Flashcards in Movement Disorders Deck (62)
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1
What is the MC movement disorder?
Tremor
2
What is the MC neurologic cause of postural or action tremor?
Essential Tremor
3
Essential Tremor treatment
Long Acting Propanolol
4
Propanolol SE's
1. Lightheadedness
2. Fatigue
3. Impotence
4. Bradycardia
5
Who should you caution with propranolol?
1. Heart block
2. Asthma
3. Type 1 diabetes mellitus
6
List the anticonvulsant used for treatment of essential tremors
1. Primidone
2. Topiramate
3. Gabapentin
7
What is the max dose where there is no benefit beyond that in Primidone
750 mg/daily
8
Main SE's of Primidone
Sedation
9
Topiramte MOA
Enhances GABA activity
Blocks voltage-gated sodium channels
10
Toprimate ADEs
Concentration difficulty
11
Gabapentin ADEs
1. Gait unsteadiness
2. "Brain fog"-interferes with memory
12
What does Botulinum toxin type A injection provide MODEST benefit in?
Limb tremor
13
What Botulinum toxin type A injection POSSIBLY reduce?
1. Head tremor
2. Voice tremor
*Limited data
14
ADEs of Botulinum toxin type A in treatment of voice tremor
1. Breathlessness
2. Hoarseness
3. Swallowing difficulty
15
Benzodiazepines MOA
Enhances GABA activity
16
Why are Benzodiazepines second-line choice in treating essential tremors?
Dependence issues
17
What part of the brain does Huntington's dz affect?
Basal Ganglia
18
How would you treat chorea in huxngtingtons?
Central Monoamine Depleting Agents
19
List the Central Monoamine Depleting Agents
1. Tetrabenazine
2. Deutetrabenazine
20
SE's of Tetrabenazineand Deutetrabenazine
Depression
21
Haloperidol MOA
Blocks Dopamine
22
Haloperidol clinical application
1. Tourette's Syndrome
2. Huntington's chorea
23
Haloperidol SE's
Extrapyramidal dysfunction
-->Get Parkinson's like movements D/T this
24
What would you use atypical antipsychotics in the treatment of?
1. Tourettes
2. Schizophrenia: Improves both positive and negative sx's
25
Tourettes Treatment for severe motor and phonic tics who have failed standard tx?
Pimozide
26
Pimozide MOA
dopamine receptor antagonist
27
Pimodize SEs
1. Sedation
2. Akathisa/Akinesia
3. Ocular accommodation decreases
28
What is the hallmark finding in Tourettes syndrome?
Phonic tics, onset during childhood
29
What associated disorder occurs in 60-70% of youth with chronic tics or Tourettes syndrome
ADHD
30
When is iron replacement indicated in the treatment of restless leg syndrome?
Serum Ferritin <75 mg/L
31
How do we choose therapy in restless leg syndrome?
Based on comorbid conditions
32
List the two medication used for INITIAL treatment in restless leg syndrome
1. Pramipexole
2. Ropinirole
33
Treatment for INTERMITTENT RLS associated with triggers from traveling by auto or airplane or specific events with prolonged sitting
Carbidopa-Levodopa
34
What is the max daily dose for Levodopa in the treatment of INTERMITTENT RLS?
200 mg/day
35
What population can we use benzodiazepines in with the treatment of RLS?
Younger patients
36
Benzodiazepines SE's
"Benzo hangover": Cognitive impairment in the morning
37
List the dopamine agonist used in the treatment of PERSISTENT RLS
Pramipexole
38
Pramipexole ADE's
1. Fatigue
2. Nasal Stiffness
3. Risk of impulse control disorder
39
Who should we avoid giving Pramipexole to?
Gambler*
40
List the Alpha-2-Delta Calcium channel ligands used in the treatment of PERSISTENT RLS
1. Gabapentin
2. Pregablin
41
Indication to use Gabapentin or Pregablin?
Comorbid insomnia or sleep disturbances that is disproportionate to other RLS sx's
42
Treatment for REFRACTORY RLS?
Opiods
43
List the chelating agents used in treatment of Wilson's Dz
1. D-Penicillamine
2. Trientine
44
D-Penicillamine MOA
Free sulfhydryl group that function as a copper chelating moiety
45
What do you want to give to prevent pyridoxal phosphate deficiency seen when using D-Penicillamine
Pyrodoxine (B6)
46
What is the major SE we are concerned about with Trientine-Copper chelator? How do we avoid this?
Nephortoxicity D/T trientine iron complex
Avoid coadministration of iron with Trientine
47
Oral zinc MOA in treatment of Wilson's Dz?
Interferes with absorption of copper excreted in the stool
48
What does ALS (Lou Gehrig's Dz) SPARE?
1. Sensory
2. Autonomic
3. Oculomotor
4. Mental function
49
What is the proposed etiology of ALS?
Glutamate reuptake abnormality
50
Lis the two main treatments for ALS?
1. Riluzole
2. Edaravone
51
Riluzole MOA
1. Inhibits Glutamate release
2. Inactivation of Na+ channels
3. Interferes with transmitter binding @ excitatory receptors
52
Riluzole ADE's
1. HTN
2. Abdominal pain
3. Increase Transminases
4. Neuromuscular and arthralgia
5. Tremor
6. Decreased lung function
53
What is a serious ADE of Edaravone?
Asthmatic reaction
54
List the agents used to treat spasticity in ALS
1. Baclofen
2. Tizanidine
3. Clonazepam
55
Balcofen MOA
GABA B receptor agonist
56
Baclofen SE's
Sedation
57
Tizanidine MOA
Alpha 2 agonist in CNS
58
Tizanidine ADE's
1. Drowsiness
2. Dizziness
3. Asthenia (lack of energy)
59
Benzodiazepine (effective anti spasticity) ADE's
1. Amnesia
2. Confusion
3. Drowsiness
4. Slurred speech
60
What other conditions exhibit Benzodiazepine side effects?
1. Alcohol
2. Stroke
3. Dementia
4. Post-concusive
5. Hypoglycemia
61
Lis the anticholinesterase inhibitors for treatment of Myasthenia Gravis
1. Pyridostigmine
1. Neostigmine
62
