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parkinsons
- disease of basal ganglia
- charecturized by
- -slowing down in the initiation and execution of movement
- -increase muscle tone
- -tremors at rest
- -impaired postural reflex
-
parkinsons
onset
clinical manifestation
-men higher than women, older than 40, gradual
-may only involve one side of body, TRAP
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primary parkinsons cause
unknown
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secondary parkinsons cayse
- chemical
- head trauma
- farm pesticides
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parkinsons
etiology and patho
- - decrease DA
- - increase ACh
- -in basal ganglia neurons in the midbrain
- -extrapyramidal motor system
- -degeneration of DA producting neurons in substantia nigra
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extrapyramidal motor system
- -causing involuntary actions
- -DA is essential for normal functioning
- -control of posture, support and voluntary motion
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What does TRAP stand for
- tremor
- rigidity
- akinesia
- postural inability
-
tremor
- -minimal initially
- -resting tremor
- -pill rolling
-
pill rolling
- thumb and forefinger appear to move in a rotary fashion
- -sign of PD
-
resting tremor
aggravated by emotional stress or increased concentration
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rigitity
- -increased resistance to passive motion when limbs are moved
- -cogwheel rigidity
- -sustained muscle contraction
- -complaint of soreness
- -tired and achy
- -pain in head, upper body, spine or legs
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cogwheel rigidity
- -jerky quality
- -as if there were intermittent catches in the passive movement of a joint
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akinesia
- -absence or loss of control of voluntary movement
- -masked face
- -drooling
- -shuffling gate
-
postural inability
- -common complication
- -propulsion
- -retropulsion
- -pull test( positive test can indicate PD)
-
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retropulsion
going backwards
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pull test
- assessment of postural inability
- - stand behind pt, give a tug backwards on shoulder, cause to fall backwards
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appearance of pt w/ PD
- -blank facial expression
- -speech slow and monotone
- -tremors
- -short shuffling gait
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PD
diagnostics
- -soely on hx, clinical features and phys exam
- -TRAP and asymmetrical onset
- -positive response to antiPD drugs
-
antiparkinsonian drugs either
- -enhance or release supply of dopamine
- -antagonize or block the effects of overactive cholenergenic neurons
- -initially only one drug is used
- -progression=combo drug therapy
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Sinemet(levodopa w/ carbidopa)
- -used to manage akinetic symptoms
- -very effective
- -wears off in a few years
- -primary
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Sinemet(levodopa w/ carbidopa)
side effects
- -dyskinesia
- -on/off periods
teach pt drug can take several weeks/moths to take effect
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dyskenisia
muscle twitches or movements involuntarily
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dopamine receptor agonists
- -directly stimulates DA receptor
- -Bromocriptine(parlodel)
- -Pramipexole(Mirapex)
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Bromocriptine(parlodel)
- -shouldn't be used first
- SE: increase BP, heart attack, stroke, seizures, ortho hypo
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monamine oxidase inhibitors
- prolong the half life of levodopa
- -selegiline(eldepryl)
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anticholinergenics
- decrease ach activity
- -benztropine(cogentin)
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COMT inhibitors
- enhances effects of sinemet
- -entacapone(comtan)
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antihistamines
- used to manage tremors
- benadryl
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PD drugs
- sinemet
- dopamine receptor agonist
- monamine oxidase inhibitor
- COMT inhibitor
- anticholenergenics
- antihistamines
-
PD
surgical interventions
- ablation(destroy area of brain)
- deep brain stim(most com, electrode in chest)
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PD
complications
- -dementia(40%)
- -dysphagia
- -sleep disorders
- -depression, anxiety
- -constipation
- -UTI
- -Pneumonia
- -skin break down
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levodopa can be impaired by
protein ingestion
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protein is needed for
wound heeling
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what size meals to eat?
6 small meals vs 3 big meals
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how to alleviate bradykinesia symptoms
- -lifting feet while walking
- -rock back and forth to intiate movement
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bradykenisisa
slowness of movement
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