Flashcards in Movement Disorders Deck (62)
What is the MC movement disorder?
What is the MC neurologic cause of postural or action tremor?
Essential Tremor treatment
Long Acting Propanolol
Who should you caution with propranolol?
1. Heart block
3. Type 1 diabetes mellitus
List the anticonvulsant used for treatment of essential tremors
What is the max dose where there is no benefit beyond that in Primidone
Main SE's of Primidone
Enhances GABA activity
Blocks voltage-gated sodium channels
1. Gait unsteadiness
2. "Brain fog"-interferes with memory
What does Botulinum toxin type A injection provide MODEST benefit in?
What Botulinum toxin type A injection POSSIBLY reduce?
1. Head tremor
2. Voice tremor
ADEs of Botulinum toxin type A in treatment of voice tremor
3. Swallowing difficulty
Enhances GABA activity
Why are Benzodiazepines second-line choice in treating essential tremors?
What part of the brain does Huntington's dz affect?
How would you treat chorea in huxngtingtons?
Central Monoamine Depleting Agents
List the Central Monoamine Depleting Agents
SE's of Tetrabenazineand Deutetrabenazine
Haloperidol clinical application
1. Tourette's Syndrome
2. Huntington's chorea
-->Get Parkinson's like movements D/T this
What would you use atypical antipsychotics in the treatment of?
2. Schizophrenia: Improves both positive and negative sx's
Tourettes Treatment for severe motor and phonic tics who have failed standard tx?
dopamine receptor antagonist
3. Ocular accommodation decreases
What is the hallmark finding in Tourettes syndrome?
Phonic tics, onset during childhood
What associated disorder occurs in 60-70% of youth with chronic tics or Tourettes syndrome
When is iron replacement indicated in the treatment of restless leg syndrome?
Serum Ferritin <75 mg/L
How do we choose therapy in restless leg syndrome?
Based on comorbid conditions
List the two medication used for INITIAL treatment in restless leg syndrome
Treatment for INTERMITTENT RLS associated with triggers from traveling by auto or airplane or specific events with prolonged sitting
What is the max daily dose for Levodopa in the treatment of INTERMITTENT RLS?
What population can we use benzodiazepines in with the treatment of RLS?
"Benzo hangover": Cognitive impairment in the morning
List the dopamine agonist used in the treatment of PERSISTENT RLS
2. Nasal Stiffness
3. Risk of impulse control disorder
Who should we avoid giving Pramipexole to?
List the Alpha-2-Delta Calcium channel ligands used in the treatment of PERSISTENT RLS
Indication to use Gabapentin or Pregablin?
Comorbid insomnia or sleep disturbances that is disproportionate to other RLS sx's
Treatment for REFRACTORY RLS?
List the chelating agents used in treatment of Wilson's Dz
Free sulfhydryl group that function as a copper chelating moiety
What do you want to give to prevent pyridoxal phosphate deficiency seen when using D-Penicillamine
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
Oral zinc MOA in treatment of Wilson's Dz?
Interferes with absorption of copper excreted in the stool
What does ALS (Lou Gehrig's Dz) SPARE?
4. Mental function
What is the proposed etiology of ALS?
Glutamate reuptake abnormality
Lis the two main treatments for ALS?
1. Inhibits Glutamate release
2. Inactivation of Na+ channels
3. Interferes with transmitter binding @ excitatory receptors
2. Abdominal pain
3. Increase Transminases
4. Neuromuscular and arthralgia
6. Decreased lung function
What is a serious ADE of Edaravone?
List the agents used to treat spasticity in ALS
GABA B receptor agonist
Alpha 2 agonist in CNS
3. Asthenia (lack of energy)
Benzodiazepine (effective anti spasticity) ADE's
4. Slurred speech
What other conditions exhibit Benzodiazepine side effects?
Lis the anticholinesterase inhibitors for treatment of Myasthenia Gravis