Parkinsons(EXAM 1)

  1. 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
  2. parkinsons

    onset
    clinical manifestation
    -men higher than women, older than 40, gradual

    -may only involve one side of body, TRAP
  3. primary parkinsons cause
    unknown
  4. secondary parkinsons cayse
    • chemical
    • head trauma
    • farm pesticides
  5. 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
  6. extrapyramidal motor system
    • -causing involuntary actions
    • -DA is essential for normal functioning
    • -control of posture, support and voluntary motion
  7. What does TRAP stand for
    • tremor
    • rigidity
    • akinesia
    • postural inability
  8. tremor
    • -minimal initially
    • -resting tremor
    • -pill rolling
  9. pill rolling
    • thumb and forefinger appear to move in a rotary fashion
    • -sign of PD
  10. resting tremor
    aggravated by emotional stress or increased concentration
  11. 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
  12. cogwheel rigidity
    • -jerky quality
    • -as if there were intermittent catches in the passive movement of a joint
  13. akinesia
    • -absence or loss of control of voluntary movement
    • -masked face
    • -drooling
    • -shuffling gate
  14. postural inability
    • -common complication
    • -propulsion
    • -retropulsion
    • -pull test( positive test can indicate PD)
  15. propulsion
    going foward
  16. retropulsion
    going backwards
  17. pull test
    • assessment of postural inability
    • - stand behind pt, give a tug backwards on shoulder, cause to fall backwards
  18. appearance of pt w/ PD
    • -blank facial expression
    • -speech slow and monotone
    • -tremors
    • -short shuffling gait
  19. PD

    diagnostics
    • -soely on hx, clinical features and phys exam
    • -TRAP and asymmetrical onset
    • -positive response to antiPD drugs
  20. 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
  21. Sinemet(levodopa w/ carbidopa)
    • -used to manage akinetic symptoms
    • -very effective
    • -wears off in a few years
    • -primary
  22. Sinemet(levodopa w/ carbidopa)

    side effects
    • -dyskinesia
    • -on/off periods

    teach pt drug can take several weeks/moths to take effect
  23. dyskenisia
    muscle twitches or movements involuntarily
  24. dopamine receptor agonists
    • -directly stimulates DA receptor
    • -Bromocriptine(parlodel)
    • -Pramipexole(Mirapex)
  25. Bromocriptine(parlodel)
    • -shouldn't be used first
    • SE: increase BP, heart attack, stroke, seizures, ortho hypo
  26. monamine oxidase inhibitors
    • prolong the half life of levodopa
    • -selegiline(eldepryl)
  27. anticholinergenics
    • decrease ach activity
    • -benztropine(cogentin)
  28. COMT inhibitors
    • enhances effects of sinemet
    • -entacapone(comtan)
  29. antihistamines
    • used to manage tremors
    • benadryl
  30. PD drugs
    • sinemet
    • dopamine receptor agonist
    • monamine oxidase inhibitor
    • COMT inhibitor
    • anticholenergenics
    • antihistamines
  31. PD

    surgical interventions
    • ablation(destroy area of brain)
    • deep brain stim(most com, electrode in chest)
  32. PD

    complications
    • -dementia(40%)
    • -dysphagia
    • -sleep disorders
    • -depression, anxiety
    • -constipation
    • -UTI
    • -Pneumonia
    • -skin break down
  33. levodopa can be impaired by
    protein ingestion
  34. protein is needed for
    wound heeling
  35. what size meals to eat?
    6 small meals vs 3 big meals
  36. how to alleviate bradykinesia symptoms
    • -lifting feet while walking
    • -rock back and forth to intiate movement
  37. bradykenisisa
    slowness of movement
Author
ChelseaL
ID
342205
Card Set
Parkinsons(EXAM 1)
Description
Parkinsons
Updated