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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

anticholinesterase inhibitor ADE's

1. SLUDE
2. Decreased HR
3. Bronchoconstriction
4. Constricted pupils