Lecture 10: Tardive Dyskinesia Flashcards
Serial monitoring of which serum value is required when alcoholic patients are admitted to the hospital?
Phosphate
At which level of serum phosphate should you begin giving phosphate in asymptomatic pt?
<2 mg/dL
Hypophosphatemic alcoholic pt’s may have a myopathy due to both phosphate depletion and alcohol toxicity, and are at risk for clinically significant what?
Rhabdomyolysis
Thiamine is a cofactor for which 3 key enzymes needed for energy metabolism?
- Transketolase
- α-ketoglutarate dehydrogenase
- Pyruvate dehydrogenase
What is the classic triad of Wernicke Encephalopathy?
- Encephalopathy
- Oculomotor dysfunction
- Gait ataxia
Which area of the hippocampus is sometimes affected in Wernicke’s and often affected in Korsakoff Syndrome?
Medial Temporal lobe
What is Tardive Dyskinesia and how long must the sx’s be going on for?
- Medication-induced hyperkinetic movement disorder caused by exposure to:
- Dopamine receptor-blocking agents, most often antipsychotics
- Persists for at least 1 month after discontinuing the offending agent
Which assessment tool is used for Tardive Dyskinesia?
Abnormal Involuntary Movement Scale (AIMS)
What are some of the drugs that can cause Tardive Dyskinesia?
- ALL dopamine-receptor blocking agents!!
- 1st or 2nd gen. anti-psychotics
- Metoclopramide
- Dopamine receptor-blocking antiemetics: Prochlorperazine and Chlorpromazine
Which 2 second-gen. antipsychotics have the highest risk for tardive dyskinesia?
Paliperidone and Risperidone
Which patients are at the highest risk of developing Tardive Dyskinesia?
- Pt’s who develop extrapyramidal sx’s as an AE of early anti-psychotic drug therapy
- Pt’s who are: older, are heavy smokers, or have DM
Which hypothesis for developing Tardive Dyskinesia has the most evidence to date?
- Dopamine-hypothesis
- Dopamine receptor hypersensitivity and/or imbalance btw D1 and D2 receptor-mediated effects in the basal ganglia
Polymorphisms in what have been linked to the development of Tardive Dyskinesia?
5-HT2A receptor gene
Which serotonin antagonist has strong binding to 5-HT 2A/2C receptor subtypes and is associated with lower incidence of T.D. and has a favorable effect on T.D.?
Clozapine (2nd gen. anti-psychotic)
Which 2 second-gen. antipsychotic drugs may have ameliorating effects on TD severity?
Cloazpine and Quetiapine
List 4 drugs which can be used to control the sx’s of TD?
Benzodiazepines + Botulinum toxin injections + Valbenazine + Tetrabenazine
Which newer pharmalogical agent has shown to be an effective tx of TD?
Gingko biloba extract, known as EGb-761
