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Clin Med B 2 > trigger - movement > Flashcards

trigger - movement Flashcards

1
Q

Exacerbated by extreme temps and hunger

A

essential tremor

also exacerbated by emotion and fatigue

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2
Q

improved by alcohol

A

Essential tremor

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3
Q

has to be present for 3 years in order to dx

A

essential tremor:

Isolated tremor consisting of bilateral UE action without other motor abnormalities
3y in duration
W or w/o tremors in other locations
Absence of other neurologic signs

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4
Q

worsened with caffeiene

A

enhanced physiologic tremor

restless leg syndrome too!

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5
Q

treatment for intermittent ET

A

1st-line: Propranolol and Primidone (slower onset)
2nd-line: xanax or klonopin

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6
Q

tx for persistent ET

A

1st-line: propanolol or primidone daily. or both! (combo)
2nd-line: gabapentin, pregabalin, topiramate.
2nd-line: Neurologist for botox A or surgical intervention via deep brain stim or thalamotomy

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7
Q

caused by damage to the pons, midbrain, thalamus or cerebellum.

A

intention/kinetic tremor

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8
Q

only treatment is to refer to neuro for surgery

A

intention tremor

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9
Q

WORSE by attempting voluntary movement

A

dystonia

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10
Q

Involuntary contraction of both agonist and antagonist muscles

A

dystonia

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11
Q

MC 30-50

A

torticollis

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12
Q

T or F: blepharospasms can be bilateral or unilateral

A

false: they are unilateral, synchronus and symmetric

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13
Q

irregular and involuntary voice breaks, pt feels like they have to yell

A

spasmodic dysphonia

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14
Q

how to treat adults with generalized dystonias

A

all pts = trial of carbidopa/levodopa

1st-line: Clonazepam (GABA)

Second-line: Baclofen (GABA agonist) or trihexyphenidyl (anticholinergic which increases dopamine release)

Alternative second-line: VMAT2 inhibitor (-benazine and off-label use)

Last resort: DBS

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15
Q

what is the tx for generalized dystonias in children

A
  1. trihexyphenadyls
  2. baclofen or BZDs
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16
Q

Treated w NSAIDS and soft cervical collar

A

infantile torticollis

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17
Q

MC in:
white women
preggo
fmhx
middle aged/older

A

restless leg syndrome

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18
Q

MC with iron deficiency anemia

A

restless leg

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19
Q

risks include alcoholism, DM, amyloidosis, motor neuron disease

A

restless leg

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20
Q

worsened by antihistamines, metoclopramide, antipsychotics and antidepressants

A

restless leg syndrome

also worse w caffeine and sleep deprivation

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21
Q

when do you initiate pharm for restless leg and what are the pharm options for tx!

A

> or equal to 3 nights/week

  • gabapentin, pregablin or gebapentin encarbamil(ER) (ER is given when they have sx throughout hte daytime.)
  • Pramipexole, ropinrole, rotigotine patch
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22
Q

risk of impulse control disorder and augmentation

A

dopamine agonists (pramipexole, ropinirole, rotigotine)

23
Q

what drug requires drug holidayrs

A

dopamine agonists (pramipexole, ropinirole, rotigotine) becuase of risk of augmentation

24
Q

what are the indication for treating tourettes and what do you treat them with.

A

Affecting ADLs, and daily life in general.
Causes pain, discomfort, or injury

FDA approved: Haldol, primozide, aripiprazole
Non-FDA approved: VMAT2 inhibitor (tetrabenazine), clonidine, guanfacine

25
hypotonia w hyperreflexia
huntingtons disease
26
presents w Wt loss and cachexia
huntingtons dz
27
Slowly progressing disease characterized by tremor, bradykinesia, rigidity, and postural instability
parkinsons disease
28
lewy bodies and decreased dopamine producing neurons
parkinsons leads to high acetylcholine and low dopamine
29
alleviated by voluntary movemen
tremors in parkinsons
30
tapping over the bridge of the nose and produces sustained blink what is the name of this test and who is it positive in
myerson sign + in parkinsons
31
what is the treatment for a young patient with a tremor in parkinsons
benzotropine and trihenxyphenidyl
32
what is the treatment for mild parkinsons symptoms
amantadine seligiline, rasagiline, safanamide
33
what is the treatment for moderate parkinsons symptoms
dopamine agonists (pamiprexole, roperinole, rotigotine) for younger carbidopa/levodopa for older
34
for severe parkinsons what is indicated
carbidopa/levodopa +/- etacapone or tolcapone
35
how do you treat dementia in parkinsons what about psychosis
Ach inhibitors and memantine atypical antipsycotics (quetipine)
36
which part of the cerebellum is asociated with ataxia of gait, balance and, ocular
midline cerebellar lesions
37
What kind of ataxia is associated with Dysdiadochokinesis, dysmetria, limb ataxia, tremor, speech
hemispheric cerebeller lesions
38
assocaited with loss of hand/eye coordinaiton, nystagmus, and unclear speech
motor/cerebellar ataxia also with: Imbalance and coordination Ataxic gait (drunk) Unclear (scanning) speech Nystagmus => visual blurring Loss of hand coordination Intention tremor
39
abnormal vibratory sense, stomping gait and positive romberg
sensory/proprioceptive ataxia
40
deviation of gait to affected side, nystagmus, NV, dizziness
vestibular ataxia
41
what do dopamine agonists treat
moderate parkinsons disease restless leg syndrome these are pamiprexole, ropinirole, and rotigotine
42
SE of viral infection and syncope
ropinirole Syncope Somnolence Dizziness Fatigue N/V Viral infection Dyskinesias
43
DDI with cipro, estrogens, and CNS depressants
ropinirole Alcohol Dopamine antagonists CNS depressants Estrogens Cipro
44
dopamine agonist w SE of hypotension
rotogotine DDI is anti-HTN
45
inhibits release of dopamine, noradrenaline and seratonin
VMAT2 inhibitors tetrabenazine
46
hepatically metabolized
tetrabenazine ropinirole amantadine entacapone
47
when are VMAT2 inhibitors used
2nd line for tourettes non FDA approved for generalized dystonias in adults
48
CI in active SI, uncontrolled depression or MAOI use in 14d
tetrabenazine (VMAT2's)
49
can cause NMS
tetrabenazine
50
DDI with tramadol
amantadine
51
SE of disturbance of cardiac rhythm
amantadine also: Restlessness Confusion Skin rashes Edema Disturbances of cardiac rhythm
52
CI in melanoma and narrow angle glaucoma
carbidopa/levodopa
53
avoid this med on a high protiein diet
carbidopa/levodopa

Clin Med B 2 (44 decks)

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