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IM4 > Parkinsons > Flashcards

Parkinsons Flashcards

1
Q

What is Parkinson’s disease?

A

A chronic, progressive neurodegenerative disease of the CNS that manifests primarily in motor dysfunction

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2
Q

Causes of Parkinson’s

A
  • Exact cause unknown
  • Family history
  • Traumatic brain injury
  • Exposure to pollutants
  • Exposure to chemicals and metal
  • Drug induced
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3
Q

Parkinson’s pathophysiology

A

Lack of dopamine that is essential for normal function of the motor system
60% neuron loss and 80% dopamine decrease

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4
Q

Parkinson’s clinical manifestations

A
  • Onset is gradual
    TRAP
  • Tremor - at rest
  • Rigidity
  • Akinesia/Bradykinesia
  • Postural instability
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5
Q

Tremor

A
  • Often first sign
  • Initially minimal
  • More prominent at rest!
  • Aggravated by emotional stress and increased concentration
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6
Q

Loss of automatic movements in Parkinson’s

A
  • Stooped posture
  • Masked face
  • Drooling
  • Festination (shuffling gait)
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7
Q

Appearance of patient with Parkinson’s

A
  • Blank facial expression
  • Slow monotone, slurred speech
  • Tremor
  • Forward told to posture
  • Short shuffling gait
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8
Q

Parkinson’s nonmotor symptoms

A
  • Depression, anxiety, apathy
  • Fatigue
  • Inability to plan/poor attention
  • Pain
  • Urinary incontinence and constipation
  • Erectile dysfunction
  • Memory changes
  • Sleep problems
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9
Q

Parkinson’s complications

A
  • Motor symptoms
  • Weakness
  • Neurological problems
  • Neuopsychiatric problems
  • Dementia sometimes
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10
Q

General debilitation may lead

A
  • Pneumonia
  • UTIs
  • Skin breakdown
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11
Q

Parkinson’s diagnostic tests

A
  • Takes a while to be diagnosed
  • Patient history and s/s
  • Presence of 2 or more elements of TRAP
  • Positive response to antiparkisonian drugs
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12
Q

Parkinson’s drug therapy

A
  • Dopaminergic agents
  • Anticholinergic agents
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13
Q

Dopaminergic agents

A
  • Levodopa
  • Most commonly used
  • Promote activation of dopamine receptors
  • Food delays absorption
  • Benefits diminish over time
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14
Q

Anticholinergic agents

A
  • Benztropine (Cogentin)
  • Prevent activation of cholinergic receptors
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15
Q

Levodopa/Carbidopa (Sinemet)
Mode of Action

A

Levodopa is converted to dopamine in the CNS.
Carbidopa prevents peripheral destruction of levodopa. Converted to dopamine in basal ganglia

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16
Q

Levodopa/Carbidopa (sinemet)
Adverse Effects

A
  • N/V
  • Dyskinesias
  • Postural hypotension
  • Dysrhythmias
  • Psychosis
  • Impulse control
  • Dark sweat and urine
17
Q

Pramipexole

A
  • Dopamine agonist
  • 1st line drug or supplement to levodopa
  • Used alone in early PD and with levodopa in advanced PD
18
Q

Pramipexole adverse effects

A

Monotherapy: sleep attacks, nausea, dizziness, insomnia, constipation, weakness, hallucinations
Combined: Orthostatic hypotension, dyskinesia, increased hallucinations

19
Q

Anticholinergics

A
  • Trihexiphenidyl & Benztropine
20
Q

Anticholinergic MOA

A

Blocks muscarinic receptors in the striatum. Decreased activity of Ach

21
Q

Anticholinergic adverse effects

A
  • Dry mouth
  • Urinary retention
  • Tachycardia
  • Blurred vision
  • Constipation
  • Photophobia
  • Confusion
  • Hallucinations
22
Q

COMT inhibitors

A
  • Entacapone and Tolcapone
  • Inhibit metabolism of levodopa in the periphery
  • No therapeutic effects of their own
23
Q

MAO-B inhibitors

A
  • Selegiline and Rasagiline
  • Prolong half life of levodopa
  • Increase dopamine
  • When used early in disease, may delay need for levodopa
24
Q

Other agents used to manage PD

A
  • Antihistamines with Anticholinergic or B-Adrenergic blockers to manage tremors
  • Antiviral agent amantadine - increases dopamine
  • Apomorphine needs to be taken with antiemetic
25
Q

Parkinson’s Surgical management

A
  • Deep brain stimulation
  • Ablation (destruction)
  • Transplantation
26
Q

Deep Brain Stimulation

A
  • Most common surgical treatment
  • Reversible and programmable
  • Improves motor function
  • Reduces dyskinesia and meds
27
Q

Seligiline

A
  • Should be taken with breakfast/lunch ONLY to avoid insomnia
  • Avoid processed foods and proteins
28
Q

Ablation Surgery

A
  • Locate, target, destroy area of brain affected by PD
  • Destroys tissue that produces abnormal chemical or electrical pulses leading to tremors or other symptoms
  • Thalamotomy, Pallidotomy, Subthalamic Nucleotomy
29
Q

Transplantation

A
  • Transplantation of fetal neural tissue into the basal ganglia
  • Research/Clinical trials ongoing
  • Provides DA producing cells in brain
30
Q

Nutritional therapy

A
  • Malnutrition and constipation can be serious
  • Adequate fiber
  • Eating more numerous small meals, provide ample time
31
Q

Patients with Dysphagia and bradykinesia need

A

Food that is easily chewed and swallowed

32
Q

Nursing Management PD

A
  • Maintain independence in ADLs
  • Remove area rugs, rails in bathroom, shower seats, ramp!
  • PT, OT, speech

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