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50 Cards in this Set
- Front
- Back
tremor?
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rhythmic/oscillatory movement around a joint
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resting tremor
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1) parkinson's dz
2) rigidity 3) impairment of volitional move. |
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essential tremor
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postural tremor
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intentional tremor
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1) brain stem/cerebellar lesion
2) alcohol/drug toxicities |
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chorea
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involuntary muscle jerks, unpredictable
1) hereditary 2) volitional activity impairement |
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athetosis
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slow, writhing abnoramal move.
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dystonia
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postural abnormality - asso. with sustained, abnormal move.
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tics
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sudden, abnormal "coordinated" move.
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choronic, multiple tics?
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Gilles de la Tourrette's syndrome
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symptoms of Parkinson's dz
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1) tremor
2) bradykinesia 3) rigidity 4) characteristic gait/ postural abnormality |
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characteristics of parkinson's
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1) choronic
2) progressive 3) begins in middle/late life 4) affects all ethnic group 5) equal gender distribution |
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frequency population over 65 yrs
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1 per 100 persons
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neuronal loss in parkinson's
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loss of "substantia nigra pars compacta cells" cause reduced "nigral-striatal dopamine input" to the putamen
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D-1 mediated direct pathway
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loss of an striatal excitatory dopamine input
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D-2 mediated, indirect pathway
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loss of an striatal inhibitory dopamine input
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cause of parkinson's?
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unknown
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possible causes of parkinson's?
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1) environmental toxin
2) endogenous toxins |
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clinical manifestations of parkinson's
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1) tremor
2) rigidity 3) bradykinesia - akinesia (severe) 4) flat affect 5) blepharoclonus 6) blepharospasm 7) drooling 8) voice: hypophonic, poorly modulted 9) small, tremulous handwriting 10) festinating gait 11) tapping over the glabella 12) depression 13) impaired cognitive function (dementia in advanced cases) |
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Dopamine
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1) does not cross BBB
2) ineffective if administered peripherally |
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L-Dopa
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1) crosses the BBB
2) metabolic precursor dopamine 3) enters neuronal cells and is decarboxylated to dopamine |
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D1 receptor
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1) anedyl cyclase stimulation
2) increase cAMP levels 3) located in substantia nigra zona compacta |
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D2 receptor
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1) adenyl cyclase inhibition
2) decreases cAMP levels 3) postsynaptic localization on striatal neurons |
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Levodopa (Dopar)is given with?
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carbidopa (Lodosyn) = dopa decarboxylase inhibitor
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Levodopa is given with Carbidopa to decrease?
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peripheral decarboxylation of levodopa
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L-dopa is most effective in diminishing?
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bradykinesia (improves all parkinson's dz symptoms)
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SE of levodopa
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1) GI prob.
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dyskinesias include
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1) chorea
2) ballismus 3) athetosis 4) dystonia 5) myoclonus 6) tics 7) tremor |
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other medications for parkinson's
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1) Selegiline (Deprenyl)
2) Amantadine (Symmetrel) 3) Anticholinergics |
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Selegiline (Deprenyl)
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1) selective monoamine oxidase B inhibitor
2) prolongs L-dopa effect |
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Amantadine (Symmetrel)
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1) antiviral drug
2) may influence dopamine release, reuptake, synthesis |
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anticholinergics
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1) improve rigidity, tremor
2) not used as much now |
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anticholinergics
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1) Bentropine (Cogentin)
2) Biperiden (Akineton) 3) Orphenadrine (Norflex) 4) Procyclidine (Kemadrin) 5) Trihexyphenidyl (Artane) |
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physiologic postural tremor (normal) is increased by?
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1) thyrotoxicosis
2) isoproterenolol (Isuprel) 3) Epinephrine 4) anxiety 5) fatigue |
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drug-induced normal physiologic tremor?
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1) bronchodilators
2) tricyclic antidepressants 3) lithium 4) possible beta2 receptor mediation |
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essential tremor
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1) postural tremor
2) possible beta 1 receptor mediation |
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medications for essential tremor
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1) beta blockers
2) Primidone (Mysoline) = anticonvulsants 3) Alprazolam (Xanax) |
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intentional tremor
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1) caused by toxic rx to alcohol and other drugs (phenytoin)
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Huntington's disease
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1) dominant
2) inherited 3) progressive chorea in dementia 4) adult onset |
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chorea
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dopamine/Ach/GABA basal ganglia imbalance (too much dopamine?)
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anti-dopaminergic agents to reduce chorea
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1) Reserpine
2) Phenothiazines 3) Butyrophenones (Haloperidol) |
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cause of chorea
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1) thyrotoxicosis
2) hypoCa 3) lupus erythematosus 4) hepatic cirrhosis 5) polycythemia vera rubra |
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drug-induced chorea
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1) L-dopa
2) antimuscarinics 3) lithium 4) phenytoin 5) oral contraceptives 6) amphetamine |
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tx for ballismus
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dopamine-blocking agents
1) Perphenazine 2) Haloperidol |
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tx for athetosis and dystonia
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1) not usually satisfactory
2) Diazepam 3) high-dose antimuscarinic agents 4) L-dopa 5) Baclofen 6) Phenothiazines 7) Amantadine |
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tx for tics, Tourette's syndrome
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Haloperidol
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phenothiazines cause
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acute dyskinesia/dystonia
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Tardive dyskinesia
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1) consequence of long-term antipsychotic drug tx
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newer antipsychotic agents that do not appear to cause tardive dyskinesia
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1) Olanzapine
2) Risperidone |
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Wilson's disease
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1) recessive, inherited copper metabolism error
2) reduced serum copper/ceruloplasmin 3) > copper concentration in brain and viscera |
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tx for Wilson's disease
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1) Penicillamine (Dimethylcysteine) = copper chelating agent
2) Trientine (Syprine) = chelating 3) Zinc accetate = > copper excretion 4) zinc sulfate = < copper absorption |