Lecture 10: Tardive Dyskinesia

Question 1

Serial monitoring of which serum value is required when alcoholic patients are admitted to the hospital?

Answer 1

Phosphate

Question 2

At which level of serum phosphate should you begin giving phosphate in asymptomatic pt?

Answer 2

<2 mg/dL

Question 3

Hypophosphatemic alcoholic pt’s may have a myopathy due to both phosphate depletion and alcohol toxicity, and are at risk for clinically significant what?

Answer 3

Rhabdomyolysis

Question 4

Thiamine is a cofactor for which 3 key enzymes needed for energy metabolism?

Answer 4

• Transketolase
• α-ketoglutarate dehydrogenase
• Pyruvate dehydrogenase

Question 5

What is the classic triad of Wernicke Encephalopathy?

Answer 5

• Encephalopathy
• Oculomotor dysfunction
• Gait ataxia

Question 6

Which area of the hippocampus is sometimes affected in Wernicke’s and often affected in Korsakoff Syndrome?

Answer 6

Medial Temporal lobe

Question 7

What is Tardive Dyskinesia and how long must the sx’s be going on for?

Answer 7

• Medication-induced hyperkinetic movement disorder caused by exposure to:
• Dopamine receptor-blocking agents, most often antipsychotics
• Persists for at least 1 month after discontinuing the offending agent

Question 8

Which assessment tool is used for Tardive Dyskinesia?

Answer 8

Abnormal Involuntary Movement Scale (AIMS)

Question 9

What are some of the drugs that can cause Tardive Dyskinesia?

Answer 9

• ALL dopamine-receptor blocking agents!!
• 1st or 2nd gen. anti-psychotics
• Metoclopramide
• Dopamine receptor-blocking antiemetics: Prochlorperazine and Chlorpromazine

Question 10

Which 2 second-gen. antipsychotics have the highest risk for tardive dyskinesia?

Answer 10

Paliperidone and Risperidone

Question 11

Which patients are at the highest risk of developing Tardive Dyskinesia?

Answer 11

• Pt’s who develop extrapyramidal sx’s as an AE of early anti-psychotic drug therapy
• Pt’s who are: older, are heavy smokers, or have DM

Question 12

Which hypothesis for developing Tardive Dyskinesia has the most evidence to date?

Answer 12

• Dopamine-hypothesis
• Dopamine receptor hypersensitivity and/or imbalance btw D1 and D2 receptor-mediated effects in the basal ganglia

Question 13

Polymorphisms in what have been linked to the development of Tardive Dyskinesia?

Answer 13

5-HT2A receptor gene

Question 14

Which serotonin antagonist has strong binding to 5-HT 2A/2C receptor subtypes and is associated with lower incidence of T.D. and has a favorable effect on T.D.?

Answer 14

Clozapine (2nd gen. anti-psychotic)

Question 15

Which 2 second-gen. antipsychotic drugs may have ameliorating effects on TD severity?

Answer 15

Cloazpine and Quetiapine

Question 16

List 4 drugs which can be used to control the sx’s of TD?

Answer 16

Benzodiazepines + Botulinum toxin injections + Valbenazine + Tetrabenazine

Question 17

Which newer pharmalogical agent has shown to be an effective tx of TD?

Answer 17

Gingko biloba extract, known as EGb-761