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Year 4: Neurology > Parkinsons > Flashcards

Parkinsons Flashcards

1
Q

pathophysiology of Parkinsons disease (PD)

A

loss of dopaminergic neurons in the substantia nigra pars compacta

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2
Q

triad of symptoms in PD

A

TEMOR
RIGIDITY
BRADYKINESIA

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3
Q

features of tremor in PD

A

asymmetrical
worst at rest
usually hands- “pill rolling” tremor
4-6Hz

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4
Q

what improves a tremor in Parkinsons disease

A

voluntary movement

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5
Q

features of rigidity in PD

A

increased tone - lead pipe rigidity

rigidity + tremor – cogwheel rigidity

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6
Q

gait seen in PD

A

shuffling
absent arm swing
flexed trunk

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7
Q

features of bradykinesia in PD

A

Decreased initiation of movement
Decreased speed of movement
Decreased amplitude of repetitive movements

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8
Q

speech in PD

A

monotone

quiet

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9
Q

what autonomic dysfunction contributes to instability + falls risk in Parkinsons

A

Orthostatic hypotension

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10
Q

sleep disorder seen in PD

A

REM sleep disorder

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11
Q

what is micrographia

A

small handwriting

- feature of PD

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12
Q

features suggestive of drug induced parkinsons

A

BILATERAL motor symptoms
rapid onset symptoms
resting tremor uncommon

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13
Q

what imaging modality can differentiate between drug induced parkinsons and parkinsons disease

A

DaTSCAN

- will show striata dopaminergic neuron loss in parkinsons disease

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14
Q

what class of drugs typically cause drug induced parkinsons

A

typical antipsychotics
- haloperidol, chlorpromazine

Block dopamine in substantia nigra

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15
Q

1st line treatment in PD where motor symptoms having greatest impact on life

A

Levodopa + dopa-decarboxylase inhibitor

  • carbidopa
  • madopar
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16
Q

what is the purpose of prescribing levodopa with a dop-decarboxylase inhibitor

A

reduces peripheral conversion of levodopa to dopamine

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17
Q

list 5 short term side effects of levodopa

A 
Nausea + vomiting 
postural hypotension 
red urine 
confusion / hallucinations / delusions / vivid dreams 
daytime drowsiness
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18
Q

what are the main long-term side effects of levodopa

A

dyskinesia (common -50%)
- involuntary movement

unpredictable ‘on-off’
- leads to bradykinesia

19
Q

treatment of nausea in PD

A

Domperidone

20
Q

which anti-emetic can induce parkinsons

A

metoclopramide

21
Q

treatment of daytime sleepiness in Parkinsons

A

modafinil

22
Q

treatment of REM sleep disorder in PD

A

melatonin or clonazepam

23
Q

1st line treatment in PD if motor symptoms are not impacting quality of life

A

MAO-B inhibitor

Dopamine agonist

24
Q

mechanism of action MAO-B inhibitors

A

block dopamine degradation within cell

25
Q

rasagiline and selegiline are examples of which class of drug

A

MAO-B inhibitors

26
Q

what drug can MAO-B inhibitors not be prescribed with

A

SSRI

- risk of serotonin syndrome

27
Q

side effects of rasagiline / selegiline

A

anticholinergic:

  • dry mouth
  • blurred vision
  • constipation
  • urinary retention
  • postural hypotension
28
Q

ropinirole, cabergoline, pramipexole are examples of which class of drug

A

dopamine agonists

29
Q

subcut apomorphine is an example of which class of drug

A

dopamine agonist

30
Q

side effects of dopamine agonists

A

fatigue
nausea + vomiting
Impulse control disorders - gambling, sex, eating, shopping
oedema

31
Q

mechanism of action catechol- O- methyltransferase inhibitors (COMT)

A

block dopamine + levodopa degradation outside the cell

32
Q

entacapone and tolcapone are examples of which class of drug

A

COMT inhibitors

33
Q

treatment pathway parkinsons disease

A

1st line motor - L-Dopa + dopa-decarboxylase inhibitor
1st line non-motor - MAOB (rasagiline) or dopamine agonist (ropinirole)

2nd line motor or development of dyskinesia add
- MAOB / dopamine agonist / COMT inhibitor

34
Q

what drug can be used to treat dyskinesia if other agents have been ineffective

A

amantadine

- increases dopamine release and reduces reuptake

35
Q

what drugs can be used to treat tremor in drug-induced parkinsons

A

antimuscarinics

- procyclidine

36
Q

what is progressive supranuclear palsy

A

a parkinsons plus syndrome - features of Parkinsonism +

  • vertical gaze palsy
  • slurred speech
  • falls
  • axial involvement
37
Q

what is multi-system atrophy

A

a parkinsons plus syndrome

  • autonomic dysfunction: postural hypotension, erectile dysfunction, atonic bladder
  • cerebellar features
38
Q

hot cross bun sign

A

cerebellar + pontine atrophy

- multi-system atrophy

39
Q

bilateral tremor, worse with movement/arms outstretched

improves with alcohol

A

essential tremor

40
Q

treatment essential tremor

A

propanolol

41
Q

uncomfortable sensations in lower legs, worse at rest

intense urge to move + movement providing relief

A

restless leg syndrome

42
Q

1st line management restless leg syndrome if affecting sleep/functioning

A

gabapentin / pregabalin

43
Q

what haematological abnormality is associated with restless leg syndrome

A

iron deficiency anaemia

Year 4: Neurology (24 decks)

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