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Geriatrics > Parkinsons > Flashcards

Parkinsons Flashcards

1
Q

TRAP pneumonic for the motor symptoms of Parkinsons?

A

Tremor
Rigidity
Akinesia (bradykinesia)
Postural instability

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2
Q

Autonomic changes that can arise in Parkinson’s disease?

A

Sweating issues
Constipation
Erectile dysfunction
Mood changes - depression, psychosis with hallucinations and paranoid delusions

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3
Q

How is sleep effected in Parkinsons disease?

A

Vivid dreams as REM sleep effected
Nocturia
Sleep akinesia

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4
Q

What kind of pain syndromes come alongside Parkinsons?

A

Frozen shoulder syndrome`

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5
Q

What medium term and long term complication of Parksinons treatment do you want to be aware of?

A

Medium term - retroperitoneal fibrosis

Long term - Derangement of the dopaminergic pathways

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6
Q

2 things that make up the striatum?

A

Putamen and the caudate nucleus

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7
Q

Where is there characteristically cell loss in a patient with Parkinsons?

A

In the basal ganglia

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8
Q

Depositions of what 2 things can sometimes be seen in Parkinsons disease?

A

Lewy bodies

Alpha-synuclein

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9
Q

In young patients presenting with Parksinon’s disease what is a key differential to think about and what is the investigation of choice?

A

Wilsons disease

Copper studies

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10
Q

When is a DaT scan primarily used in Parkinsons and what does it exclude?

A

Used in tremor dominant Parkinsons

Helps to exclude an essential tumour

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11
Q

Side effects of levodopa?

A

Nausea, vomiting, hallucinations, constipation, dizziness, long term motor complications

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12
Q

What is the mode of action of levodopa and how does it differ to that of dopamine agonists?

A

Allows conversion of Dopa to Dopamine within the brain

Dopamine agonists provide direct receptor stimulation

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13
Q

Examples of 3 dopamine agonists used for treatment of Parkinsons?

A

Ropinirole
Pramipexole
Rotigotine

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14
Q

What are some side effects of dopamine agonists?

A 
Nausea
Vomiting
Hallucinations
Dizziness
Sleep and sedation
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15
Q

2 examples of MAOB inhibitors used in Parksinons disease?

A

Rasagiline

Selegiline

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16
Q

2 examples of CMOT inhibitors used to treat Parkinson’s?

A

Entacapone

Tolcapone

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17
Q

What are 3 additional side effects of using COMT inhibitors as well as the usual Parkinsons drug SE?

A

Liver effects
Diarrhoea
Discolouration of urine

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18
Q

What are 3 main aspects of Parkinsons and its treatment that the patient must be informed about?

A

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

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19
Q

What treatment of Parkinsons can be given to selected cases where there is inability to manage symptoms or motor symptoms persist despite maximal medication?

A

Bilateral subthalamic deep brain stimulation

20
Q

2 main classes of drugs that can lead to drug induced parkinsonism?

A

Antipsychotics

Antiemetics

21
Q

What is akinesia?

A

Slowing of the ability to initiate movement

22
Q

How would you describe the facial movements of those with Parkinsons?

A

Mask like and staring

23
Q

Cause of cog wheel movements in Parkinsons?

A

Mix between the rigidity of increased muscle tone and the tremor

24
Q

How would you describe the tremor in Parkinsons?

A

Tremor at rest, abolished by movement
Worse in hands
Worse on one side of the body

25
Q

WHat happens to handwritting in Parksinsons?

A

Micrographia

26
Q

How do you test a Parkinsons patient’s balance and posture?

A

Push them and they will fall

27
Q

What is the gait known as in parkinsons?

A

Festinating gait!

28
Q

What occurs to secretions in parkinsons?

A

Increased sebaceous secretions and increased salivation

29
Q

If the gait disorder in Parkinsons is more pronounced than the Intellectual disorder what must be considered as a potential diagnosis?

A

Normal pressure hydrocephalus

30
Q

What enzyme metabolises L-Dopa?

A

Dopa decarboxylase

31
Q

what is given alongside L-Dopa medication?

A

Dopa decarboxylase inhibitor

32
Q

What is the purpose of prescribing a dopa decarboxylase inhibitor?

A

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

33
Q

What drug class are benztropine and orphenidrine?

A

Anticholinergic drugs

34
Q

What is a drug that is often used when L-Dopa is not toelrated?

A

Bromocriptine

35
Q

Recently introduced dopamine agonists that help in the fluctuating later stages of Parkinsons?

A

Pergdide

Lysuride

36
Q

What is the ‘on-off’ phenomena described in Parkinsons?

A

variability in patient response with L-dopa
Become akinetic for periods of the day
usually due to drug titres - peak or wearing off

37
Q

What is the process of skin to a pressure sore development?

A

Early erythema and oedema, erythema becomes fixed and cyanotic, blister formation, breaks down, exudate causes coagulum, skin loss, fat necrosis, muscle damage

38
Q

Type of organisms that usually infect pressure sores?

A

Gram negative

39
Q

What is the mainstay of management of deep pressure sores?

A

Debridement, cleaning, removal of eschar and slough, consider skin grafting

40
Q

Predisposing factors to the development of pressure sores?

A

Patient that is shocked or hypotensive
Sensory loss or immobility
Poor general health
Cardiac failure, anaemia, metabolic disturbances

41
Q

What are decubitus ulcers?

A

Caused by pressure most commonly on heel

42
Q

Why do gravitational ulcers develop?

A

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

43
Q

WHere do gravitational ulcers usually develop?

A

Around medial malleolus although may be anywhere on leg and even the whole way round

44
Q

Treatment of gravitational ulcers?

A

elevation of the leg, support bandages or hose, weight loss and regular exercise

45
Q

3 main types of ulcers?

A

Gravitational
Ischaemic
Decubitus

Geriatrics (10 decks)

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