Essential tremor, chorea, tics, and related disorders Flashcards
Which drugs can be used to suppress chorea in Huntington’s disease? (5)
Tetrabenazine Haloperidol [unlicensed] Olanzapine [unlicensed] Risperidone [unlicensed] Quetiapine [unlicensed]
What drug can you use for the treatment of tardive dyskinesia if switching or withdrawing the causative antipsychotic drug is not effective?
Tetrabenazine
- Oral: Initially 12.5 mg daily, dose to be gradually increased according to response
Which drugs can be used to treat Tourette syndrome? (4)
Haloperidol
Pimozide [unlicensed]
Clonidine hydrochloride [unlicensed]
Sulpiride [unlicensed]
Which drugs can be used to relieve intractable hiccup? (2)
Chlorpromazine hydrochloride
Haloperidol
Which drugs are used to treat essential tremor? (2)
Propranolol (or other beta-blocker)
Primidone
Which drug can be used to treat myoclonus of cortical origin?
Piracetam
After an acute episode attempts should be made every 6 months to decrease or discontinue treatment
What drug can be used to extend life in patients with motor neurone disease who have amyotrophic lateral sclerosis?
Riluzole
What can be used after an acquired non-progressive brain injury if rapid-onset spasticity causes postural or functional difficulties?
Botulinum toxin type A
What are the indications for the use of botulinum toxin type A? (10)
- Hand and wrist disability due to upper limb spasticity associated with stroke
- Foot and ankle disability due to lower limb spasticity associated with stroke
- Blepharospasm
- Hemifacial spasm
- Spasmodic torticollis
- Severe hyperhidrosis of the axillae
- Prophylaxis of headaches in chronic migraine
- Temporary improvement of moderate to severe upper facial lines in adults under 65 years
- Management of bladder dysfunctions
- Chronic sialorrhoea (due to neurological disorders)
What are the contraindications of using botulinum toxin type A to treat bladder disorders? (4)
- Acute urinary retention
- Catheterisation difficulties
- Presence of bladder calculi
4 Urinary tract infection
What are the risks that require caution when using botulinum toxin type A to treat blepharospasm or hemifacial spasm?
- Increased risk of angle-closure glaucoma
- Reduced blinking can lead to:
- corneal exposure
- persistent epithelial defect
- corneal ulceration
Botulinum toxin type A should be avoided in women of child-bearing age unless using effective …(?)
contraception
What do you need to warn patients about before using botulinum toxin type A?
Signs and symptoms of toxin spread
- muscle weakness
- breathing difficulties
What are the indications for the use of chlorpromazine hydrochloride? (7)
- Schizophrenia and other psychoses
- Mania
- Short-term adjunctive management of severe anxiety
- Psychomotor agitation, excitement, and violent or dangerously impulsive behaviour
- Intractable hiccup
- Relief of acute symptoms of psychoses
- Nausea and vomiting in palliative care (where other drugs have failed or are not available)
What are the contraindications to the use of chlorpromazine hydrochloride? (4)
CNS depression
Comatose states
Hypothyroidism
Phaeochromocytoma
What lifestyle change may require dose adjustments of chlorpromazine hydrochloride?
Smoking - starting or stopping during treatment
What are the indications for the use of clonidine hydrochloride? (4)
- Hypertension
- Prevention of recurrent migraine
- Prevention of vascular headache
- Menopausal symptoms, particularly flushing and vasomotor conditions
What symptoms in palliative care can haloperidol be used to treat?
Restlessness
Confusion
What lifestyle change may require dose adjustments of haloperidol?
Smoking - starting or stopping during treatment
(drug?) can be used to treat severe tics in Tourette’s syndrome and mild-to-moderate chorea in Huntington’s disease
Haloperidol
Haloperidol can be used to treat severe (?) in Tourette’s syndrome and mild-to-moderate chorea in Huntington’s disease
tics
Haloperidol can be used to treat severe tics in (?) syndrome and mild-to-moderate chorea in Huntington’s disease
Tourette’s
Haloperidol can be used to treat severe tics in Tourette’s syndrome and mild-to-moderate (?) in Huntington’s disease
chorea
Haloperidol can be used to treat severe tics in Tourette’s syndrome and mild-to-moderate chorea in (?) disease
Huntington’s
What are the contraindications to the use of haloperidol? (12)
- CNS depression
- Comatose states
- Congenital long QT syndrome
- Dementia with Lewy bodies
- History of torsade de pointes
- History of ventricular arryhthmia
- Parkinson’s disease
- Progressive supranuclear palsy
- QTc interval prolongation
- Recent acute myocardial infarction
- Uncompensated heart failure
- Uncorrected hypokalaemia
What are the common side effects of haloperidol? (9)
- Depression
- Eye disorders
- Headache
- Hypersalivation
- Nausea
- Neuromuscular dysfunction
- Psychotic disorder
- Vision disorders
- Weight decreased
Which type of antipsychotic is haloperidol?
First-generation (typical)
Which type of antipsychotic is chlorpromazine hydrochloride?
First-generation (typical)
All antipsychotics have some sedating effect, however, does haloperidol have a significant or less sedating effect than other antipsychotics?
Less
Haloperidol is a less sedating antipsychotic.
Olanzapine is a (?)-, (?), (?)-, and (?)-receptor antagonist
Dopamine D1, D2, D4
5-HT2
Histamine 1
Muscarinic
(drug?) is a dopamine D1, D2, D4, 5-HT2, histamine 1-, and muscarinic-receptor antagonist
Olanzapine
What type of antipsychotic is olanzapine?
Second-generation (atypical)
What are the indications for the use of olanzapine? (5)
- Schizophrenia
- Combination therapy for mania
- Preventing recurrence in bipolar disorder
- Monotherapy for mania
- Control of agitation and disturbed behaviour in schizophrenia or mania
What are the contraindications to the IM use of olanzapine?
- Acute MI
- Bradycardia
- Recent heart surgery
- Severe hypotension
- Sick sinus syndrome
- Unstable angina
What needs to be monitored for at least 4 hours after the IM injection of olanzapine? (3)
BP
Pulse
Respiratory rate
Particularly in those also receiving a benzodiazepine or another antipsychotic (leave at least one hour between administration of olanzapine intramuscular injection and parenteral benzodiazepines).
How long should you wait between administration of olanzapine IM injection and parenteral benzodiazepines?
At least one hour
Risk of CNS and respiratory depression
What lifestyle change may require dose adjustments of olanzapine?
Smoking - starting or stopping during treatment
What needs to be monitored in patients taking antipsychotic drugs? (2)
- Prolactin concentration
- At the start of therapy, at 6 months and then yearly - Annual physical health (including cardiovascular disease risk assessment)
In addition to the monitoring required for all antipsychotic drugs, what also needs to be monitored in patients taking olanzapine? (3)
- Blood lipids
- Every 3 months in the first year, then yearly - Weight
- Every 3 months in the first year, then yearly - Fasting blood glucose
- baseline, after 1 months’ treatment, then every 4-6 months
What advice do patients and carers need for all antipsychotic drugs?
Photosensitisation may occur with higher dosages
Avoid direct sunlight
What type of antipsychotic is pimozide?
First-generation (typical)
What are the indications for the use of pimozide?
- Schizophrenia
- Monosymptomatic hypochondrical psychosis
- Paranoid psychosis
In addition to the monitoring required for all antipsychotic drugs, what additional monitoring is required for patients taking pimozide?
ECG monitoring (QT interval prolongation?)
What is the indication for the use of piracetam?
Adjunctive treatment of cortical myoclonus
What are the contraindications to the use of piracetam? (2)
Cerebral haemorrhage
Huntington’s chorea
What are the common side effects of piracetam? (3)
Anxiety
Movement disorders
Weight increased
What are the indications for the use of the primidone? (2)
- All forms of epilepsy except typical absence seizures
2. Essential tremor
Which type of epilepsy can you NOT use primidone?
Typical absence seizures
What are the common side effects of primidone? (6)
- Apathy
- Ataxia
- Drowsiness
- Nausea
- Nystagmus
- Visual impairment
What dose of propranolol is used to treat essential tremor in an adult? (initial and maintenance dose)
Initially 40 mg 2-3 times a day
Maintenance 80-160 mg daily
When might a prescription for propranolol be potentially inappropriate in the elderly (STOPP criteria)?
- In combination with verapamil or diltiazem (risk of heart block)
- Bradycardia, type II heart block or complete heart block
- Diabetes mellitus patients with frequent hypoglycaemic episodes
- If prescribed a non-selective beta-blocker in a history of asthma requiring treatment (risk of bronchospasm)
What are the signs and symptoms of a beta-blocker overdose?
- Lightheadedness
- Dizziness
- Syncope
As the result of bradycardia and hypotension
Heart failure may be precipitated or exacerbated
If a patient has overdosed on a beta-blocker and has excessive bradycardia, what can be used to treat this patient?
IV atropine sulfate
Quetiapine is a (?), (?), (?) and (?)-receptor antagonist
Dopamine D1, D2
5-HT2
Alpha 1-adrenoceptor
Histamine-1
(drug?) is a dopamine D1, D2, 5HT-2, alpha-1-adrenoceptor, and histamine-1 receptor antagonist
Quetiapine
What type of antipsychotic is quetiapine?
Second-generation (atypical)
What is the indication for the use of riluzole?
To extend life in patients with amyotrophic lateral sclerosis (motor neurone disease)
What foods decrease the exposure to riluzole?
Charcoal-gilled foods
What are the common side effects of riluzole? (10)
- Abdominal pain
- Asthenia
- Diarrhoea
- Drowsiness
- Headache
- Nausea
- Oral paraesthesia
- Pain
- Tachycardia
- Vomiting
What advice do patients taking riluzole and their carers need to know?
Signs of neutropenia and seek medical attention is symptoms such as fever occur
Risperidone is a (?), (?), (?). and (?) receptor antagonist
Dopamine D2
5HT2A
Alpha-1-adrenoceptor
Histamine-1
(drug?) is a dopamine D2, 5HT2A, alpha-1 adrenoceptor, and histamine-1 receptor antagonist
Risperidone
What type of antipsychotic is risperidone?
Second-generation (atypical)
What are the indications for the use of tetrabenazine? (2)
- Movement disorders - Huntinton’s chorea, hemiballismus, senile chorea, and related neurological conditions
- Moderate to severe tardive dyskinesia
What are the contraindications for the use tetrabenazine? (4)
- Depression
- Parkinsonism
- Phaeochromocytoma
- Prolactin-dependent tumours
What are the common side effects of tetrabenazine?
- Anxiety
- Confusion
- Depression
- Diarrhoea
- Drowsiness
- Hypotension
- Insomnia
- Nausea
- Parkinsonism
- Vomiting
(drug?) exerts its effects by reducing the effects of the relative central cholinergic excess that occurs as a result of dopamine deficiency.
Trihexyphenidyl
Trihexyphenidyl exerts its effects by reducing the effects of the relative central (?) excess that occurs as a result of dopamine deficiency.
cholinergic
Trihexyphenidyl exerts its effects by reducing the effects of the relative central cholinergic excess that occurs as a result of (?) deficiency.
dopamine
What are the indications for use of trihexyphenidyl? (3)
- Parkinson’s disease (if used in combination with co-careldopa or co-beneldopa)
- Parkinsonism
- Drug-induced extrapyramidal symptoms (but NOT tardive dyskinesia)
Trihexyphenidyl is used in the treatment of drug-induced extrapyramidal symptoms except for …(?)
tardive dysknesia
What is the contraindication to the use of trihexyphenidyl?
Myasthenia gravis
Trihexyphenidyl exerts its effects by reducing the effects of the relative central cholinergic excess that occurs as a result of dopamine deficiency.
