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Neurology > Parkinsons > Flashcards

Parkinsons Flashcards

1
Q

Describe the pathophysiology of Parkinsons

A

Degeneration of the dopamine producing neurons in the substantia nigra leading to a hypokinetic state

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2
Q

Where is the substantia nigra located?

A

The pars compacta of the basal ganglia

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3
Q

What is the biggest risk factor?

A

Age

Over the age of 60 increases your risk

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4
Q

List some risk factors for developing Parkinson’s:

A 
Male
>60y/o
Rural living
Pesticide exposure
Previous head injury
Beta blocker use
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5
Q

What protein is found in Lewy bodies associated with Parkinson’s?

A

Alpha-synuclein protein

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6
Q

How is the alpha-synuclein gene inherited

A

Autosomal dominant

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7
Q

What are the main motor symptoms of Parkinsons

A 
Bradykinesia (unilateral initially) 
Shuffling gait
Pill rolling tremor
Rigidity
Postural Instability - stooping
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8
Q

List some of the non-motor related features of Parkinson’s:

A 
Inability to sleep
Hallucinations
Expressionless face
GI dysfunction
Cognitive impairment
Pain
Fatigue
Olfactory dysfunction
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9
Q

What is a prodromal, non-motor clinical symptom that should make you suspicious of Parkinson’s?

A

Anosmia / Hyposmia

i.e. loss or reduced sense of smell

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10
Q

What are some of the neuro-psych complications of Parkinson’s?

A

Depression
Parkinson’s dementia
Hallucinations

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11
Q

What investigations should be done for Parkinson’s?

A

No specific investigations to diagnose PD

Only carry out investigations to eliminate other potential DDx

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12
Q

What is first line treatment for Parkinson’s with motor symptoms?

A

Levodopa

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13
Q

What is the mechanism of action in Levodopa?

A

Is the inactive form of dopamine - crosses the blood brain barrier and is converted to dopamine, increasing the overall levels

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14
Q

What medications should be avoided in older patients and why?

A

Dopamine agonists

Can induce hallucinations and delirium

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15
Q

What is the main principle of drug management in PD?

A

Symptomatic treatment

There is no neuroprotective or disease modifying agents available for PD

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16
Q

What can be given to treat a tremor?

A

Anticholinergics e.g. clozapine

Be careful when prescribing to elderly

17
Q

What groups of people other than the elderly should you be wary of prescribing dopamine agonists and levadopa to?
WHY?

A

Patients with history of addiction, OCD and impulsive personalities

Impulsive behaviors can occur as a s/e of these drugs

18
Q

What drug must be combined/ prescribed alongside levodopa?

Describe its mechanism of action:

A

Carbidopa

A dopa-decarboxylase inhibitor which catalyses the conversion of levodopa to dopamine

19
Q

What should you consider doing if a patient develops hallucinations?

A

Lower their dose of levodopa

If that doesn’t work prescribe an atypical anti psychotic

20
Q

What drugs can induce “Parkinsonism”

A

Any drugs which inhibit dopamine production e.g. anti psychotics

21
Q

What other class of drugs can be used in early Parkinson’s?

A

MAO-B inhibitors

e.g. rasagiline

22
Q

Other than medication, how else can Parkinson’s be managed?

A

Physiotherapy
Deep Brain stimulation
Basal ganglia ablation

23
Q

Give an example of a Dopamine Agonist:

A

Ropinirole

Pramipexole

24
Q

What are some of the S/E’s of Levodopa and dopamine agonists:

A 
Nausea
Oedema
Daytime somnolence 
Hallucinations
Motor complications e.g. response fluctuations and dyskinesia
25
Q

What drug can be given if dyskinesia’s are not be controlled effectively by levodopa and dopamine agonists?

A

Amantadine Hydrochloride

26
Q

What is the mechanism of action of amantadine hydrochloride?

A

Amantadine is a weak dopamine agonist with modest antiparkinsonian effects.

27
Q

What chronic diseases are contraindications for amantadine therapy?

A

Gastric ulcers

epilepsy

28
Q

What are some (uncommon) severe side effects of amantadine that need to be aware of?

A

Psychosis
Neuroleptic malignancy syndrome
Seizures
Tremor

29
Q

What is the classic triad of symptoms in Parkinson’s?

A

Resting tremor
Bradykinesia
Rigidity

Neurology (15 decks)

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