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14 Cards in this Set
- Front
- Back
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T/F Cigarette smoking & caffeine intake are protective for Parkinson Disease |
TRUE |
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What are the risk factors for Parkinson's Disease? |
Advanced age Male Family Hx Environmental exposure to herbicide & pesticide |
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________ in the substantia nigra pars compacta, decrease dopamine & lead to parkinsonian features |
Lewy bodies = eosinophilic, round intracytoplasmic inclusions, contain alpha synclein protein |
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What are the 4 cardinal signs of Parkinson Disease (PD)? |
Bradykinesia ( + 1 other sx = dx) Resting Tremor Rigidity Postural instability (late feature) |
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What is the mc 1st symptom of PD? |
Resting tremor -usually asymmetric, 1 hand tremors at rest, becomes more constant w/ progression |
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Postural Instability & Gait dysfunction worsen w/ disease progression. How are they assessed? How do they differ in mild, moderate, & advanced PD? |
assess w/ Pull test--> more than 3 steps backward when pulled back mild- shortened stride length, decr arm swing, stooped posture moderate- shuffling gait, takes several steps to turn advanced- festination or freezing of gait |
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Secondary features of PD? |
micrographia (small handwriting) hypomimia (loss of facial expression) foot drag (on affected side) hypophonia (muffled speech) retropulsion (fall backwards) decreased blinking, swallowing (drooling) depression/anxiety hallucinations/ psychosis sleep disturbances ANS disturbances (orthostatic hypotension, GI/GU/Sexual dysfxn) Cognitive impairment Sensory disturbance (pain perception) |
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You may suspect a secondary cause of PD when pts do NOT respond to dopaminergic meds. What are the mc secondary causes of PD (non-idiopathic or familial)? |
Vascular- chronic ischemic infarcts in brain--> symmetric akinetic rigid presentation Drug induced- antipsychotic, anti emetics |
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PD: management |
Regular exercise (Thai Chi) PT OT Levodopa/carbidopa (sinemet) Dopamine agonists COMT inhibitors MAO-B Anticholinergic Surgical (DBS) |
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Levodopa/Carbidopa (sinemet) is the most effective drug in PD tx. What are the neg SEs? |
Orthostatic hypotension "on" & "off" motor fluctuations Dyskinesia Anorexia, N/V Hallucinations, delusions Sleep disturbance "sleep attacks: Neuroleptic malignant syndrome |
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________ is usually given in early stage to delay the use of Sinemet & prolong it's efficacy *may be combined w/ L-dopa to reduce risk of dyskinesia |
Dopamine Agonists: Bromocriptine Pergolide ropinirole Pramipexole apomorphine (fast onset, for "off" episode) |
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What are the SEs assoc w/ dopamine agonists? |
hallucinations, psychosis compulsive behaviors postural hypotension sleep attacks N/V tolerance over days to weeks |
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___________ can be used w L-dopa to decrease "on" & "off" sx |
COMT inhibitors: Tolcapone Entacapone |
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______ can be used to help reduce PD tremors & dystonia |
Anticholinergics or Amantadine (antiviral) |
