirole are the best initial therapy in SEVERE
Apomorphine
Rotigotine: patch
AMBOSS: they are the best initial treatment for <65y
Levodopa/ carbidopa, is characterized by:
the most effective medication
Associated with
“on/off” phenomena
Amboss: this is the best initial treatment for >65y
wtf is “on/off” phenomena?
episodes of insufficient dopamine (“off”) characterized by bradykinesia. The “on” effect is too much dopamine, resulting in dyskinesia.
who are the COMT inhibitors
(tolcapone, entacapone)
COMT inhibitors (tolcapone, entacapone) extend the duration of ____ by blocking the metabolism of ____. That’s why it’s only used in those _____. And specifically when_____, or when _____.
levodopa/carbidopa
dopamine
treated with evodopa/carbidopa
“on/off” phenomena to even out the dopamine level
the response to therapy
is inadequate.
MAO inhibitors. who are they?(2). when to use them? how do they work?
(rasagiline, selegiline) as a single agent or an adjunct to levodopa/carbidopa. They block metabolism of dopamine.
Deep brain stimulation: consist of _____. And it’s highly effective for _____
electrical stimulation
tremors and rigidity in some patients.
Avoid _____-containing foods (e.g., _____) with MAO inhibitors; they precipitate _____.
tyramine
cheese
hypertension
Psychosis and confusion are a known adverse effect of ______ treatment. Treat_____
Use antipsychotic medications with the fewest extrapyramidal (antidopaminergic) effects.
No by stoping Antiparkinsonian Meds!!!!!
parkinsonism+ dementia=
Lewy body dementia
parkinsonism predominantly with orthostasis=
Shy-Drager syndrome
________is an antipsychotic medication that does not worsen Parkinson disease. It works by ________
Pimavanserin
inhibiting 5HT, not through dopamine inhibition.
