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CM Clinical Symposia > Parkinsons disease 1 > Flashcards

Parkinsons disease 1 Flashcards

1
Q

Neurodegenerative disorders

A

Loss of neurones, progressive, irreversible

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2
Q

PD

A

‘Shaking palsy’, akinetic-rigid syndrome (loss of movement, increased muscle tone), extrapyramidal disorder

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3
Q

Extrapyramidal disorder

A

Can be drug induced

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4
Q

Symptoms

A
  • Tremor (‘pill rolling’, unilateral, 4-7Hz)
  • Rigidity (‘lead piping’)
  • Speech
  • Akinesia
  • Posutral changes
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5
Q

Changes in speech

A

Slurred, monotone, dribbles, dysphagia

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6
Q

Akinesia

A

Difficulty in initiating movement, facial immobility, serpentine stare

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7
Q

Postural changes

A

Stoop, shuffling, poor arm swinging, balance impaired, telegraph pole falls

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8
Q

Pathology

A
  • Loss of neurones in substantia nigra
  • Lewy bodies (spherical, eosinophilic, contain cellular proteins)
  • DA-ergic neurones affected (neuromelanin)
  • Loss of nigro-striatal inhibitory/excitatory pathway
  • Midbrain nuclei
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9
Q

Causes

A
  • Unknown
  • Sporadic
  • Drug-induced
  • MPTP-induced (amphetamines)
  • Post-encephalitic
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10
Q

Treatment - increase dopamine

A
  • Replace DA (L-DOPA)
  • Decrease DA breakdown (MAO/COMT inhibitors)
  • Increase DA release (amantidine)
  • DA agonists (bromocriptine, pergolide)
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11
Q

Treatment - decrease ACh activity

A

Antimuscarinics (behzhexol, orphenadrine)

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12
Q

L-DOPA

A

DA precursor, crosses BBB, enters neurones via DA uptake transporter > DA (in neurones and glia) retained mainly be neurones, increased DA release from remaining neurones

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13
Q

L-DOPA problems

A

Metabolism in periphery 1% reaches brain, given with cabidopa (doesn’t pass BBB, inhibits DOPA decarboxylase)

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14
Q

L-DOPA adverse effects

A

‘On-off effect’, nausea, vomiting, anorexia, dyskinesias, tachycardia, extrasystoles (domperidone), hypotension, insomnia, confusion, schizophrenic effect (clozapine)

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15
Q

Selegiline/deprenyl

A

MAOb selective inhibitor, prevents breakdown of dopamine, will improve motor symptoms of disorder, neuroprotective, ineffective alone in later stages - prolong L-DOPA

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16
Q

COMT inhibitors

A

Prevent breakdown DA, used for on-off problems

17
Q

COMT inhibitors adverse effects

A

Aggravate L-DOPA dyskinesias, nausea, diarrhoea, abdo pain, dry mouth

18
Q

Amantidine

A

Increase DA release

19
Q

Amantidine useful for

A

Early - mid

20
Q

Amantidine adverse effects

A

Confusion and hallucination in elderly (usually well tolerated)

21
Q

Dopamine agonists

A

Bromochriptine (D1/D2) or Pergolide (D2), 6-8hr 1/2 life, 1-3 hr peak taken regularly

22
Q

Bromochriptine (D1/D2) or Pergolide (D2) adverse effects

A

Dyskinesias, nausea, vomiting, severe hypotension, hallucinations

23
Q

Antimuscarinics

A

Block ACh receptor in striatum

24
Q

Examples of Antimuscarinics

A

Benzhexol/orphenadrine

25
Q

Antimuscarinics useful for

A

Young with severe tremor (drool)

26
Q

Antimuscarinics adverse effects

A
  • Periperhal anticholinergic

- Central (confusion, delusions, hallucinations, drowsiness, mood changes)

27
Q

Surgery of lesions

A

Thalamotomy (motor thalamus), pallidotomy (globus pallidus), subthalamotomy (subthalamus)

28
Q

Surgery - grafts

A

Adrenal medulla, foetal nigral tissue (not ethical), GM fibroblasts, stem cells, xenografts (substania nigra pigs)

29
Q

Huntington’s disease

A

Gradual onset, progressive, chorea and dementia, starts 30-50 (juvenile onset more severe), death 10-20 years, cerebellar atrophy

30
Q

Huntington’s symptoms

A

Irritability, moodiness, antisocial behaviour (dementia), fidgeting, restlessness (Gross choreiform movements)

31
Q

Huntington’s disease pathology

A

Selective cell loss in cerebral cortex and corpus striatum (first medium-sized spiny neurones contain GABA and enkephalin)

32
Q

Huntington’s disease pathology - neurotransmitters

A

Decrease in GABA, GAD, ACh, choline acetyltransferase, DA stays same or increases

33
Q

Huntington’s disease cause

A

AD CAG repeat, 4p16.3 (short arm), codes for ‘Huntingtin’ protein

34
Q

Huntington’s disease treatment

A

Can only control movement

  • D2 antagonists (haloperidol, chlorpromazine)
  • DA depletion (reserpine, tetrabenzine)
35
Q

D2 antagonist adverse effect

A

Parkinsonism, restlessness

36
Q

DA depletion adverse effect

A

Hypotension, depression, sedation, GI disturbances

37
Q

Dystonia treatment

A

DOPA replacement, anticholinergics, benzodiazepines (GABA increasing), Baclofen (GABAb receptor agonist), Botulinum toxin (effect motor ouput)

38
Q

Dystonia

A

Sustained muscle contractions, causing twisting and repetitive movements or abnormal postures

CM Clinical Symposia (24 decks)

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