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  1. 4 cardinal clinical features of Parkinson's
    • tremor
    • bradykinesia
    • rigidity
    • postural instability
  2. 5 supportive features of Parkinson's
    • hypomimia
    • hypophonia
    • micropraphia
    • stooped-flexed posture
    • shuffling gait and festination
  3. Non motor symptoms of Parkinson's
    • disturbed sleep
    • bowels demand stimulating medicines
    • depression
    • anxiety
    • excessive sweating
  4. what is the pathology of Parkinson's
    • loss of the pigmented dopaminergic cell in the substantial nigra pars compact and the formation of lewy bodies int he brainstem
    • lewy bodies are cytoplasmic inclusion bodies that contain alpha- synuclein
  5. What percent of neurons are degenerated by the time of clinical Parkinson's?
  6. Pre Parkinson's symptoms
    • rapid eye movement sleep behavior disorder (RBD)
    • Constipation
    • Olfactory dysfunction
  7. What is RBD?
    REM behavior disorder characterized by loss of normal muscle atonia during REM sleep resulting in violent limb and body movements and vocalizations allowing people to act out dreams (associated with hyposmia and poor color discrimination)
  8. how long does it take for major Parkinson's symptoms to occur?
    12-14 years
  9. what is associated with long term use of levodopa?
    motor complications
  10. what is the most efficacious drug to treat Parkinson's?
  11. Levodopa is always administered with what?
  12. what happens to the the therapeutic window of levodopa as the disease progresses?
    it shrinks
  13. what are the 3 dopamine agonists?
    • pramipexole
    • ropinirole
    • rotigotine patch
  14. Issues with dopamine agonists
    • sudden onset sleep
    • inpulse control disorders
  15. 2 major categories of drug therapy for Parkinson's
    • dopaminergic agents
    • anticholinergic agents
  16. what kind of drug is tylenol pm?
  17. giving older people anticholinergic agents can cause delirium
  18. what does dopamine agonists do?
    either blocks the metabolism or acts like dopamine
  19. What is the mechanism of action of levodopa?
    promotes dopamine synthesis
  20. What is the mechanism of action of of selegiline?
    inhibits dopamine breakdown
  21. What is the mechanism of action of COMT inhibitors?
    enhance effects of levodopa by blocking its degradation
  22. Effectiveness of levodopa over time
    benefits diminish over time
  23. considerations while taking levodopa
    • food delays absorption
    • neutral amino acids compete with levodopa for intestinal absorption and of transport across blood brain barrier
    • high protein foods will reduce therapeutic effects
  24. adverse effects of levodopa
    • nausea and vomiting
    • dyskinesias
    • cardiovascular effects
    • psychosis
    • may darken sweat and urine
    • can activate malignant melanoma
  25. Advantages of carbidopa
    • No adverse effects
    • increases the available levadopa in CNS which allows for 75% decrease of levodopa dosage
  26. what is the first line drug for parkinsons?
    dopamine agonists
  27. two types of dopamine agonists
    • derivatives of ergot
    • Nonergot derivatives
  28. main nonergot dopamine agonists
  29. How is pramipexole used?
    used alone in early PD and with levodopa in advancing PD
  30. How long does it take for pramipexole to see benefits?
    several weeks
  31. Advese effects of pramipexole alone
    • nausea
    • dizziness
    • daytime somnolence
    • insomnia
    • constipation
    • weakness
    • hallucinations
  32. Adverse effects of pramipexole with levodopa
    orthostatic hypotension and dyskinesias and increase in hallucinations
  33. Two COMT inhibitors available
    • entacapone
    • tolcapone
  34. second/third line drug for PD
    MAO-B inhibitors
  35. Nonmotor symptoms of PD
    depression, dementia, psychosis ect.
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2014-05-22 04:48:52
parkinsons 173

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