Term
| Describe the pathophysiology of Parkinson's Disease. |
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Definition
- Destruction of dopaminergic neurons in substantia nigra pars compacta
- Depletion of dopamine stores and degeneration nigrostriatal pathway
- Imbalance of Ach and D in corpus striatum
- Impairment of extrapyramidal tracts responsible for body movements
- Tremors, Rigidity, bradykinesia
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Term
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Definition
| Spherical intracytoplasmic aggregates in the remaining neurons of substantia nigra pars compacta |
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Term
| What part(s) of the brain can lewy bodies be found during preclinical phase of Parkinson's disease? |
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Definition
medulla oblongata
locus ceruleus
raphe nuclei
olfactory bulb |
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Term
| During the progression of Parkinson's disease, lewy bodies may ascend from the medulla oblongata, locus ceruleus, raphe nuclei and olfactory bulb to what? |
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Definition
| Midbrain (substantia nigra pars compacta) |
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Term
In advanced cases of Parkinson's Disease, where can Lewy bodies be found?
What can this cause? |
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Definition
Cortex;
behavioural and cognitive changes |
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Term
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Definition
jerky, stiff, variable rigidity affecting upper arms
painful stiffness when walking |
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Term
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Definition
| feeling of total muscle rigidity and inability to walk at initiation of movement |
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Term
| Other than tremor, rigidity, and bradykinesia, what other symptoms may be observed in Parkinson's patients? |
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Definition
Postural instability
Constipation
Sweating
Pain
Speech/facial expression
Poor sleep
Fatigue
Anxiety
Depression |
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Term
How is Parkinson's Disease diagnosed?
Progression monitored? |
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Definition
Neurologic assessment
Neuroimaging - MRI, PET (Positron Emision Tomography) - needs to be validated
Diagnose confirmed by response to therapy
Progression monitored by using assessment scale (Unified Parkinson's Disease Rating Scale)
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Term
| Apart from carbidopa and benserazide, which drugs decrease the metabolism of levadopa? |
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Definition
entacapone (COMT inhibitor)
selegiline (MAO-B inhibitor) |
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Term
| Name 6 dopamine agonists; 3 ergot, 3 non-ergot. |
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Definition
Ergot: Bromocriptine, Cabergoline, Pergolide
Non ergot: Pramipexole, Ropinirole, Apomorphine |
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Term
Which drugs may be used to treat 'wearing-off' symptoms of levadopa?
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Definition
Selegiline
COMT inhibitors- entacapone, tolcapone
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Term
| What is the usual daily dose of levadopa? |
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Definition
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Term
| What are counselling points associated with levadopa? |
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Definition
Take on empty stomach, though if feeling GI discomfort, take with food.
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Term
| Which complications are associated with long-term therapy of Levadopa? |
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Definition
movement fluctuations
dyskinesia |
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Term
| What are the side effects of dopamine agonists? |
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Definition
nausea
orthostatic hypertension
lower extremity oedema |
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Term
| What are the side effects of Levadopa? |
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Definition
GI: nausea, vomiting (treat with domperidone), constipation, dry mouth, peptic ulcers
CVS: orthostatic hypotension, syncope (fainting), dizziness, fatigue. Treat hypotension with more carbidopa; addition of fludrocortisone with salt; midodrine; or use of elastic stockings.
CNS: sedation, psychosis - reduce or stop amantadine, MAOIs and Anticholinergics stopped. Give clozapine or quetiapine
Motor: Fluctuations - end of dose wearing off, and also dykinesias: involuntary movements
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Term
| What drug may be used as a 'rescue therapy' for "off" episode inspite of optimal dose? |
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Definition
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Term
| Nocturnal symptoms of parkinson's are relieved by what? |
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Definition
Clonzepam, or
small doses of carbidopa/levadopa |
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Term
| How is entacapone and tolcapone categorised? MOA? |
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Definition
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Term
| What is the normal dose for tolcapone? |
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Definition
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Term
| What surgery may be done in treating Parkinson's disease? |
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Definition
| Chronic high frequency deep brain stimulation. |
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Term
| What are the side effects of anticholinergics? |
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Definition
Dry mouth
blurred vision
dry eyes
constipation
urinary retention
tachycardia
memory loss |
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Term
| What anticholinergic drugs are used in the treatment of Parkinson's disease? |
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Definition
benztropine
trihexyphenidyl
biperiden |
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Term
| What are the side effects of amantadine? |
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Definition
confusion
hyperexcitability
insomnia
dizziness
orthostatic hypotension
livedo reticularis (vascular cutaneous reaction with redish purple fish net mottling on extremeties)
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