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44 Cards in this Set
- Front
- Back
basal ganglia |
-caudate, putamen, globus pallidus -subthalamic nucleus -substania nigra |
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movement disorders: basal ganglia |
not weak, just hard to control |
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how does the cortex communicate with the basal gang? |
via the striatum (caudate putamen), then this info is processed and output goes back to MOTOR CORTEX via thalamus |
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interneurons WITHIN the striatum use what as their neurotransmitter? |
Ach |
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inputs to the striatum form the globus pallidus use what as the NTS? |
Dopamine |
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D1 receptor: stimulated by dopamine (increasing cAMP) |
D2 receptor: inhibited by dopamine |
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subthalamic nucleus |
relay between the external segment of the globus pallidus (GABA) and the internal segment of the globus pallidus (glutamate). |
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less DOPA by substantia nigra leads to less GLUTAMATE stimulation of cerebral cortex |
leads to poverty of movement (bradykinesia) |
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PK |
-Tremor -Rigidity -Akinesia -Postural Instability
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asymmetrical tremor, worse during stress and walking |
PK |
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cogwheel rigidity |
rigidity in PK is the same, no matter the velocity (how fast you move muscle) |
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softern voice, drooling, smaller handwriting |
akinesia in PK |
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REM sleep behavior disorder: acting out dreams |
PK |
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alpha synuclein makes up Lewy Bodies |
replace dopa in S.N. |
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3 drugs for EARLY Parkinsons |
1. Rasagilin: MAO-B inhibitor (slows down DOPA breakdwon in striatum) 2. Amantadine: 3. Anticholinergics (trihex/benztropine): best for tremor |
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SE of anticholinergics |
constipation, dry mouth, blurry vision, retention (muscarinic) |
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Tx for MILD PK when symptoms start interfering with life |
DOPA receptor agonists: Bromocriptine, Pramipexolem, Ropinirole
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if patient is less than 60: use dopa agonists |
if patient is over 70 or has severe dz, go straight to Levodopa |
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Why is Bromocriptine used less frequently? |
MORE SE!!! (also used to treat prolactinomas) |
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Common SE of pramipexole & ropinorole |
- Nausea - Hallucinations - Sudden attacks of sleep – this requires discontinuation of the medications - Gambling and other obsessive behaviors - Confusion |
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Tx for moderate to severe PK |
1. Levodopa 2. COMT inhibitors 3. DOPA agonists 4. low protein diet 5. surgery |
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how is levodopa different from dopamine? |
precursor of dopamine and actually crosses the BBB (converted in the striatum) |
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how does carbidopa help? |
inhibits peripheral conversion of Levodopa, leading to less SE like naseau/hypotension |
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SE of levodopa |
- Nausea - Hallucinations - DYSKINESIAS*** (more common than with dopamine agonists) - Vivid dreams - Hypotension - Confusion (less common than dopamine agonists) |
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how do COMT inhibitors work (Tolcapone & Entacapone)? |
inhibit destruction of dopa in the periphery, prolonging effect of levodopa |
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SE of Tolcapone |
liver failure: check liver enzymes every 2 weeks |
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Entacapone is short! |
Entacapone is usually given with levodopa since its duration of action is only 2 hours. It is used primarily in patients that have the wearing off phenomenon. |
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Surgical options for PK |
-pallitodomy -thalotomy -deep brain stimulation of globus pallidus |
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3 types of Multisystem Degeneration |
1. progressive supranuclear palsy 2. multisystem atrophy 3. corticobasal degeneration |
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looks like PK but EARLY FALLING***** |
PSP |
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special parts of PSP |
-bulbar (dysarhria/dysphagia/EMO****) -vertical gaze palsy -FRONTAL SUBCORTICAL DEMENTIA (withdrawn apathy**) -poor response to medication |
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MRI for PSP |
-midbrain atrophy**** (hummingbird) without pontine atrophy -Tau proteins on pathology |
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looks like PK, but RAPID PROGRESSION |
· Early falling · Craniocervical dystonia (especially anterocollis where the head is pulled forward) · Poor response to therapy · Minipolymyoclonus tremor (more prominent with hands outstretched and during action****) · Autonomic instability (orthostatic hypotension, erectile dysfunction) · Pseudobulbar palsy (dysarthria, dysphagia, emotional incontinence) · Sometimes a high-pitched dysarthria · REM sleep disorder -> 50% also have an obstructive sleep apnea |
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MRI of MSA |
putaminal atrophy and with a hyperintense rim around the putamen on T2 weighted images. -signal changes in the pons and middle cerebellar peduncle: “hot cross bun” sign. |
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Antipsychotics & Dopamine blockers can cause PK!!!!! |
-Metoclopromide & prochlorperazine -first generation antipsychotics (neuroleptics): Haldol (blocks dopa) - Quietapine & Clozapine DO NOT CAUSE PK!!! |
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sustained muscle contractions that are twisting in nature |
DYSTONIA (Tx: botox) |
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too much copper in liver and BASAL GANGLIA |
Wilsons |
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low ceruloplasmin, high urine copper |
wilsons |
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GABA deficit (atrophy in caudate) |
huntingtons |
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3 main features of Huntingtons |
1. dementia/irritability 2. chorea 3. FHx |
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CAG |
huntingtons |
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stroke in CONTRA subthalamic*** nucleus |
hemiballismus |
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multiple*** motor tics, one or more vocal tics, onset before age 21 |
touretes |
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neuroleptics (antipsychotics) and anti-emtics block dopamine and lead to PK, what else can they do |
TARDIVE DYSKINESIA!!! permanent! |