Tremor Flashcards
What is the pathology behind Parkinson’s disease?
Loss of the dopaminergic neurons in the substantia nigra
How will a Parkinson’s patient present?
Mask like facies cogwheel rigidity bradykinesia resting tremor ie pill-rolling gait/postural instability
What will CT show in a Parkinson’s patient?
Nothing, use MRI to diagnose degeneration in the substantia nigra;
Imaging should not be necessary as Parkinson’s is a clinical diagnosis
What Ach antagonist can be used in the treatment of Parkinson’s?
Benztropine;
Only use in young people with mild disease ie tremor
What is selegiline?
MAO-B inhibitors;
Treatment of Parkinson’s;
Prevent breakdown of dopamine in the CNS by MAO-B
Where to COMT inhibitors act?
COMT inhibitors act in the peripheral nervous system to prevent breakdown of L-DOPA;
“-capones”
What is the MOA of carbidopa?
Carbidopa prevents the breakdown of L-DOPA to dopamine in the PNS
What is Ropinerole?
Dopamine agonist;
activates D2 receptors;
Pramipexole is another
When do you prescribe dopamine agonists, such as Pramipexole and Ropinerole, for Parkinson’s?
If they are <70 and functional
When do you prescribe Levodopa/carbidopa for Parkinson’s?
If they are >70;
L-dopa, carbidopa will wear off over time;
Use MAO-B inhibitors and COMT inhibitors to augment the function of Levodopa/carbidopa
What is the pathology behind essential tremor?
Familial;
Tremor with movement, no tremor at rest;
usually middle-aged males
What is the treatment for essential tremor?
Low dose non-selective beta-blocker
What is the pathology behind intention tremor?
Cerebellar dysfunction;
tremor with movement, no tremor at rest;
worsens closer to target;
no treatment
What is the pathology behind Huntington’s?
Anticipation - trinucleuotide repeats;
AD;
Chorea - purposeless, ballistic and uncontrolled movements
