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17 Cards in this Set
- Front
- Back
Rasagiline (Azilect)
- early/mild/late P.D. treatment |
- early
- MAO-B inhibitor - slows breakdown of DA in striatum |
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Amantidine (Symmetrel)
- early/mild/late P.D. treatment |
- early
- augments DA release, blocks re-uptake. benefits are modest. - HELPS WITH DYSKINESIAS |
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Anticholinergic drugs (muscarinic antagonists)
- early/mild/late P.D. treatment |
- early
- most effective FOR TREMOR! - cholinergic side effects |
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Pramipexole (Mirapex)
- early/mild/late P.D. treatment - adverse effects |
- mild
- DA receptor agonist - agonist at D2 and D3 - symptomatic relief - sudden attacks of sleep, and gambling/compulsive behavior - DA receptor agonists in combination with levodopa is good |
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Ropinirole (Requip)
- early/mild/late P.D. treatment - adverse effects |
- mild
- DA receptor agonist - agonist at D2 and D3 - symptomatic relief - sudden attacks of sleep,and gambling/compulsive behavior - DA receptor agonists in combination with levodopa is good |
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Levodopa (Sinemet = carbidopa + levodopa)
- early/mild/late P.D. treatment - adverse effects - diet? |
- late/severe
- levodopa is a DA precursor, crosses the bbb, and converted to DA in striatum - carbidopa inhibits peripheral decarboxylation of levodopa to DA - most effective tx for PD! a lack of response to levodopa raises the q if patient has PD or not - low protein diet - protein competes with absorption of levodopa in duodenum and at bbb |
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adverse effects of BOTH levodopa and dopamine receptor agonists
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- nausea
- hallucinations - vivid dreams - hypotension - dyskinesias (more with levodopa) - confusion (treatment of PD in a demented patient is very challenging) |
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Entacapone (Comtan)
- type of med - indicated for? |
- COMT inhibitor
- indicated for the "wearing-off" effect. ONLY taken with levodopa. COMT breaks down DA peripherally. Inhibition of COMT prolongs effects of levodopa |
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surgical options
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- pallidotomy - surgical lesion placed in the internal segment of the globus pallidus
- thalamotomy - lesion in the thalamus - more helpful for tremor - deep brain stimulation (DBS) - battery-powered neurostimulator intoglobus pallidus. advantage: can be adjusted!! |
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Secondary Parkinsonsim
- drugs that cause - toxins |
- MPH - Metoclopromide, Prochlorperazine, Haloperidol
- MPTP (methyl-phenyl-tetrahydropyridine) is destructive to neurons in the substantia nigra |
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disorders that commonly present with hyperkinetic movement
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1. wilson's dz
2. huntington's dz 3. hemiballismus 4. tourette's syndrome 5. tardive dyskinesia |
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Hyperkinetic movement disorders
- idiopathic focal dystonias - tx? |
- blepharospasm, torticollis, spasmodic dysphonia (strained or breathy voice), writer's cramp
- BOTULINUM TOXIN lasts for few months |
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Wilson's dz
- what - who - lab tests? |
- inborn error of copper metabolism
- ALL YOUNG PATIENTS with a movement disorder should be checked! - LOW CERULOPLASMIN BLOOD LEVEL - HIGH 24HR URINE COPPER LEVEL |
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huntington's dz
- genetics - traits |
- autosomal dominant (family hx). ^ CAG trinucleotide repeats (recall myotonic dystrophy had CTG)
- traits 1. dementia - generalized brain atrophy 2. choreiform movements - degeneration in the striatum (especially CAUDATE nucleus) 3. gait often affected |
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Hemiballismus
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- stroke of the contralateral subthalamic nucleus
- acute onset of wild, flinging, "ballistic" movements in contralateral arm/leg - b/c is a small vessel stroke, no other clinical features! (sensory, motor, etc) |
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tourette's syndrome
- what - timeline for dx - **association |
- motor/vocal tics
- onset before age 21, present for > 1 year - a/w OCD (atleast 50%)!!! |
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tardive dyskinesia
- cause - trait |
- chronic tx with neuroleptic medications
- repetitive sterotypic movements particularly of the LOWER FACE (chewing, "flycatcher tongue", etc) |