Parkinson's Disease

Front 1

When do Parkinson's Symptoms start to show...

Back 1

When you lose 70% of Dopamine Neurons.

Front 2

What is the most common brain degenerative disorder?

Back 2

Alzheimer's Disease

(Parkinson's is second.)

Front 3

What are the motor symptoms of Parkinson's Disease?

Back 3

TRAP

T- Tremor at rest "Pill-rolling"
---> This is a slow asymmetric tumor. It stops with movement..but eventually will continue with movement.

R - Rigidity (stiffness) - "Cogwheel"
---> Stiffness d/t inability for opposing muscle to relax (DA helps with involuntary movement.).
--> You try to push the arm down and it will move in a cogwheel fashion.

A - Akinesia (inability to move)/ Bradykinesia (slow movement)

P- Postural Instability with gait problems.

Front 4

How is parkinson's disease diagnosed?

Back 4

There is no discriminate test for Parkinson's disease...so you have to diagnose it based on it's symptoms and pt hx.

Physician must exclude causes of secondary parkinsonism.

Front 5

What is an essential tremor and how do you distinguish it from Parkinson's?

Back 5

An essential tremor is a tremor that occurs during voluntary movement.

It is caused by SNS outflow. Tx it with Propanolol or Ethanol.

A Parkinson's Tremor Occurs at rest, not movement. You cannot tx it with propanolol or ethanol.

Front 6

What are the non-motor symptom of Parkinson's Disease?

Back 6

Depression
Anxiety/ Panic
Apathy

Front 7

Define Parkinson's Disease

Back 7

A progressive neurodegenerative disorder caused by slow degeneration and death of Dopaminergic Neurons in the Nigrostriatal Pathway of the brain.

No cure.

The balance of DA (inhibitory) and ACh (excitatory) provides control of movement. The imbalance is caused by too much ACh compared to DA in the STRIATUM of the basal ganglia.

Leads to impaired CONTROL of movement...can't make yourself do the things you want to do and can't make yourself not do the things you don't want to do.

Front 8

Most of the causes of parkinson's disease are ______.

Back 8

Idiopathic.

Front 9

Does L-Dopa work for post-encephalitic Parkinson's Disease?

Back 9

For a while...then stops working.

Front 10

How can cerebral atherosclerosis cause parkinson's disease?

Back 10

Causes a stroke which kills DA neurons in the nigro-striatal pathway.

Front 11

Causes of Secondary Parkinsonism

Back 11

* Cerebral Atherosclerosis (causes a stroke and death of striatal neurons).

* Brain Tumor/ Injury

* IATROGENIC: D2 Receptor Blocking Drugs.
--> Phenothiazines (Chloropromazine too)
--> Butrophenones (haloperidol)
--> Metoclopramide (Reglan)

Front 12

What are the stages of Parkinson's Disease?

Back 12

EARLY - No Functional Impairment

MILD - Honeymoon Period...all drugs work and not many symptoms. (Start with selegilline). Fine motor movements affected but tx easily.

MODERATE -Multiple Drugs, Occupational And Social Activities Affected

SEVERE - Side Effects From Drugs (b/c taking so much), Resistant To Therapy (neurons are dying), Reduced Quality Of Life

LATE - Wheelchair Or Bed Bound (Parkinson's does not kill you...just decreases your quality of life).

* Progression through these takes about 7 years.

Front 13

What are the two mechanisms to tx parkinson's disease?

Back 13

1) Increase DA in the nigrostriatal pathway
---> Inhibit degradation (inhibit MAO-B) - Selegilline
---> Stimulate more DA release (amantidine)
---> Increase DA synthesis (L-Dopa) (Endogenous L-dopa is made from tyrosine and then turns into DA.).
---> DA agonists: Activate DA receptors.

2) Block muscarinic receptors in the nigrostriatal pathway.

Front 14

What is a classic sign of end of dose deterioration syndrome with later stages of parkinson's?

Back 14

Pt takes their L-dopa at night and goes to bed. when they wake up in the morning they are rigid, bradykinesia, etc.

Tx: grind up some Sinemet and have it sitting in a glass of water by the bed for when they wake up.

Front 15

Describe a vacation holiday

Back 15

Can help reduce end dose deterioration in late state parkinsons...pt is taken off L-Dopa for 3 days. Must be admitted to the hospital d/t risk of neuroleptic malignant syndrome with removal of DA stimulation.

Front 16

Goals of Parkinson Therapy

Back 16

* Delay disease progression if possible.
* Reduce the incidence and severity of symptoms.
* Improve activities of daily living.
* Minimize complications of drug therapy.

Front 17

Fill in what meds go where:

NO FUNCTIONAL DISABILITY:
MILD FUNCTIONAL DISABILITY:
MODERATE FUNCTIONAL DISABILITY:
LATE STAGE PARKINSONS:

Back 17

NO FUNCTIONAL DISABILITY:
-->Selegilline

MILD FUNCTIONAL DISABILITY:
--> Selegilline
--> +/- Amantidine
--> +/- Antimusc agent (tx's tremor)(Benzotropine, Benadryl)
--> +/- Bromocriptine (DA Agonist)

MODERATE FUNCTIONAL DISABILITY:
--> L-Dopa/Carbidopa (Sinemet)
--> +/- DA Agonist (Bromocriptine)
--> +/- COMT Inhibitor
--> +/- Antimusc
--> +/- Selegilline

LATE STAGE PARKINSONS:
--> L-Dopa/ Carbidopa
--> + DA Agonist (Bromocriptine)
--> +/- Antimusc (Benzotropine, Benedryl)
--> +/- COMT Inhibitor
--> +/- Selegilline