Movement Disorders Flashcards
(113 cards)
1
Q
Is Multiple system atrophy (MSA) a hypokinetic or hyperkinetic disorder?
A
Hypokinetic
2
Q
Is progressive supranuclear palsy (PSP) a hypokinetic or hyperkinetic disorder?
A
Hypokinetic
3
Q
Is corticobasal degeneration (CBD) a hypokinetic or hyperkinetic disorder?
A
Hypokinetic
4
Q
Parkinson’s disease is caused by a loss of cells that produce this neurotransmitter in the substantia nigra pars compacta
A
Dopamine
5
Q
Parkinson’s disease is caused by the loss of dopamine-producing cells in this structure
A
Substantia nigra pars compacta
6
Q
“TRAPS” is an acronym for the symptoms of Parkinson’s disease, and stands for this
A
Tremor at rest
Rigidity
Akinesia/bradykinesia
Postural instability / flexed balance
Shuffling gait
7
Q
Can Parkinson’s disease present with hallucinations and psychosis?
A
Yes (usually drug induced)
8
Q
Does Parkinson’s disease disrupt sleep?
A
Yes
9
Q
Does Parkinson’s disease cause orthostatic hypo- or hyper-tension
A
Hypotension
10
Q
Olfactory disturbances can occur in this condition characterized by resting tremor, rigidity, or bradykinesia
A
Parkinson’s disease
11
Q
This occurs when symptoms similar Parkinson’s disease are caused by certain medicines, a different nervous system disorder, or another illness
(examples: viral encephalitis, microvascular lesions, dopamine antagonists)
A
Secondary Parkinsonism
12
Q
Does idiopathic Parkinson’s disease present with unilateral or bilateral onset of symptoms?
A
Unilateral
13
Q
Does Multiple system atrophy present with symmetric or asymmetric symptoms?
A
Symmetric
14
Q
Does corticobasal degeneration present with symmetric or asymmetric symptoms?
A
Marked asymmetric symptoms
15
Q
Hypokinetic disorder with early autonomic dysfunction, early falls and gait difficulty
A
Multiple system atrophy
16
Q
Hypokinetic disorder with oculomotor abnormalities
A
Progressive supranuclear palsy
17
Q
Hypokinetic disorder with apraxia, alien limb phenomenon, loss of limb function
A
Corticobasal degeneration
18
Q
Hypokinetic disorder with normal MRI
A
Idiopathic Parkinson’s disease
19
Q
Hypokinetic disorder with Hot cross bun sign and Putaminal rim sign on MRI
A
Multiple system atrophy
20
Q
Hypokinetic disorder with Humming bird sign and Micky mouse sign on MRI
A
Progressive supranuclear palsy
21
Q
Hypokinetic disorder with asymmetric parietal and/or frontal cortical atrophy seen on MRI
A
Corticobasal degeneration
22
Q
Is MRI normal in Parkinson’s disease?
A
Yes
23
Q
What is the average age of diagnosis for Parkinson’s disease?
A
55-60 years of age
24
Q
These two genes linked to Parkinson’s disease have an autosomal dominant pattern
A
LRRK2 (kinase) and SNCA (alpha-synuclein)
25
These three genes linked to Parkinson's disease have an autosomal recessive pattern
PARK2 (parkin protein), PARK7 (DJ-1 protein), and PINK1 (kinase)
26
LRRK2 (kinase) and SNCA (alpha-synuclein) are genes associated with Parkinson's disease with this inheritance pattern
Autosomal dominant
27
PARK2 (parkin protein), PARK7 (DJ-1 protein), and PINK1 (kinase) are genes associated with Parkinson's disease with this inheritance pattern
Autosomal recessive
28
Clumping of this misfolded protein forms Lewy bodies
Alpha synuclein
(binds ubiquitin in damaged cells)
29
Is there a cure for Parkinson's disease?
No
30
Levodopa is a treatment for this condition
Parkinson's disease
31
Central conversion of this drug to dopamine allows enhancement of dopamine levels in the remaining nerve terminals, ‘restoring’ net function in the basal ganglia in Parkinson's disease
Levodopa
32
Levodopa is a precursor to this molecule
Dopamine
33
Does dopamine cross the blood brain barrier?
No
34
Does levodopa cross the blood brain barrier?
Yes
(using the competitive aromatic acid transport system)
35
Absorption of Levodopa can be enhanced by doing this
Taking drug on empty stomach
(or with low protein foods)
36
This enzyme converts levodopa to dopamine outside of the CNS
Peripheral decarboxylase
37
Is carbidopa a reversible or irreversible inhibitor of peripheral decarboxylase?
Reversible
38
Peripheral decarboxylase can be blocked by this reversible inhibitor to enhance net central conversion of dopa to dopamine
Carbidopa
39
Carbidopa is given to enhance the effect of this Parkinson's drug
Levodopa
40
This symptom of Parkinson's shows the least improvement with treatment of Levodopa
Postural defects
41
Postural defects show the least improvement with this Parkinson's drug
Levodopa
42
Peripheral adverse effects of levodopa caused mainly by dopamine (Nausea and vomiting, orthostatic hypotension, cardiac arrhythmias) are all reduced by use of this drug
Carbidopa
43
How can central adverse effects of levodopa (anorexia, visual and auditory hallucinations, dyskinesias) be reduced?
Lowering dose or drug holiday
44
How can peripheral adverse effects of levodopa (Nausea and vomiting, orthostatic hypotension, cardiac arrhythmias) be reduced?
Use carbidopa
45
Carbidopa is a reversible inhibitor of this
Peripheral decarboxylase
46
This drug for Parkinson's disease has response fluctuations
Levodopa
47
This direct dopamine agonist should be given with levodopa when there is slow onset of action (delayed ON or no ON)
Apomorphine
48
Apomorphine is an agonist of this
dopamine
49
This drug should be given when there is sudden return of symptoms with levodopa use (ON-OFF dyskinesias)
Amantadine
50
Either of these should be given with levodopa when there is a return of symptoms shortly before the next scheduled dose (end-of-dose or wearing OFF reactions)
COMT or MAO-B inhibitors
or dopamine agonist
(can also increase dose frequency)
51
Bromocriptine is this type of drug
Dopamine receptor agonist
52
Apomorphine is this type of drug
Dopamine receptor agonist
53
Pramipexole is this type of drug
Dopamine receptor agonist
54
Ropinirole is this type of drug
Dopamine receptor agonist
55
Rotigotine is this type of drug
Dopamine receptor agonist
56
This type of drug can be used as monotherapy or as adjunct to L-DOPA for Parkinson's disease
Direct Dopamine receptor agonists
57
This type of drug for Parkinson's disease can also be used for restless leg syndrome
Direct dopamine receptor agonists
58
This type of drug for Parkinson's disease must be used while L-DOPA is still beneficial, and has more adverse effects than with Levodopa
Direct dopamine receptor agonists
59
Compulsive behaviors, such as increased gambling, can be seen with this type of drug for Parkinson's disease
Direct dopamine receptor agonists
60
This drug for Parkinson's disease has a short-lived amphetamine-like effect
Amantadine
61
Amantadine is an antagonist of this receptor
NMDA
62
Is Amantadine an agonist or antagonist of the NDMA receptor?
Antagonist
63
Drug for Parkinson's disease that is unique in that it doesn’t directly replace dopamine like levodopa, but instead modulates dopamine activity
Amantadine
64
This is the primary degradative enzyme for dopamine in the brain
Monoamine oxidase B
65
Selegiline is an irreversible inhibitor of this enzyme
Monoamine oxidase B
66
Is Selegiline a reversible or irreversible inhibitor of MAO-B?
Irreversible
67
Selegiline should not be used if the patient has taken this opioid analgesic
Meperidine
68
This MAO-B inhibitor should not be given if the patient has taken meperidine
Selegiline
69
Hallucinations, insomnia, jitteriness, dyskinesia and delusions may be amphetamine/methamphetamine response adverse effects of this drug for Parkinson's disease
Selegiline
70
MAO-B inhibitor with lower risk of hallucinations, insomnia, jitteriness, and delusions
May be neuroprotective
Rasagiline
71
Which MAO-B inhibitor has lower risk of hallucinations, insomnia, jitteriness: Selegiline or Rasagiline?
Rasagiline
72
COMT inhibition slows dopa conversion in periphery to this
3-O-methyldopa
73
This is the primary dopamine degradative enzyme in the periphery
Catechol-O-methyltransferase (COMT)
74
Inhibitors of this are especially good in managing response fluctuations associated with levodopa therapy
Catechol-O-methyltransferase (COMT) inhibitors
75
This Catechol-O-methyltransferase (COMT) inhibitor crosses the blood brain barrier
(may prolong central duration of dopamine)
Tolcapone
76
Tolcapone is this type of drug
Catechol-O-methyltransferase (COMT) inhibitor
77
Entacapone is this type of drug
Catechol-O-methyltransferase (COMT) inhibitor
78
Diarrhea and orange discoloration of urine are adverse effects of this type of drug for Parkinson's disease
Catechol-O-methyltransferase (COMT) inhibitor
79
Hepatic necrosis can occur with this Catechol-O-methyltransferase (COMT) inhibitor
Tolcapone
80
This drug is a combination of entacapone, levodopa and carbidopa, designed to allow patients to take one pill rather than two
Stalevo
81
Trihexyphenidyl is this type of drug
Anticholinergic
(treats Parkinson's)
82
This type of drug for Parkinson's disease is used when the primary complain is tremor
Anticholinergic drugs
(e.g. Trihexyphenidyl)
83
Anticholinergic drugs (e.g. Trihexyphenidyl) are used in Parkinson's disease when this symptom is the primary complaint
Tremor
84
This vitamin may enhance the breakdown of levodopa into dopamine, particularly in peripheral tissue, which may reduce its effectiveness
B6
85
Central side effects of levodopa include psychosis, which should be treated with this drug
Pimavanserin
86
This type of drug for Parkinson's disease is likely to have significant interactions with peripheral adrenergic agents
MAO inhibitors
87
Do Selegiline, Rasagiline, and Safinamide inhibit central or peripheral dopamine degradation?
Central
(inhibit MAO)
88
Do Entacapone and Tolcapone inhibit central or peripheral dopamine degradation?
Peripheral
(COMT inhibitors)
89
This MAO inhibitor has a mixed agonist metabolite that increases risk of psychosis
Selegiline
90
Selegiline has a mixed agonist metabolite that increases the risk of this adverse effect
Psychosis
91
This COMT inhibitor may cause liver damage
Tolcapone
92
Tolcapone is a COMT inhibitor that may cause damage to this organ
Liver
93
This type of drug for Parkinson's disease has a higher level of confusion and hallucination
Anticholinergics
(e.g. Trihexyphenidyl)
94
Anticholinergics (trihexyphenidyl) and/or amantadine are used in Parkinson's disease when this symptom is the primary problem
Tremor
95
This is the treatment for fluctuating, dyskinetic Parkinson's disease without dementia after exhausting medical options
Surgical treatment
96
These two structures are the common targets for deep brain stimulation in Parkinson's disease
Subthalamic nucleus and Globus pallidus internus
97
This structure is a common target for deep brain stimulation in essential tremor
Ventral intermediate nucleus (VIM) of the thalamus
98
This structure is a common target for deep brain stimulation in Dystonia
Globus pallidus internus
99
This structure is a common target for deep brain stimulation in Huntington's disease
Globus pallidus internus
100
This structure is a common target for deep brain stimulation in Tourette's syndrome
Globus pallidus internus
101
Essential tremors usually respond to this type of drug
Beta blockers
(e.g. propranolol)
102
Ventral intermediate nucleus (VIM) of the thalamus is the most common deep brain stimulation target in this condition
Essential tremor
103
Involuntary, sustained, patterned and repetitive muscle contractions of muscles leading to twisting postures
Dystonia
104
This is the first line therapy for focal dystonia
Botulinum toxin
105
Are levels of glutamate, acetylcholine, and GABA reduced or increased in Huntington's disease?
Reduced
(due to loss of caudate)
106
This structure of the basal ganglia is lost in Huntington's disease, leading to reduced glutamate, acetylcholine, and GABA
Caudate
107
Tetrabenazine or reserpine can be used to treat this condition
Huntington's disease
108
What age does Tourette's syndrome begin?
Childhood
109
What is the treatment for Tourette's syndrome?
Antipsychotic (e.g. haloperidol)
110
Autosomal recessive genetic disorder in which excess copper builds up in the body
Wilson's disease
111
What is the inheritance pattern of Wilson's disease?
Autosomal recessive
112
Wilson's disease is a disorder that results in excess of this that builds up in the body
Copper
113
Wilson's disease involves this chromosome
13
