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Phase 2a Neuro > Parkinsons 3A > Flashcards

Parkinsons 3A Flashcards

1
Q

What is Parkinson’s disease?

A

Loss of dopaminergic neurones from substantia nigra pars compacta

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2
Q

Is It the MC neurodegenerative disorder?

A

2nd MC after dementia

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3
Q

RF for Parkinsons
Protective factors?

A

fHx, males, increased age,

Protective = smoking, caffeine, physical activity

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4
Q

Pathology ?

A

To initiate movement - nigrostriatal pathway signals striatum to STOP firing to SNpr therefore stop movement inhibition

Degenerated SNpc = Harder to initiate movement

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5
Q

Cardinal Sx of Parkinson’s

A

Bradykinesia (slow movement, smaller writing, can’t do buttons, small steps, reduced arm swing)

Resting tremor
(At rest, unilateral, U/L pill rolling thumb, 3-5Hz)

Rigidity
(cogwheel, lead pipe)

Postural Instability (Parkinsonism, camptocormia - abnormal posture - bent forwards)

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6
Q

What is often seen early?

A

anosmia (partial loss of smell)
constipation common

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7
Q

What are some other signs of Parkinson’s?

A

Hypomimia (expressionless face)

Micrographia (small tailing off writing)

Postural hypotension (autonomic failure)

REM sleep disorder

Seborrhoea (high seborrheic dermatitis - red scaly patches)

Punding (non goal orientated behaviour)

Urinary freq/urge/incontinence

Sweating

Hypersalivation

Erectile dysfunction

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8
Q

Why can’t dopamine be given itself?

A

Doesn’t cross BBB

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9
Q

What is a Ddx for parkinsons?

A

Lewy body dementia (associated with parkinsons)

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10
Q

If a patient has Parkinson Sx then dementia?
Dementia then Parkinson Sx?

A

Parkinson dementia
Lewy body dementia with Parkinsonism

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11
Q

what medications exacerbate Parkinson’s Sx?

A

Antipsychotics (eg. haloperidol)
Metoclopramide
(drug induced often = bilateral resting tremor - inhibit movement)

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12
Q

what is cogwheel and lead pipe rigidity?

A

Cogwheel = jerky tremor superimposed on hyperfine, elicited on reinforcement

Leadpipe = smooth tremor throughout movement

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13
Q

Name some Parkinson’s Plus syndromes?

A

Lewy body dementia
Multiple system atrophy
Progressive supranic palsy
Cortico-basal degeneration
Wilsons disease, drug induced, NPH (Neurogenic orthostatic hypotension)

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14
Q

what Sx do you get in lewy body dementia?

A

Dementia / hallucination then parkinsons

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15
Q

what Sx do you get in multiple system atrophy?

A

Parkinsonism + cerebellar + autonomic features - postural hypotension, incontinence, impotence

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16
Q

what Sx do you get in progressive supranic palsy?

A

Parkinsonism + fixed upwards gaze

17
Q

what Sx do you get in cortico-basal degeneration?

A

Parkinsonism + alien limb / loss of control of one hand - moved itself

18
Q

If parkinsons is suspected in GP, what is done?

A

urgent referral

19
Q

Dx of Parkinsons?
what is found?

A

Clinical
(bradykinesia + 1 other Sx)

MRI = Normal

DaT scan = 2 dots instead of 2 commas (basal ganglia usually 2 commas)

Post excisional biopsy = loss of DA neurones in SN + Lewy bodies (ubiquitin + alpha synuclein)

20
Q

MDT Tx of parkinsons?

A

OT
SALT
PT
Vit D suppose
manage complications eg. hyper salivation, constipation

21
Q

what is the first line medical Tx of parkinsons?

A

Co-careldopa (L-DOPA + decarboxylase-i)

22
Q

what does carbidopa do?
how does it help L-DOPA?

A

Prevents L-DOPA breakdown before reaching brain

L-DOPA = Converted to DA (an amino acid) taken up by serotinergic neurones

23
Q

Why is a decarboxylase inhibitor given?

A

enzyme breaks down LDOPA so need inhibitor

24
Q

What is the problem with LDOPA?

A

Initially works very well BUT soon body becomes resistant to it, effects were off so dont give LDOPA too early (eg. v mild Sx)
‘on - off’ fluctuations, well controlled periods with sudden decline following

Add MAO-i or COMT-i

25
Q

L-DOPA is good to give to who?
SE of L-DOPA?

A

motor Sx impacting QOL
Over 65

Postural hypotension, confusion, psychosis, chorea

26
Q

What is second line medical Tx of parkinsons?

A

COMT-i = entacapone

DA Agonisms

Amantadine

27
Q

what are the SE of entacapone (COMT-i)?

A

orange urine
dyskinesia (worsens L-DOPA effect)

28
Q

what are the 2 groups of DA agonist and give examples of each?

A

Ergot derivatives = Bromocriptine, cabergoline

Non ergot derived = Ropinerole, pramipexole

29
Q

what is long term tx of parkinsons?

A

deep brain stimulation

30
Q

SE of ergot and non ergot derivatives?

A

Ergot = pulmonary / CV fibrosis

Non ergot = hallucinations

31
Q

what is the shared care plan?

A

specialist Dx + starts Tx
GP monitors + refers back if problems

32
Q

Parkinsons tremor vs benign essential tremor:
U/L or B/L?
Intention or resting?
Hz?
Alcohols effect?
Tx?

A

Parkinsons:
U/L, resting
3-5Hz
Alcohol worsens
Tx = L-DOPA

Benign Essential:
B/L, Symmetrical, intention
5-8Hz
Alcohol improves
Tx = Propanolol

33
Q

what type of inheritance is benign essential tremor?

A

Auto dominant

34
Q
A

Phase 2a Neuro (17 decks)

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