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Neurology > Parkinsons > Flashcards

Parkinsons Flashcards

1
Q

What is Parkinsons Disease

A

Condition where there is progressive reduction of dopamine in the basal gangia of the brain, leading to disorders of movement

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2
Q

Classic triad of PD

A

Asymmetrical resting tremor, rigidity, bradykinesia

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3
Q

Pathophysiology of PD

A

Degeneration of the corpus striatum and basal ganglia in nigrostriatal pathway - where dopamine is produced

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4
Q

What is the role of dopamine

A

Essential for the functioning of basal ganglia, responsible for movements and patterns

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5
Q

Motor symptoms in PD

A

Cogwheeling, parkinsonian gait, hypomimetic faces, postural instability, difficulty getting going, fine motor problems

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6
Q

Non-motor symptoms in PD

A

Autonomic involvement such as constipation and ED, olfactory loss, REM behaviour disorder, psychiatric problems

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7
Q

How is the tremor descibed in PD

A

Frequency of 4-6Hz (4-6 times a second). ‘Pill rolling tremor’.

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8
Q

What exaggerates the resting tremor

A

Distracting patient with other tasks

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9
Q

What makes the tremor better

A

Voluntary movement

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10
Q

What is ‘Cogwheel’ rigidity

A

If you take the hand and passively flex and extend their arm at the elbow, there is a tension in their arm that gives way to movement in small increments like tiny jerks

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11
Q

What is bradykinesia

A

Movements start to get slower and smaller

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12
Q

What is the Parkinsonian gait

A

Small steps when walking. ‘Shuffling gait’

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13
Q

What is hypomimia

A

Reduced facial movements and expressions

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14
Q

What can happen to a patients hand writing

A

Gets smaller and changes

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15
Q

What are Parkinson’s-plus Syndromes

A

Progressive supranuclear palsy, multiple system atrophy, cortico-basal degeneration, lewy body dementia

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16
Q

What is multiple system atrophy

A

Degeneration of basal ganglia and other structures in the brain - leads to Parkinsonism, autonomic dysfunction and cerebellar dysfunction

17
Q

What is progressive supranuclear palsy

A

Parkinsonism and a vertical gaze

18
Q

What is cortico-basal degeneration

A

Parkinsonism and spontaneous activity by an affected limb or akinetic rigidity

19
Q

What type of dementia is associated with Parkinson’s

A

Lewy body demetia

20
Q

What happens in Lewy body dementia

A

Parkinsonism, and fluctuations in cognitive impairment, visual hallucinations, delusions, disorders of REM

21
Q

Diagnosis of PD

A

Based on clinical symptoms and examination - NICE recommend using specific guidelines

22
Q

Aims of treatment in PD

A

Enhance nigrostriatal dopaminergic activity and secondly to inhibit cholinergic activity

23
Q

What is the first line treatment

A

Levadopa - dopamine precursor. Given with peripheral decarboxylase inhibitor

24
Q

Co-formulations of levadopa and PDI

A

Carbidopa and Benserazide given so form Co-careldopa and co-beneldopa.

25
Q

Side effects of levadopa coformulations

A

N+V, dystonia, chorea, athetosis, hallucinations, anxiety, sedation, confusion, dizziness

26
Q

What difficulties can happen with Levadopa over time

A

Becomes less effective over time

27
Q

Medical options for management of PD

A

COMT inhibitors, dopamine agonists, MAOBI, levadopa

28
Q

Eg of COMT

A

Entacapone and Tolcapone

29
Q

What do COMT inhibitors do

A

Stop metabolism of dopamine in body and brain

30
Q

Eg of dopamine receptor agonists

A

Bromocryptine, pergolide, carbergoline, apomorphine, pramipexole, ropinirole, rotigotine

31
Q

What do dopamine receptor agonists do

A

Used as an adjunct and in longer duration than levadopa. Usually used after levadopa

32
Q

Side effects of dopamine agonists

A

Pulmonary fibrosis, more psychomimetic

33
Q

What is Domperidone used for

A

Reduces N+V effects of levadopa

34
Q

Side effects of domperidone

A

Vasodilation, postural hypotension, arrhythmias

35
Q

Eg of monoamine oxidaase-B inhibitors

A

Selegiline and Rasagaline

36
Q

What do MOAB inhibitors do

A

Block enzyme from breaking down dopamine. Used in combination with levadopa

Neurology (21 decks)

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