Term
| How is muscle tone affected in Parkinson's? |
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Definition
| Increased tone or rigidity leading to resistance to passive movement, with ratchet like 'cogwheel' interruptions of passive movement |
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Term
| How is gait and posture affected in Parkinson's? |
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Definition
difficulty getting out of a bed or chair
Difficult to initiate walking, must lean forward and walk in place to initiate
Gait is small shuffling steps, no arm swing
Gait increases in speed as they walk so they can prevent falling: 'festinating' gait
Unsteadiness on turning and difficulty stopping |
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Term
| How are facial expressions affected by Parkinson's? |
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Definition
| Face becomes relatively immobile, lack of expression |
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Term
| What are early s/sx of Parkinson's dz? |
|
Definition
depression
constipation
impaired smell
insomnia
blepharoclonus (eyelid flutter); often with blepharospasm
Myerson's Sign - glabellar reflex
cognitive decline
Dysphagia and weight loss |
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Term
|
Definition
| fluttering of closed eyelids |
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Term
|
Definition
| If the glabella (top of nose between eyebrows) is tapped, pt is unable to resist blinking |
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Term
| What is a very early sign of Parkinson's dz? |
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Definition
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Term
| Why is a walker not a useful device for Parkinson's dz tx? |
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Definition
| It forms a visual block of the floor, which leads to inability to gauge movement, so they simply choose not to move and risk falling |
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Term
| When can olfactory compromise begin to present if Parkinson's is developing? |
|
Definition
| Up to 5 years prior to dx, an early sign |
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Term
| When can depression begin to present as Parkinson's develops? |
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Definition
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Term
| How does the cognitive decline associated with PD compare to AD? |
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Definition
| PD is milder, less debilitating |
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Term
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Definition
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Term
| What is a frontal override? |
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Definition
| A conscious decision in the frontal cortex overruling a reflexive action |
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Term
| What must be restored to treat PD? |
|
Definition
| balance between dopaminergic and cholinergic influences of GABA |
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Term
| What are drugs that increase dopamine levels in PD? |
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Definition
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Term
| What is the mechanism and use of levodopa? |
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Definition
| dopamine precursor used to increase dopamine levels in PD. Is given w/ carbidopa (Sinemet) |
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Term
| What is the mechanism and use of amantadine? |
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Definition
| Antiviral drug that enhances dopamine synthesis, release, and re-uptake in surviving neurons of PD pt's. Mechanism ultimately unknown. Does not work on all individuals, loses effectiveness over time on pt's it does work on. |
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Term
| What is the dose of Levodopa? |
|
Definition
| .5 to 1 g qd (sometimes bid-qid) |
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Term
| What are PD drugs that stimulate dopamine receptors? **edit: this will not be on the test** |
|
Definition
apomorphine
pramipexole
ripinirole
pergolide
bromocriptine |
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Term
| What are drug classes that inhibit DA metabolism for PD tx? |
|
Definition
MAO-B inhibitors
COMT inhibitors (Catechol-o-methyltransferase)
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|
|
Term
|
Definition
DA metabolism inhibitor (COMT inhibitor), used to treat PD and is now on the market, given in 1 tab q3-8h
Is mixed with Sinemet to form Stalevo. |
|
|
Term
|
Definition
| DA metabolism inhibitor (COMT inhibitor), used to treat PD, given in 100 to 200 mg t.i.d. doses |
|
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Term
| What are anti-cholinergice drugs used to treat PD? |
|
Definition
hyoscyamine
trihexyphenidyl
biperiden
benztropine |
|
|
Term
| What are ocular SE of anti-cholinergic drugs? |
|
Definition
dry eye
lose accommodation
pupillary dilation |
|
|
Term
| How can PD related spasms be treated? |
|
Definition
|
|
Term
|
Definition
| production of a lesion the thalamic nuclei by thermal or electrical means. Now largely obsolete due to L-dopa drug classes, but still used some. |
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|
Term
|
Definition
| surgical destruction of part of the thalamus |
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Term
| What is deep brain stimulation? |
|
Definition
| Thalamic stimulation: pacemaker implanted into thalamus to control tremor. Mechanism unknown. |
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Term
| What are 4 future PD tx that are currently being evaluated? |
|
Definition
neuroprotective deactivation of free-radicals
neural tissue transplants from fetal pigs to restore affected area
modification of genetic code of others cells to create dopamine
implantation of human RPE cells (they produce L-dopa) |
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|
Term
|
Definition
Destruction of cholinergic and GABA-ergic neurons that leads to excess DA
autosomally dominant inheritance
s/sx do not appear until adulthood, generally 4th or 5th decade. |
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Term
| What is the mechanism of Huntington's dz? |
|
Definition
loss of cerebral cortex and corpus striatum
destruction of cholinergic and GABA-ergic neurons which results in imbalance with excess DA |
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|
Term
|
Definition
| movement disturbance 'dancelike' herky jerky movement. Typical of Huntington's. |
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Term
| What are the precursors of HD related dementia? |
|
Definition
| moodiness and irritability --> full blown dementia |
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|
Term
|
Definition
positive family history
genetic testing |
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|
Term
|
Definition
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Term
| What drugs are used to treat HD symptoms? |
|
Definition
haloperidol for spasmodic movement of limbs and face
tetrabenazine decreases involuntary movements by decreasing DA level |
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|
Term
| What is myasthenia gravis? |
|
Definition
| autoimmune attack of ACh receptors by Ab's that damage postsynaptic muscle membrane |
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Term
| Myasthenia gravis is often comorbid with what disorders? |
|
Definition
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|
Term
| Myasthenia is more prone in what gender? |
|
Definition
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|
Term
| When is onset of myasthenia gravis seen? |
|
Definition
| Two peak onsets: ~20 yr and then 50-60 yrs |
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Term
| In what dz does bradykinesia sometimes present as a sudden stoppage of all movement? |
|
Definition
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|
Term
| Does Parkinson's related tremor induce the 'cogwheel' stepped motion that presents as s/sx of PD? |
|
Definition
| No, the stepped motion will be observed even if tremor is not present |
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|
Term
|
Definition
| A carbidopa/levodopa mix that is used to treat PD. |
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|
Term
| What is the advantage of sinemet? |
|
Definition
| The carbidopa prevents levodopa induced nausea due to levodopa digestion in the stomach. |
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|
Term
| What is the #1 Parkinson's drug? |
|
Definition
| Sinemet (levodopa/carbidopa mix) |
|
|
Term
| What s/sx are dopamine agonists effective at treating in Parkinson's? |
|
Definition
| hypokinesia, but not tremor |
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Term
| What Parkinson's drugs are associated reduced inhibition and impulsive behavior such as gambling, hypersexuality, reckless driving, and shoplifting? |
|
Definition
| Some dopamine agonists, in particular pramipexole and ropinirole |
|
|
Term
| What is the most common dopamine agonist used to treat Parkinson's dz? |
|
Definition
|
|
Term
| How do COMT inhibitors increase the effectiveness of administered levodopa? |
|
Definition
| The COMT pathway reduces levodopa via 3-O-methyldopa competition, so blocking this pathway results in more levodopa. |
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|
Term
| What kind of hypersensitivity is myasthenia gravis? |
|
Definition
| Either type II (Ab attacks own cells) or Type V (Ab attack of neurotransmitter receptors) |
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|
Term
|
Definition
| A mixture of carbidopa, levodopa and entacapone. |
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