Clin Med Final-Parkinson's Disease

Front 1

__ is caused by degeneration of the dopamine containing cells in the substantia nigra of the basal ganglia.

Back 1

PD

Front 2

what is the triad of PD?

Back 2

resting tremor (pill-rolling)
bradykinesia
muscle tone rigidity

Front 3

what is the most freqently encountered extrapyramidal movement disorder?

-PD
-MS
-MD

Back 3

PD

Front 4

__ is characterized by low dopamine levels in the corpus striatum.

Back 4

PD

Front 5

what disease process will you see a pt having difficulty initiating and stopping movement?

Back 5

PD

Front 6

what are other common s/s of parkinson's disease?

Back 6

expressionless 'mask-like' face
shuffeling gait with lack of arm swing
monotone voice/low volume
stooped posture
drooling
small spidery handwriting
greasy skin

Front 7

what drug is used to tx PD that helps restore the dopamine within the brain and are particularly useful for treating bradykinesia and rigidity?

-amantadine
-benzotropine
-L dopa

Back 7

L dopa

Front 8

which drug alleviates the s/s but does not stop the progression of the disease?

Back 8

L dopa

Front 9

which class of drugs tends to alleviate tremor and rigidity rather than bradykinesia?

-L dopa
-anticholinergics
-amantadine

Back 9

anticholinergics

Front 10

anticholinergics should not be given to what patients?

Back 10

pt's with narrow-angle glaucoma

Front 11

what should you treat a pt's tremors with in PD?

Back 11

anticholinergics

Front 12

what should you treat a pt's bradykinesia/rigidity with?

Back 12

levodopa

Front 13

which drug is an anti-viral used in the tx of PD?

Back 13

amantidine

Front 14

sialorrhea is another name for what?

Back 14

drooling

Front 15

micrographia is another name for what?

Back 15

small and spidery handwriting

Front 16

what is bradykinesia?

Back 16

slowness of movement,-assess by asking the pt to tap a hand on to their lap as fast as they can

Front 17

What is the MOA of carbidopa?

Back 17

an inhibitor of the enzyme that breaks down peripheral dopamine in the body it is used to decrease the dose of dopamine administered

Front 18

what is another name for levadopa/carbidopa?

Back 18

sinemet

Front 19

if a pt taking levodopa develops dyskinesia, what is the tx?

Back 19

necessitates a drug holiday

Front 20

what is the purpose of giving L-dopa to a PD pt?

Back 20

help restore the dopamine within the brain and are particularly useful for treating bradykinesia and rigidity

Front 21

t/f

dopamine can be directly administered because it can't cross the BBB.

Back 21

false; dopamine cannot be administered because it can't cross the BBB

Front 22

t/f

levodopa can cross the BBB

Back 22

true

Front 23

what are some common s/e of levodopa?

Back 23

n/v
hypotension
involuntary movements
restlessness

Front 24

__ is involuntary movements such as nodding, jerking, and twitching

Back 24

dyskinesia

Front 25

what is the tx of dyskinesia from levodopa?

Back 25

start tx with other drugs that will prolong the effectiveness of levodopa or reduce the necessary dosage

Front 26

what are 2 common additive drugs to sinemet that are dopamine agonists?

Back 26

mirapex and requip

Front 27

__ are chemicals which affect the same or similar neurons as dopamine.

-dopamine agonists
-anticholinergics

Back 27

dopamine agonists

Front 28

t/f

dopamine agonists are often very effective as an initial treatment for the motor related sx's of PD are are often used in exactly that way to reduce the total amt of time the pt is on levodopa.

Back 28

true; but the are also overall less effective than levodopa, so they're only useful in the early stages of the disease.

Front 29

what is the name of the anti-viral medication that has been shown to help reduce sx's of PD?

Back 29

amantadine

Front 30

what are s/e of amantadine?

Back 30

mottled skin
edema
confusion
blurred vision
depression

Front 31

what is the MOA of Amantidine?

Back 31

inhibits dopamine release and blocks dopamine reuptake, but the exact mechanism is unknown

Front 32

what are the popular anticholinergics used in the tx of PD?

Back 32

artane
cogentin

Front 33

__ can be used with tardive dyskinesia or dystonic reaction

-artane
-cogentin

Back 33

cogentin

Front 34

what is the MOA of anticholinergics?

Back 34

inhibit the function of acetylcholine

Front 35

the 2 neurotransmitters role in the motor system is to say that acetylcholine __ and dopamine__.

-excites/inhibits
-inhibits/excites

Back 35

acetylcholine excites
dopamine inhibits

Front 36

in PD an excess amount of __ the motor cortex becomes overstimulated, resulting in tremors, twitches, and lack of motor control.

Back 36

acetylcholine

Front 37

what are the 3 neurotransmitters in the brain?

Back 37

dopamine, epinephirine, norepi

Front 38

what is the role of dopamine in basal ganglia?

Back 38

GABA inhibitor

Front 39

in PD a loss of dopmine causes increased GABA output. A disorder of GABA and __ within the basal ganglia and its connections results in impaired motor function.

Back 39

acetylcholine

Front 40

what are the poison's in PD?

Back 40

lewy bodies

Front 41

-death of dopamine neurons in the substantia nigra
-loss of dopamine in the caudate
-loss of inhibition in caudate
-overactive output to the thalamus
-thalamus overinhibis the motor cortex
-complex basal ganglia-cortical loops

this system is describing?

Back 41

the pathology of PD

Front 42

in a healthy brain dopamine is produced from ?

Back 42

levodopa (l-dopa)

Front 43

where is l-dopa produced from?

Back 43

tyrosine

Front 44

what are the 3 catecholamines that fcn as neurotransmitters in the brain?

Back 44

dopamine
epinephrine
norepinephrine

Front 45

where are all 3 catecholamines synthesized from?

Back 45

amino acids

Front 46

what are the parkinsonian symptoms?

Back 46

tremor
rigidity
bradykinesia

Front 47

the imbalance between the excitatory neurotransmitter __ and inhibitory neurotransmitter dopamine in the basal ganglia, keep us from parkinsonism.

Back 47

acetylcholine

Front 48

PD is the opposite of what psychiatric condition?

-bipolar disorder
-schizophrenia
-psychosis

Back 48

schizophrenia

Front 49

what etiological factors are r/t parkinson's?

Back 49

low vitamins and antioxidants increases the incidence
smoking decreases incidence
increase incidence in rural areas

Front 50

what affect does nicotine have on process?

Back 50

nicotine increases the rate of firing of dopaminergic neurons

Front 51

what is the most common encountered extrapyramidal movement disorder?

Back 51

Pd

Front 52

PD begins most often in the __ what decades.

Back 52

5th and 6th

Front 53

parkinson's is characterized by low dopamine levels in the __

Back 53

substania nigra

Front 54

in what condition will a patient have difficulty initiating and stopping motion?

Back 54

PD

Front 55

t/f cogwheel rigidity may be present unilaterally or bilaterally

Back 55

true

Front 56

is PD a slow and gradual or fast and rapid onset?

Back 56

slow, progressive disease that develops over months to years

Front 57

what drug is used for pt's who have mild symptoms? it is an anti-viral.

Back 57

amantidine

Front 58

benzotropine is what class of drug and what does it do for PD patients?

Back 58

it is an anticholinergic, alleviates tremors and rigidity NOT bradykinesia

-dont give to pt's with narrow angle glaucoma

Front 59

levodopa works well for what symptom?

-tremor
-rigidity
-bradykinesia

Back 59

bradykinesia

Front 60

what is the MOA of carbidopa?

Back 60

enzyme inhibitor that breaks down peripheral dopamine in the body, therefore is used to decrease the dose of dopamine administered

Front 61

what is the name of the combo drug used to treat PD?

Back 61

sinemet, levodopa/carbidopa

Front 62

why would you not give a PD pt thorazine (chlorpromazine)?

Back 62

can cause parkinsonian symptoms

Front 63

t/f

all neuroleptics can cause parkinsonian like symptoms

Back 63

true

Front 64

what is the most commonly used medication in the treatment of PD?

Back 64

levodopa (carbo/levo) is commonly referred to as levodopa

Front 65

t/f

dopamine can't be directly administered because it can't cross the BBB

Back 65

true but levodopa can cross

Front 66

what is the MOA of carbidopa?

Back 66

prevents the breakdown of levodopa in the blood, insuring that more of the levo reaches the brain

Front 67

what are s/e of levodopa?

Back 67

n/v
hypotension
involuntary movements
restlessness

as dose goes up, pt may experience dyskinesia

Front 68

mirapex and requip are what class of drug?

Back 68

dopamine agonists

Front 69

how are dopamine agonist used in the tx of PD?

Back 69

additive to sinemet, usually very effective as an initial treatment for the motor related sx's of PD. but only useful in early disease

Front 70

what is the initial treatment of trauma to the spinal cord?

Back 70

methylprednisolone if given within 8 hours of the injury