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Pharm 3 Shea > Movement Disorders 1- MJ > Flashcards

Movement Disorders 1- MJ Flashcards

1
Q

What is 1st line tx for Essential Tremor?

A

Propanolol

(nonselective beta blocker; can cross the blood brain barrier)

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2
Q

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?

A

Propanolol

intermittent tx PRN for situations that exacerbate tremor

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3
Q

What are the 3 first line tx options for a person w/ essential tremor that has persistent disability due to tremor?

A
  1. Propanolol
  2. Primidone
  3. Propanolol + primidone
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4
Q

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?

A
  1. Gabapentin
  2. Topiramate
  3. Nimodipine
  4. Combination of agents

“Grandpa Takes Cookies Nightly”

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5
Q

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
A

Essential Tremor

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6
Q

______is the most common of all movement disorders*

A

*Tremor*

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7
Q

**_________ is the most common neurologic cause of postural or action tremor**

A

**Essential tremor (ET) **

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8
Q

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
A

Propanolol (first line tx of Essential Tremor)

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9
Q

Is the long acting or short acting form of Propanolol preferred in the tx of Essential Tremors?

A

Long acting form is preferred

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10
Q

What are the 4 ADEs of Propanolol (first line tx of essential tremor)

A
  1. Lightheadedness
  2. Fatigue
  3. Impotence
  4. Bradycardia
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11
Q

Which essential tremor treatment?

Caution in heart block, asthma, or Type 1 DM

A

Propanolol

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12
Q

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?

A

Atenolol or metoprolol

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13
Q

Essential Tremor Treatments: Which anticonvulsants drug?

  • Mechanism-unknown
  • Metabolite includes phenobarbital (more effective than phenobarbital)
  • Promotes inhibitory action of GABA
A

Primidone (off-label use)

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14
Q

The following are ADEs of which anticonvulsant used to tx essential tremor?

  • *Sedation*
  • drowsiness
  • confusion
  • fatigue
  • malaise
  • depression
  • N/V
  • ataxia
  • dizziness
  • unsteadiness
  • vertigo
A

Primidone (off-label use)

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15
Q
A
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16
Q

Essential Tremor treatments: Anticonvulsants-

What is the mechanism of Topiramate?

A
  • Not totally understood
  • Enhances GABA (inhibitory neurotransmitter in the CNS)
  • Blocks voltage-gated sodium channel
  • Antagonizes AMPA/kainite glutamate receptors
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17
Q

Essential Tremor treatments: Anticonvulsants-

What are the 3 ADEs of Topiramate?

A
  1. Nausea
  2. Paresthesia

3.*Concentration difficulty*

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18
Q

T/F: Gabapentin is a GABA agonist

A

FALSE

Gabapentin is NOT a GABA agonist

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19
Q

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
A

Gabapentin

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20
Q

What are the 3 ADEs of Gabapentin (an anticonvulsant used to treat essential tremor)

A
  1. Sleepiness
  2. Dizziness

3. Gait unsteadiness**

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21
Q

Botulinum toxin type A (Botox) injections:

There is a modest benefit for ______ temor associated with ET

*May reduce ______ and ______ tremor: data limited*

A

limb

*May reduce head and voice tremor*

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22
Q

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
A

Botulinum toxin type A (Botox)

23
Q

Essential Tremor Tx:

What are the 3 ADEs of Botox with tx of voice tremor?

A
  1. Breathiness
  2. Hoarseness
  3. Swallowing difficulty

“SHB”

24
Q

What is the mechanism of Alprazolam or Clonazepam (Benzodiazepines):

A

Enhances GABA activity

25
Q

If your patient has an essential tremor and their limb tremor is aggravated by anxiety, which medication should partially reduce this?

A

Alprazolam or Clonazopam (Benzodiazepines)

26
Q

What are the 2 ADEs of Alprazolam/Clonazepam (benzos used to tx essential tremor)?

A
  1. Mild sedation
  2. Fatigue

“MF”

27
Q

Why are benzodiazepines such as Alprazolam, a second line choice for tx of essential tremor?

A

Dependence issues

28
Q

What is the role of alcohol in the treatment of Essential Tremor?

A

ET related gait ataxia

29
Q

What is the role of Nimodipine in the treatment of essential tremor?

A

Limb tremor associated with ET

30
Q

Is Huntingtons Disease autisomal dominant or recessive? What chromosome?

A

Autosomal dominant

Chromosome 4

31
Q

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
A

Huntington Disease

32
Q

Which disorder has the following?

Chorea

  • rapid, involuntary, nonrepetitive movement involving the face, trunk, and limbs
A

Huntington Disease

33
Q

Which disease has Chorea- early stage movements may be misinterpreted as restlessness

A

Huntington Disease

34
Q

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
A
  • The dopaminergic neron in Parkinson disease is lost
  • In Huntington disease, the GABAergic neuron is lost; acetylcholine or overactivity of dopaminergic neurons
35
Q

Care is _______ for Huntington Disease

A

Supportive

36
Q

How do you treat Chorea in Huntington Disease? (2 options)

A

Central monoamine-depleting agents:

  1. Tetrabenazine
  2. Deutetrabenazine
    (note: monoamine= norepinephrine, serotonin, dopamine)
37
Q

What 3 antipsychotic (dopamine antagonist) medications can be used to suppress movement in Huntington Disease?

A
  1. Haloperidol
  2. Fluphenazine
  3. Olanzapine

“HOF”

38
Q

T/F: Antidepressants, Anticonvulsants (Topiramate, Levetiracetam) and Amantadine can all be used as supportive tx for Huntington Disease?

A

True

39
Q

•Drugs used for controlling dyskinesia in patients with Huntington’s disease interfere with _______ activity

A

dopamine

40
Q

Huntington Disease Treatments:

•Reduction of abnormal movements may be associated with iatrogenic _______ through low brain dopamine levels.

A

parkinsonism

41
Q

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)

A

Tetrabenazine

42
Q

What is the clinical application of Tetrabenazine (drug used to tx Huntington Disease?

A

Reduce sxs (eg. chorea) severity

43
Q

What are the 3 toxicities of Tetrabenazine (drug used to tx Huntingtons disease)

A

1. Depression*

  1. hypotension
  2. sedation
44
Q

Tetrabenazine (drug for Huntingtons) is metabolized by ______

Reduce dose w/ ______ or _____

A
  • Metabolized by cytochrome P450
  • Reduce dose w/ fluoxetine or paroxetine
45
Q

MOA of which Huntingtons drug?

Blockade of D2 receptors >> 5-HT2A receptors

A

Haloperidol

46
Q

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

A

Haloperidol

47
Q

What are the 5 clinical applications of Haloperidol (tx for behavioral disturbances in Huntingtons disease)

A
  1. Schizophrenia (alleviates positive symptoms)
  2. bipolar disorder (manic phase)
  3. Huntington’s chorea-Dyskinesia**
  4. Behavioral disturbances
  5. Tourette’s syndrome**
48
Q

Extrapyramidal dysfunction is major adverse effect of which medication used to tx behavioral disturbances in Huntingtons Disease?

A

Haloperidol

49
Q

What are the 6 atypical antipsychotics that can be used to tx behavioral disturbances in Huntingtons?

A
  1. Aripiprazole
  2. Clozapine
  3. Olanzapine
  4. Quetiapine
  5. Risperidone
  6. Ziprasidone

“ZAC ROQ”

50
Q

MOA of which group of drugs that are used to tx behavioral disturbances in Huntingtons?

Blockade of 5-HT2A receptors > blockade of D2 receptors

A

Atypical antipsychotics

51
Q

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)

A

Atypical antipsychotics

52
Q
  1. What are the 5 clinical applications of the atypical antipsychotics?
A
  1. Schizophrenia—improve both positive and negative symptoms
  2. bipolar disorder (olanzapine or risperidone adjunctive with lithium)
  3. agitation in Alzheimer’s and Parkinson’s patients (low doses)
  4. major depression,
  5. Tourette’s (aripiprazole)
53
Q

Toxicity of which group of meds:

  1. Agranulocytosis (clozapine)
  2. diabetes (clozapine, olanzapine)
  3. hypercholesterolemia (clozapine, olanzapine)
  4. hyperprolactinemia (risperidone)
  5. QT prolongation (ziprasidone)
  6. weight gain (clozapine, olanzapine)
A

Atypical antipsychotics (used in the tx of behavioral disturbances in Huntington disease)

54
Q

What are the 4 other agents that can be used to tx behavioral disturbances in Huntington Disease? (besides haloperidol, atypical antipsychotics)

A
  1. Topiramate
  2. Levetiracetam
  3. Amatadine
  4. Benzodiazepines (for stress)

“TABL”

Pharm 3 Shea (17 decks)

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