Parkinsons Flashcards
Average age of onset of parkinsons
60 y/o
Where is there degeneration of neurons in parkinsons?
Substantia nigra
What type of neurons are degenerated in parkinsons?
Domapinergic
What jobs can be linked to parkinsons and why?
Farmer - pesticides
Classical triad of parkinsons
resting tremor, limb rigidity and bradykinesia
In what state should they be referred to a specialist?
untreated
How can a parkinsons tremor be exasserbated?
Distration / emotion
rigidity =
stiffness of limbs
how best is rigidity tested for?
Passive movement of the arms
how to distinguish from spasticity?
EQUAL in both extensors and flexors
what is intact on the neuro exam?
power
5 cognitive / psychiatric features
Constipation Urinary difficulties depression sexual problems dementia (late)
What is used when difficult to differentiate from essential tremor?
DAT scan - Dopamine active transporters
Nuclear medicine scan which allows you to see how the dopamine active transporters are working
What is given in combo with L-dopa
peripheral decarboxylase inhibitor
What does L-dopa specifically improve?
Bradykinesia and rigidity
Below what age may L-dopa be held off?
<55
3 SE of L-dopa
Drowsines
Postural hypotension
Psychiatric complications
Example of a dopamine agonist
bromocriptine
Additional SE with dopamine agonist
N&V
Drug type that helps tremors
Anticholinergic drug
Example of ACH drugs
Benzhexol
SE of ACH drugs (5)
Dry mouth Constipation Urinary retention Blurred vision Hallucinations
Which drugs can delay the need for L-dopa
MOA B inhibitors
4 drugs mimicking parkinsons
Neuroleptics
Metoclopromide
Prochloroperazine
Lithium
5 red flags of P+
Early postural instability Early autonomic features Fluctuating cognition and hallucinations Akinetic rigidity in one limb Pyramidal signs
Definition of P+
Other forms of parkinsonism that have clinical features not typical of parkinsons disease
What may indicate progressive supranuclear palsy?
Little response to L-dopa
3 characteristics of PSP
falls early on (backwards)
symmetrical parkinsonism
cognitive decline
Multi-system atrophy 2 characteristics
symmetrical Parkinsonism and cerebellar signs
Which drugs commonly lead to drug induced parkinsonims
Antipsychotics
3 features of vascular Parkinsonism
Lower body signs predominate
Tremor less common
lack of facial expression
dystonia =
state of abnormal muscle tone
define akathisia
severe restlessness
tardive dyskinesia =
abnormal involuntary movements
“choreoathetoid”
anti emetic to be given in parkinsons
Domperidone (DOES NOT CROSS THE BBB)
