Parkinsons Flashcards

1
Q

Death of neurons in what area of the brain cause Parkinson’s

A

substantia nigra

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2
Q

What neurotransmitter decreases in PD due to neuronal death?

A

Dopamine

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3
Q

What type of functions does dopamine assist with

A

smooth, coordinated function

movement

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4
Q

What are the major symptoms

A
TRAP
tremor
rigidity
akinesia/bradykinesia
postural instability
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5
Q

Does PD start unilateral or bilateral?

A

unilateral then progresses to bilateral

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6
Q

What is the AIMS scale?

A

measures involuntary movements caused by meidcations

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7
Q

which medications can worsen PD

A
dopamine blockers
phenothiazines (pyschosis)
butyrophenones (haloperidol) 
FGAs and SGAs
metoclopramide (renally cleared, can accumulate in elderly)
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8
Q

what is anosmia?

A

loss of sense of smell

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9
Q

what is an off period in PD

A

symptoms of disease worsen before the next dose of the med is due

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10
Q

What antidepressants are often used in PD patients?

A

SSRIs however secondary amine tricyclics could be used if worried about worsening tremors or sertonin syndrome (nortriptyline)

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11
Q

Which drug is preferred in pyschosis in PD patients

A

quetiapine

low risk of movement disorders s

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12
Q

role of levodopa

A

assists with movement issues
prodrug of dopamine
most effective agent

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13
Q

Why is carbidopa given with levodopa

A

prevents peripheral metabolism of levodopa so that it can cross the BBB

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14
Q

Which patient population do we mainly use dopamine agonists first line in?

A

younger patients

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15
Q

Why are multiple drugs needed in PD

A

to reduce “off” periods and limit dyskinesias

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16
Q

what can be used to in tremor predominant younger patients

A

centrally acting anticholinergics

MAO inhibitors can also be used (amantadine)

17
Q

how are the MAO inhibitors in PD different from the ones used in depression?

A

they are selective

ones in depression are non-selective and are CI with dopaminergic drugs due to blocking the metabolism

18
Q

What is our primary treatment goal with PD and the options?

A

REPLACE DOPAMINE

  • give a precursor like Sinemet
  • give a dopamine agonist
  • give drugs for specific symptoms
19
Q

what drug can help with the symptoms of resting tremor?

A

benztropine

20
Q

Side effects with carb/levo

A

pyschosis, dyskinesias, orthostasis, dizziness, nausea

darkening of body secretions

21
Q

When can a COMT inhibitor be initiated?

A

only if levodopa is on board

it increases the duration of action of levo

22
Q

COMT inhibitor

A

Entacapone

23
Q

warnings with dopamine agonists

A

sudden daytime sleep attackces
hallucinations
dyskinesias

24
Q

Which dopamine agonist comes as a patch

A

rotigotine

25
Q

list of dopamine agonists

A

pramipexole

ropinirole

26
Q

what type of drug is benztropine?

A

anticholinergic