Movement Disorders 1- MJ Flashcards
What is 1st line tx for Essential Tremor?
Propanolol
(nonselective beta blocker; can cross the blood brain barrier)
What is the first line tx for a person w/ essential tremor that has intermittent disability due to tremor exacerbation during stressful situations? How often should it be used?
Propanolol
intermittent tx PRN for situations that exacerbate tremor
What are the 3 first line tx options for a person w/ essential tremor that has persistent disability due to tremor?
- Propanolol
- Primidone
- Propanolol + primidone

Tx of Essential Tremor:
What are the 4 second line tx options for a patient with persistent disability due to tremor if they had inadequate respone to first line agents (propanolol, primidone, propanolol+primidone) or if they were poorly tolerated?
- Gabapentin
- Topiramate
- Nimodipine
- Combination of agents
“Grandpa Takes Cookies Nightly”

The following describes which movement disorder?
- A rhythmic and oscillatory movement of a body part
- relatively constant frequency and variable amplitude
- Caused by either alternating or synchronous contractions of antagonistic muscles
Essential Tremor
______is the most common of all movement disorders*
*Tremor*
**_________ is the most common neurologic cause of postural or action tremor**
**Essential tremor (ET) **
Mechanism of which Essential tremor treatments?
- Non-selective beta blocker
- Depression of CNS activity
- Beta 2 antagonist action on intrafusal fibers of muscle spindles
- sensory component in proprioception
Propanolol (first line tx of Essential Tremor)
Is the long acting or short acting form of Propanolol preferred in the tx of Essential Tremors?
Long acting form is preferred
What are the 4 ADEs of Propanolol (first line tx of essential tremor)
- Lightheadedness
- Fatigue
- Impotence
- Bradycardia
Which essential tremor treatment?
Caution in heart block, asthma, or Type 1 DM
Propanolol
What are 2 other non-selective beta blockers that can be used in the tx of essential tremor in asthmatic patients, but are less effective?
Atenolol or metoprolol
Essential Tremor Treatments: Which anticonvulsants drug?
- Mechanism-unknown
- Metabolite includes phenobarbital (more effective than phenobarbital)
- Promotes inhibitory action of GABA
Primidone (off-label use)
The following are ADEs of which anticonvulsant used to tx essential tremor?
- *Sedation*
- drowsiness
- confusion
- fatigue
- malaise
- depression
- N/V
- ataxia
- dizziness
- unsteadiness
- vertigo
Primidone (off-label use)
Essential Tremor treatments: Anticonvulsants-
What is the mechanism of Topiramate?
- Not totally understood
- Enhances GABA (inhibitory neurotransmitter in the CNS)
- Blocks voltage-gated sodium channel
- Antagonizes AMPA/kainite glutamate receptors
Essential Tremor treatments: Anticonvulsants-
What are the 3 ADEs of Topiramate?
- Nausea
- Paresthesia
3.*Concentration difficulty*
T/F: Gabapentin is a GABA agonist
FALSE
Gabapentin is NOT a GABA agonist
The following is the mechanism of which anticonvulsant used to treat essential tremors?
- interacts with an auxiliary subunit of voltage-sensitive Ca2+ channels—after that remains unknown
Gabapentin
What are the 3 ADEs of Gabapentin (an anticonvulsant used to treat essential tremor)
- Sleepiness
- Dizziness
3. Gait unsteadiness**
Botulinum toxin type A (Botox) injections:
There is a modest benefit for ______ temor associated with ET
*May reduce ______ and ______ tremor: data limited*
limb
*May reduce head and voice tremor*
MOA of which drug used to treat essential tremors?
- Prevents calcium dependent release of acetylcholine and produces a state of denervation
- Affects only at presynaptic membrane of neuromuscular junction
Botulinum toxin type A (Botox)
Essential Tremor Tx:
What are the 3 ADEs of Botox with tx of voice tremor?
- Breathiness
- Hoarseness
- Swallowing difficulty
“SHB”
What is the mechanism of Alprazolam or Clonazepam (Benzodiazepines):
Enhances GABA activity
If your patient has an essential tremor and their limb tremor is aggravated by anxiety, which medication should partially reduce this?
Alprazolam or Clonazopam (Benzodiazepines)
What are the 2 ADEs of Alprazolam/Clonazepam (benzos used to tx essential tremor)?
- Mild sedation
- Fatigue
“MF”
Why are benzodiazepines such as Alprazolam, a second line choice for tx of essential tremor?
Dependence issues
What is the role of alcohol in the treatment of Essential Tremor?
ET related gait ataxia
What is the role of Nimodipine in the treatment of essential tremor?
Limb tremor associated with ET
Is Huntingtons Disease autisomal dominant or recessive? What chromosome?
Autosomal dominant
Chromosome 4
The following describes which disease?
- Inherited progressive neurodegenerative disorder involving the basal ganglia
- movement abnormalities +/- with psychiatric and cognitive features
- slow course of progressive deterioration in cognitive and motor function
Huntington Disease
Which disorder has the following?
Chorea
- rapid, involuntary, nonrepetitive movement involving the face, trunk, and limbs
Huntington Disease
Which disease has Chorea- early stage movements may be misinterpreted as restlessness
Huntington Disease
The following neuronal changes are seen in which disease?
- The dopaminergic neron in _____ disease is lost
- In ______ disease, the GABAergic neuron is lost; acetylcholine or overactivity of dopaminergic neurons
- The dopaminergic neron in Parkinson disease is lost
- In Huntington disease, the GABAergic neuron is lost; acetylcholine or overactivity of dopaminergic neurons
Care is _______ for Huntington Disease
Supportive
How do you treat Chorea in Huntington Disease? (2 options)
Central monoamine-depleting agents:
- Tetrabenazine
- Deutetrabenazine
(note: monoamine= norepinephrine, serotonin, dopamine)
What 3 antipsychotic (dopamine antagonist) medications can be used to suppress movement in Huntington Disease?
- Haloperidol
- Fluphenazine
- Olanzapine
“HOF”
T/F: Antidepressants, Anticonvulsants (Topiramate, Levetiracetam) and Amantadine can all be used as supportive tx for Huntington Disease?
True
•Drugs used for controlling dyskinesia in patients with Huntington’s disease interfere with _______ activity
dopamine
Huntington Disease Treatments:
•Reduction of abnormal movements may be associated with iatrogenic _______ through low brain dopamine levels.
parkinsonism
MOA of which drug used to tx Huntington disease?
deplete amines, especially dopamine, from nerve endings; acts by inhibiting presynaptic vesicular monoamine transporter type 2 (VMAT2)
Tetrabenazine
What is the clinical application of Tetrabenazine (drug used to tx Huntington Disease?
Reduce sxs (eg. chorea) severity
What are the 3 toxicities of Tetrabenazine (drug used to tx Huntingtons disease)
1. Depression*
- hypotension
- sedation
Tetrabenazine (drug for Huntingtons) is metabolized by ______
Reduce dose w/ ______ or _____
- Metabolized by cytochrome P450
- Reduce dose w/ fluoxetine or paroxetine
MOA of which Huntingtons drug?
Blockade of D2 receptors >> 5-HT2A receptors
Haloperidol
The following is the effects of which huntington drug (tx for behavioral disturbances)?
Some α blockade, but minimal M-receptor blockade and much less sedation than the phenothiazines
Haloperidol
What are the 5 clinical applications of Haloperidol (tx for behavioral disturbances in Huntingtons disease)
- Schizophrenia (alleviates positive symptoms)
- bipolar disorder (manic phase)
- Huntington’s chorea-Dyskinesia**
- Behavioral disturbances
- Tourette’s syndrome**
Extrapyramidal dysfunction is major adverse effect of which medication used to tx behavioral disturbances in Huntingtons Disease?
Haloperidol
What are the 6 atypical antipsychotics that can be used to tx behavioral disturbances in Huntingtons?
- Aripiprazole
- Clozapine
- Olanzapine
- Quetiapine
- Risperidone
- Ziprasidone
“ZAC ROQ”
MOA of which group of drugs that are used to tx behavioral disturbances in Huntingtons?
Blockade of 5-HT2A receptors > blockade of D2 receptors
Atypical antipsychotics
Effects of which group of meds used to tx Huntingtons?
Some α blockade (clozapine, risperidone, ziprasidone) and M-receptor blockade (clozapine, olanzapine)
• variable H1-receptor blockade (all)
Atypical antipsychotics
- What are the 5 clinical applications of the atypical antipsychotics?
- Schizophrenia—improve both positive and negative symptoms
- bipolar disorder (olanzapine or risperidone adjunctive with lithium)
- agitation in Alzheimer’s and Parkinson’s patients (low doses)
- major depression,
- Tourette’s (aripiprazole)
What are the 4 other agents that can be used to tx behavioral disturbances in Huntington Disease? (besides haloperidol, atypical antipsychotics)
- Topiramate
- Levetiracetam
- Amatadine
- Benzodiazepines (for stress)
“TABL”
Which 2 atypical antipsychotics have the following toxicities:
- DM
- Hypercholesterolemia
- weight gain
Clozapine and Olanzapine
Which atypical antipsychotic can cause agranulocytosis?
Clozapine
Which atypical antipsychotic has the following toxicity:
hyperprolactinemia
Risperidone
(“Risperidone gives RISE to a PAIR of breasts”)
Which atypical antipsychotic can cause QT prolongation?
Ziprasidone
(“The QT car ZIPs aLONG”)