parkinsonism

Question 1

what is the pathophysiology of parkinsons?

Answer 1

dopamine deficiency in the basal ganglia

Question 2

what are the non modifiable risk factors of parkinsons?

Answer 2

Age
gender (men)
race (caucasians)
genetics

Question 3

what are the modifiable risk factors of parkinsons ?

Answer 3

well water 
farming 
rural residence
tobacco 
trauma

Question 4

what is the clinical picture of parkinsons?

Answer 4

manifested by resting tremors (pill rolling tremors), rigidity, bradykinesia and postural instability , propulsion/retropulsion

Question 5

what does rigidity mean ?

Answer 5

resistance to passive movements

Question 6

what are some non-motor symptoms of parkinsons?

Answer 6

cognitive dysfunction and dementia
sleep disturbances
olfactory dysfunction
fatigue

Question 7

how is PD diagnosed

Answer 7

mainly a clinical diagnosis, MRI can be used to exclude PD mimics, but a good response to l dopa therapy can confirm PD

Question 8

what are the differential diagnosis in PD ?

Answer 8

mild Parkinsonism with aging
hereditary diseases such as Wilsons disease and Huntingtons
Could be toxic - manganese , CO

Question 9

What are the treatment options for PD

Answer 9

Non pharmacological
pharmacological
surgical therapy

Question 10

what is the true gold standard for diagnosing PD?

Answer 10

Neuropathological examination

Question 11

what is the drug of choice for primary treatment of Parkinsons?

Answer 11

levodopa which is dosed orally 3-5 times a day

Question 12

what drugs inhibit. levodopa metabolism?

Answer 12

COMT inhibitors and AADC inhibitors

Question 13

what are the indications for using COMT inhibitors ?

Answer 13

must be only given with levodopa and levodopa levels must be decreased

Question 14

what is the drug of choice in early PD monotherapy ?

Answer 14

MAO-B inhibitor (Selegiline/eldepryl)

Question 15

what drugs are to be avoided in elderly PD patients?

Answer 15

Bromocriptine ( dopamine receptor agonists)

Question 16

what does surgical therapy for PD include?

Answer 16

deep brain stimulation (DBS)
Continuous dopa-carbidopa intestinal gel
Continuous subcutaneous apomorphine infusion

Question 17

which drug can be used in younger PD patients ?

Answer 17

begin MAO-b inhibitor and bromocriptine could be used

Question 18

what are the disadvantages of using dopamine re-uptake inhibitors ?

Answer 18

they start working within a week and they stop working within a few months

Question 19

if we need to use a fast acting drug what is the drug of choice ?

Answer 19

levodopa