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NSG 470 > The Physical and Psych impact of PD > Flashcards

The Physical and Psych impact of PD Flashcards

1
Q

Hallmark signs of PD

A

-Tremors
-Bradykinesia
-Muscular rigidity
-Postural instability

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2
Q

Autonomic nervous system symptoms of PD

A

Postural Hypotension
-Dysphagia
-Urinary dysfunction
-Constipation

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3
Q

Dopamine in PD

A

Dopamine levels decrease

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4
Q

Acetylcholine in PD

A

As a result of decreasing dopamine there is increased Ach released into the synapse increasing excitability leading to movement issues

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5
Q

Braak stages of PD (Stage 1)

A

Oldfactory bulb is affected

-Nuclei 9 and 10 in medulla is affected

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6
Q

Braak stages of PD (Stage 2)

A

Intermediate reticular zone,
Lower raphe, coeruleous complex

-Cellular level

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7
Q

Braak stages of PD ( Stage 3)

A

-Substantia nigra, amgydala, hippocampus

-Motor deficits become present

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8
Q

Braak stages of PD ( Stage 4)

A

Temporal mesocortex and allocrtex

Further degeneration of motor, and cognition and emotion

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9
Q

Braak stages of PD ( Stages 5-6)

A

-High order sensory association areas of neocortex and prefrontal cortex

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10
Q

Stages in PD based on symptoms progression ( Stage 1)

A

Mild , unsevere symptoms
-Tremors on ONE SIDE and postural changes are observed

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11
Q

Stages in PD based on symptoms progression ( Stage 2)

A

Moderate symptoms with facial modifications
-Tremors on both sides and postural changes are observed
-mask like face,shuffling gait

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12
Q

Stages in PD based on symptoms progression ( Stage 3)

A

Progression of disease occured

-Imbalance of body and improper reflexes are observed
-postural instability

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13
Q

Stages in PD based on symptoms progression ( Stage 4)

A

Drastic change is observed, decrease in tremors however there is increased amines is and rigidity
-Personal assistance is required in simple tasks

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14
Q

Stages in PD based on symptoms progression ( Stage 5)

A

Advanced stage with aggressive symptoms, may not be able to walk. Would need care for every daily task

-Hallucinations and spasm occur in this stage

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15
Q

Why is the scale based on symptoms progression favored over the Braak stages in the clinical practice

A

The former is easier to detect on clinical practice as it relates directly to their symptoms

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16
Q

Acetycholine

A

Excitability

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17
Q

Young onset PD

A

-Rare, occurs in ages 20-40
-Micheal J fox

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18
Q

Idiopathic PD

A

Occurs later in life
-More common
-Progresses faster in older patients
_Muscular rigidity is already present
-Cardinal signs
-Tremors at rest
-Bradykinesia
-Muscular rigidity

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19
Q

Drug induced PD

A

-Some drugs block or limit dopamine
-this is REVERSIBLE, just stop giving the drug
-Mostly antipsych

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20
Q

Common drugs that cause drug induced PD

A

-Lithium
-Haldol (Haloperidol)
-Thorazine (Chlorpromazine)
-Reglan (Metoclopermide)
-Phenergan (Promethazine)
-Methyldopa (Aldomet)

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21
Q

PD occurs more in males (T/F)

A

True, however postmenopausal women also have an increased rate in comparison to those prior to menopause

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22
Q

Age of onset for PD

A

40-70

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23
Q

Environmental exposure in relation to PD

A

-Occupational: Lead exposure
-Exposure to toxins
-Exposure to pestisides
-Exposure to heavy metals
-Drinking well water

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24
Q

Dopamine

A

Inhibition of muscle fibers

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25
Q

Diagnosis of PD

A

-Diagnosis of occlusion, no definite test
-Hallmark signs
-Levodopa challange
-Smell test
Neuro imaging
-MRI, PET, SPET

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26
Q

Levodopa challenge

A

-Giving a small dose of levodopa and seeing if there is improvement

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27
Q

Smell test

A

-Old factory is one of the first to be affect by PD and can be an early indication with a smell test

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28
Q

Which cranial nerves are affected by PD

A

-Oldfactory
-Ocular-motor, decreased blinking, impairment of upward gaze

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29
Q

Motor disturbances in PD

A

-Shuffling Gait (Cant pick up feet due to decreased muscle control)
-Stooped posture
-Decreased arm swing
-Rigidity
-Cog-wheeling (Arms move up jumpy like a robot)

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30
Q

True or false those with early PD with tremors, the tremors are always present

A

False, the can go away with movement and when sleeping, later into the disease it will be present even with movement

31
Q

Bradykinesia

A

-Slowness of voluntary movement
-Reduced automatic movements
-Difficulty with initiation with movement, impacting fine motor control.
-Micrographia
-Soft voice or monotone

-Example, Issues with buttoning with the shirt

32
Q

Autonomic (Non-motor) disturbances

A

-Dizziness or vertigo
-Orthostatic hypotension
-Drooling
-Constipation
-Sweating
-Erectile dysfunction

33
Q

Mask like face

A

Symptoms with PD, Affect becomes flat, they cannot smile or frown.

-Voice becomes soft and quiet

34
Q

Pill rolling

A

Symptom with PD which a person looks like they are rolling a marble in their hands

35
Q

Tremors in PD

A

-Rhythmic movement of a limb
-Usually the presenting symptom
-Most reliable sign of degeneration of substantia nigra
-Pill rolling
-Usually arm before leg
-Finger shaking to entire hand shaking
-More noticeable under stress
-Can disappear with activity or sleep

36
Q

Micrographia

A

occurs with PD, hand writing becomes tiny, linked to decreased fine motor control

37
Q

Muscular rigidity

A

-Stiffness of the muscles
-Felt with passive ROM (Cog wheel, jumpy movement)
-Affects both extensors and flexors
-Resistance is felt when they are relaxed, lead pipe

38
Q

Postural instability

A

Dopamine is responsible for inhibition, leading to smooth movement, with PD this is interfered
-Control over pace is worsened, can have periods where they increase pace and decrease pace (Racing baby steps)
-Wide base, dont wanna fall

-FALL RISK

39
Q

Racing baby steps

A

Going fast and then slow, they cant control pace

40
Q

Orthostatic hypotension

A

-Disorder of the autonomic nervous system
-Failure of arterial baro-receptors (Cant regulate BP effectively)

-Criteria
-SBP decrease of 20 mmHg with change of position
-DBP decrease of 10 mm Hg with change of position

41
Q

Dysphagia

A

Difficulty swallowing

-Later complication of neurologic degeneration
-CN 9,10,12 regulate tongue and swallowing

-Drooling, inability to automatically swallow saliva

42
Q

Issues with urinary dysfunction

A

-Frequency, urgency, incontinence
-UTI

-FUNCTIONAL incontinence related to mobility issues

43
Q

Constipation in PD

A

-ANS dysfunction (Decreased Motility)
-Decreased physical activity (shuffling doesnt move as much bowels)
-Anticholinergic meds (Dries you out)
-Other constipating meds

-Decreased oral intake, cannot swallow as well

44
Q

Collaborative problems

A

-Physical S+S of PD
-Seborrhea (Over-secretion of oils)
-Corneal abrasions
-Lewy body dementia

45
Q

Dopaminergic agents

A

-Acts to increase dopamine within the basal ganglion
-Essentially artificial dopamine
-There is increased tolerance and drug metabolism over time,
-Wearing off effect leading to returning symptoms

-Short half life (90-120 min) needs like 3-6 doses a day
-Tolerance is frequent
-Need to administer between meals for adequate absorption

46
Q

side Effects of Dopaminergic agents

A

-Increased restlessness (Too high of a dose)
-Dyskinesia
-Orthostatic hypotension
-Mental disturbances
-Insomnia

47
Q

Levo-dopa/ Carbidopa

A

-Gold standard of PD treatment
-Most potent anti-PD agent
-Precursor to dopamine, develops into dopamine in circulation

-Carbidopa blocks PNS inhibition
-Sinemet (Combo of the drugs) only works on the CNS

48
Q

Dopamine agonist

A

-Acts to release dopamine, more dopamine in the synapse
-More effective when used in combination with dopaminergic drugs

-Side effects: Orthostatic hypotension, Dyskinesia, Hallucinations

49
Q

bromocroptine (Paradol)

A

Dopamine Agonist

50
Q

Ropinirole (Requip)

A

Dopamine agonist

51
Q

Pramipexole (Mirapex)

A

Dopamine Agonist

52
Q

Carbidopa

A

Dopaminergics agent, that acts to reduce metabolism of levodopa

53
Q

Anti-cholinergic agents

A

-Decreases Ach, which decreases the excitability
-Helps to control tremors and rigidity
-Drys you out
-Used also in treatment of tardive-dyskinesia

-Side effects: Dry mouth, Constipation, Urinary retention, Confusion

54
Q

Benztropine (Cogentin)

A

Anti-cholinergic agent

55
Q

Trilhexyphenidyl (Artane)

A

Anti-Cholinergic agent

56
Q

Catechol O-Methyltransferace Inhibitor (COMT)

A

-Prevents the breakdown of Levodopa, leaving more dopamine in the receptor

-Works best when combined with dopaminergic and dopamine agonist agents

-Side effects: Monitor for dyskinesia when given with levodopa
-Diarrhea
-Causes the urine to turn dark

57
Q

Entacapone (Comtan)

A

COMT

58
Q

Monoamine Oxidase Type B (MAO-B) Inhibitors

A

-Inhibits Monoxidase B activity, Increasing activity levels
-Reduces “Wear off” effect of levodopa when given with levodopa

*Need to avoid foods with tyramine, can cause hypertensive crisis

59
Q

Selegiline

A

MAO-B inhibitor

60
Q

Rasagine

A

MAO-B inhibitor

61
Q

Foods rich with tryamine

A

-Aged cheese, Cured meats, red wine, broad beans, ripened fruit

-Smoked and old stuff

62
Q

Anti-virals medications

A

-Stimulates release of dopamine and prevents reuptake
-We dont know why it works

-Side effects: Anxiety, confusion, anticholinergic effects (Dry)

63
Q

Amantadine (Symmetrel)

A

Anti-viral

64
Q

Deep brain stimulation

A

-Invasive, electrode implanted into thalmus, and shock is delivered to interfere with tremor cells and reduces tremors

-Monitor for infection, hemorrhage or stroke

65
Q

Stereotactic pallidotomy

A

-Destroy a chunk of the brain, (Globus pallidus)
-Insert probe through probe hole (Destroys that area of the brain as well), to provide electrical stimulation to destroy part of globus pallidus and thalamus (Decreasing motor symptoms
-Improves: Tremor, muscle rigidity, bradykinesia, dyskinesia

-Need to assess for neurologic deficits and brain hemorrhage and infection post op,
-destroying a part of the brain you need to monitor to make sure you didnt destroy something important

66
Q

Complications of PD/Collaborative problems:

A

-Decreased Mobility
-Falls
-Dysphagia
-Weight loss
-Aspiration pneumonia
-Urinary/retention/UTI/ Incontinence
-Bowel obstructions
-Self care Deficits (Loss of independence)

-Altered cognition: Lewy body Dementia

67
Q

Psychosocial impact of PD (Depression): Physiological causes

A

-imbalance of serotonin
-Sleeping disturbances
-Sexual dysfunction

68
Q

Psychosocial impact of PD (Depression) Cognitive causes

A

1/3 of persons with PD develop cognitive impairment and dementia (Lewy body)

69
Q

Psychosocial impact of PD (Depression) Psycho-social

A

-Adaptation to chronic and slowly debilitating illness
-Personality changes, becomes more withdrawn
-Mood changes
-Lewy-body Type: hallucinations/anger/agitation

70
Q

Which protein is responsible for Lewy body dementia

A

alpha synuclein

71
Q

Lewy Body dementia

A

Alpha-synucle is a protein that clumps up in large deposits occluding transmission of chemicals

-Results in deficits in Thinking, Movement, Behavior, Mood
-Lots of psychosis
-Doesnt respond to dementia drugs

72
Q

Fetal Stem cell transplant

A

Implantation of cells which develop into dopamine producing cells
-Sucks, because initially it releases too much dopamine
-Also sucks because those new cells become diseased over time

73
Q

Where is dopamine stored in the brain

A

Substantia Nigra, and when it becomes dmg it leads to decreased dopamine levels

NSG 470 (26 decks)

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