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Quiz

NE4 Parkinson's disease

Usuário eliminado 8 perguntas Atualizado em 11 out 2019

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  1. 1Epidemiology of PD:
    - [blank_start]65[blank_end] year mean age of onset
    - 50% more likely to affect [blank_start]men[blank_end]
    - 90% [blank_start]idopathic[blank_end], 10% hereditary

    Primary motor symptoms:
    - [blank_start]Tremor[blank_end] affects 70%
    - [blank_start]Bradykinesia[blank_end] (slow movement) affects everyone
    - [blank_start]Rigidity[blank_end] affects 90%

    Psychiatric disturbances [blank_start]5-10 years[blank_end] post diagnosis.
    Dementia affects [blank_start]80[blank_end]% of patients [blank_start]20 years[blank_end] after diagnosis.
    1. A65
    2. Bmen
    3. Cidopathic
    4. DTremor
    5. EBradykinesia
    6. FRigidity
    7. G5-10 years
    8. H20 years
    9. I80
  2. 2Former smokers have 20% decreased risk of getting PD while current smokers have a 50% decreased risk.
    1. AVerdadeiro
    2. BFalso
  3. 3Reminder: The basal ganglia. [blank_start]Grey[blank_end] matter structures - [blank_start]striatum, globus pallidus[blank_end]. Connections to [blank_start]thalamus[blank_end], subthalamic nuclei, substantia nigra. Important in coordinating motor function.

    Neurochemistry of PD: Dopamine (DA) deficient because of a greater than [blank_start]50[blank_end]% loss of DA neurons in [blank_start]substantia nigra[blank_end], and degeneration of [blank_start]terminals[blank_end] in the striatum. [blank_start]Lewy[blank_end] bodies cause functional changes.
    1. AGrey
    2. Bstriatum, globus pallidus
    3. Cthalamus
    4. D50
    5. Esubstantia nigra
    6. Fterminals
    7. GLewy
  4. 4Basal ganglia-thalamo-cortical loop is the [blank_start]motor loop[blank_end] in the brain where choices about planned movements are made. 4 linked parts: motor cortex, striatum, basal ganglia, thalamus.
    The motor [blank_start]cortex[blank_end] sends information about all planned movement to the [blank_start]striatum[blank_end]. The signals then move to the [blank_start]basal ganglia[blank_end], and then to the [blank_start]thalamus[blank_end] completing the selection process. The signals contain information about which moves to make and which moves to block.
    1. Amotor loop
    2. Bcortex
    3. Cstriatum
    4. Dbasal ganglia
    5. Ethalamus
  5. 5Degeneration of dopaminergic neurons in the [blank_start]substantia nigra[blank_end] results in reduced stimulation of [blank_start]D1 and D2[blank_end] receptors in the striatum.
    The consequence is overactive [blank_start]GABA[blank_end] inhibition of the thalamus, and reduced [blank_start]glutamate[blank_end] excitation/activation of cortical systems. At the same time, [blank_start]hyperactivity[blank_end] in the glutamate pathways that connect the cortex to the [blank_start]striatum[blank_end] reinforce the [blank_start]inhibitory[blank_end] influence that basal ganglia has on movement.
    The symptom most clearly related to this dopamine deficiency is hypokinesia.
    Rigidity and tremor more complex and involve disturbances in [blank_start]Ach, NA, 5HT[blank_end] and GABA.

    > what ?
    - old dopamine neurons not making enough dopamine = too much gaba going to thalamus. not enough glutamate going to cortex and too much glutamate coming from it = no movey movey
    1. Asubstantia nigra
    2. BD1 and D2
    3. CGABA
    4. Dglutamate
    5. Ehyperactivity
    6. Fstriatum
    7. Ginhibitory
    8. HAch, NA, 5HT
  6. 6Drug that enhance dopaminergic activity
    1. Levodopa
    • Dopamine [blank_start]precursor[blank_end] (DA cannot cross BBB)
    • Extensive [blank_start]decarboxylation[blank_end] (periphery)
    • SEs: nausea, vomiting, [blank_start]arrhythmias, vasodilation[blank_end]
    • 1% oral dose reaches brain
    • t1/2 [blank_start]short[blank_end] (1h)
    Modified release preps: more continuous supply
    .. so we add DDC inhibitors e.g. carbedopa, benserazide. DCC inhibitors [blank_start]prevent[blank_end] peripheral conversion:
    - decreases L-dopa [blank_start]dose[blank_end] required
    - decreases [blank_start]side[blank_end] effects
    Carbidopa + levodopa = [blank_start]Sinemet[blank_end]
    Benserazide + levodopa = Madopar
    .. can also add [blank_start]COMT[blank_end] inhibitors e.g. entacapone, tolcapone
    • Prevent breakdown in periphery/CNS (30%)
    • [blank_start]Double[blank_end] half life

    1. Aprecursor
    2. Bdecarboxylation
    3. Carrhythmias, vasodilation
    4. Dshort
    5. Eprevent
    6. Fdose
    7. Gside
    8. HSinemet
    9. ICOMT
    10. JDouble
  7. 7Usually around 3-4 hours after a dose of levodopa, the medication [blank_start]wears[blank_end] off and symptoms re-emerge or worsen. Symptoms then typically improve 15-45 [blank_start]minutes[blank_end] after the next dose is taken. This phenomenon is called ‘wearing off’.

    Motor fluctuations (e.g. [blank_start]on/off[blank_end] phenomenon) are the changes in motor performance associated generally with taking levodopa but also with dopamine agonists in some cases. It is caused by a [blank_start]gradual[blank_end] loss of DA producing cells over time. This means that the level of dopamine in your brain is increasingly dependent on the availability of levodopa in the [blank_start]blood[blank_end], which in turn relies on your most recent dose of medication. ‘On’ time is when levodopa is [blank_start]working[blank_end] well and symptoms are controlled. ‘Off’ time is when levodopa is no longer working well and symptoms such as [blank_start]tremor, rigidity and slow[blank_end] movement re-emerge. As PD progresses they become less dose-[blank_start]timing[blank_end] related.
    1. Awears
    2. Bminutes
    3. Con/off
    4. Dgradual
    5. Eblood
    6. Fworking
    7. Gtremor, rigidity and slow
    8. Htiming
  8. 8DA agonists - [blank_start]Ergot[blank_end] derivatives: e.g. Bromocriptine, cabergoline, (pergolide*)
    L-DOPA adjunct:
    • Dose reduction
    • Exacerbates L-DOPA motor [blank_start]complications[blank_end]

    Monotherapy:
    Longer [blank_start]t1/2[blank_end] , delay L-DOPA (L-DOPA sparing)
    • increases SEs especially [blank_start]psychiatric[blank_end]
    • N&V, orthostatic hypotension,
    • Serious [blank_start]pulmonary, peritoneal and pericardial[blank_end] fibrosis
    1. AErgot
    2. Bcomplications
    3. Ct1/2
    4. Dpsychiatric
    5. Epulmonary, peritoneal and pericardial

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O usuário eliminou as informações de disciplina Quiz sobre NE4 Parkinson's disease, criado por Usuário eliminado em 11-10-2019.
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Usuário eliminado
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English
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Criado em 11 out 2019 · atualizado em 11 out 2019
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