Parkinsons Flashcards
TRAP pneumonic for the motor symptoms of Parkinsons?
Tremor
Rigidity
Akinesia (bradykinesia)
Postural instability
Autonomic changes that can arise in Parkinson’s disease?
Sweating issues
Constipation
Erectile dysfunction
Mood changes - depression, psychosis with hallucinations and paranoid delusions
How is sleep effected in Parkinsons disease?
Vivid dreams as REM sleep effected
Nocturia
Sleep akinesia
What kind of pain syndromes come alongside Parkinsons?
Frozen shoulder syndrome`
What medium term and long term complication of Parksinons treatment do you want to be aware of?
Medium term - retroperitoneal fibrosis
Long term - Derangement of the dopaminergic pathways
2 things that make up the striatum?
Putamen and the caudate nucleus
Where is there characteristically cell loss in a patient with Parkinsons?
In the basal ganglia
Depositions of what 2 things can sometimes be seen in Parkinsons disease?
Lewy bodies
Alpha-synuclein
In young patients presenting with Parksinon’s disease what is a key differential to think about and what is the investigation of choice?
Wilsons disease
Copper studies
When is a DaT scan primarily used in Parkinsons and what does it exclude?
Used in tremor dominant Parkinsons
Helps to exclude an essential tumour
Side effects of levodopa?
Nausea, vomiting, hallucinations, constipation, dizziness, long term motor complications
What is the mode of action of levodopa and how does it differ to that of dopamine agonists?
Allows conversion of Dopa to Dopamine within the brain
Dopamine agonists provide direct receptor stimulation
Examples of 3 dopamine agonists used for treatment of Parkinsons?
Ropinirole
Pramipexole
Rotigotine
What are some side effects of dopamine agonists?
Nausea Vomiting Hallucinations Dizziness Sleep and sedation
2 examples of MAOB inhibitors used in Parksinons disease?
Rasagiline
Selegiline
2 examples of CMOT inhibitors used to treat Parkinson’s?
Entacapone
Tolcapone
What are 3 additional side effects of using COMT inhibitors as well as the usual Parkinsons drug SE?
Liver effects
Diarrhoea
Discolouration of urine
What are 3 main aspects of Parkinsons and its treatment that the patient must be informed about?
DVLA must be informed
Drugs indice sleep so use of machinery and driving will be effected
Dopamine dysregulation syndrome - gambling and hypersexuality need to be looked out for
What treatment of Parkinsons can be given to selected cases where there is inability to manage symptoms or motor symptoms persist despite maximal medication?
Bilateral subthalamic deep brain stimulation
2 main classes of drugs that can lead to drug induced parkinsonism?
Antipsychotics
Antiemetics
What is akinesia?
Slowing of the ability to initiate movement
How would you describe the facial movements of those with Parkinsons?
Mask like and staring
Cause of cog wheel movements in Parkinsons?
Mix between the rigidity of increased muscle tone and the tremor
How would you describe the tremor in Parkinsons?
Tremor at rest, abolished by movement
Worse in hands
Worse on one side of the body
WHat happens to handwritting in Parksinsons?
Micrographia
How do you test a Parkinsons patient’s balance and posture?
Push them and they will fall
What is the gait known as in parkinsons?
Festinating gait!
What occurs to secretions in parkinsons?
Increased sebaceous secretions and increased salivation
If the gait disorder in Parkinsons is more pronounced than the Intellectual disorder what must be considered as a potential diagnosis?
Normal pressure hydrocephalus
What enzyme metabolises L-Dopa?
Dopa decarboxylase
what is given alongside L-Dopa medication?
Dopa decarboxylase inhibitor
What is the purpose of prescribing a dopa decarboxylase inhibitor?
Stops L-Dopa break down but doesnt cross blood brain barrier so L-Dopa can still be broken down in the brain and have central effects
What drug class are benztropine and orphenidrine?
Anticholinergic drugs
What is a drug that is often used when L-Dopa is not toelrated?
Bromocriptine
Recently introduced dopamine agonists that help in the fluctuating later stages of Parkinsons?
Pergdide
Lysuride
What is the ‘on-off’ phenomena described in Parkinsons?
variability in patient response with L-dopa
Become akinetic for periods of the day
usually due to drug titres - peak or wearing off
What is the process of skin to a pressure sore development?
Early erythema and oedema, erythema becomes fixed and cyanotic, blister formation, breaks down, exudate causes coagulum, skin loss, fat necrosis, muscle damage
Type of organisms that usually infect pressure sores?
Gram negative
What is the mainstay of management of deep pressure sores?
Debridement, cleaning, removal of eschar and slough, consider skin grafting
Predisposing factors to the development of pressure sores?
Patient that is shocked or hypotensive
Sensory loss or immobility
Poor general health
Cardiac failure, anaemia, metabolic disturbances
What are decubitus ulcers?
Caused by pressure most commonly on heel
Why do gravitational ulcers develop?
Insufficiency of the leg valves
usually following DVT
Venous hypertension is transmitted to communicating veins
Tissue oedema and fibrin develop around veins leading to insufficient nutrient and gas exchange
WHere do gravitational ulcers usually develop?
Around medial malleolus although may be anywhere on leg and even the whole way round
Treatment of gravitational ulcers?
elevation of the leg, support bandages or hose, weight loss and regular exercise
3 main types of ulcers?
Gravitational
Ischaemic
Decubitus
