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MJ- Pharm Exam 3 > Movement Disorders 2- MJ > Flashcards

Movement Disorders 2- MJ Flashcards

1
Q

Which disorder?

  • Neurological disorder manifested by motor and phonic tics with onset during childhood
A

Tourette Syndrome

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2
Q

What are the clinical hallmark of Tourette Syndrome?

A

Tics

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3
Q

The following can be components of which disorder?

  • sudden, brief, intermittent movements (motor tics) or utterances (vocal/phonic tics)
  • fluctuating symptom severity with tics worsening and remitting in an unpredictable pattern
A

Tourette Syndrome

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4
Q

What are the 2 most common comorbidities of patients with Tourette Syndrome?

A
  1. ADHD (50-60% of kids w/ Tourettes have ADHD, 20% of kids with ADHD go on to develop Tourettes)
  2. OCD
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5
Q
  • Which disorder is likely though to be a disturbance in the striatal-thalmic-cortical (mesolimbic) spinal system, which leads to disinhibition of the motor and limbic system
A

Tourette Syndrome

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6
Q

What is the treatment for patients with mild and nondisabling symptoms of Tourette Syndrome?

A

Education and counseling

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7
Q

What are the 4 possible treatments for bothersome tics associated with Tourette Syndrome?

A
  • Neuroleptics pimozide (Orap)- FDA approved
  • Haloperidol- FDA approved
  • Fluphenazine (dopamine antagonists)- off label
  • Aripiprazole (can also use Risperidone or ziprasidone but this is the only one FDA approved)
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8
Q

What is used to treat Tourette Syndrome if only focal motor or phonic tics?

A

Botulinum toxin injection (Botox)

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9
Q

MOA of which Tourette Syndrome medication?

D2 receptor blocker (antagonist)

A

Haloperidol

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10
Q

What is the clinical application of Haloperidol?

A

**Reduce vocal and motor tic frequency and severity**

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11
Q

What is the one toxicity of Haloperidol?

A

**Extrapyramidal dysfunction**

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12
Q

What is the MOA of Pimozide, a med used to tx Tourette syndrome

A

Dopamine receptor antagonist

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13
Q

What is the clinical application of Pimozide, a med used to tx Tourette syndrome?

A

**Severe motor and phonic tics who failed standard treatment**

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14
Q

What are the toxicities of Pimozide, a med used to tx Tourette Syndrome?

A
  1. Sedation
  2. Akathisia
  3. Akinesia
  4. Ocular-accommodation decreased
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15
Q

What 2 meds are often used in patients with Tourette Syndrome who have comorbid ADHD but is only effective in ~50% of patients?

A
  1. Clonidine
  2. Guanfacine
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16
Q
A
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17
Q

Which syndrome?

•*Overwhelming urge to move the legs*

•*Worse at rest and at night and relieved by movement*

A

Restless Leg Syndrome

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18
Q

What 4 things make worsen the sxs of Restless Leg Syndrome (RLS)?

A
  1. Caffeine
  2. Stress
  3. Alcohol
  4. Fatigue

(“CAFS”)

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19
Q

What 4 groups of drugs can cause Restless Leg Syndrome?

A
  1. Antidepressants (except bupropion)
  2. Antipsychotics
  3. Dopamine-blocking antiemetics (eg, metoclopramide)
  4. Centrally-acting antihistamines

(“In high school I was restless to go to CADA”)

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20
Q

What are the 2 types of Restless Leg Syndrome?

A
  1. *Periodic leg movements of sleep (PLMS)*
    • ​​jerking movements of the legs during sleep
  2. *Periodic limb movement disorder (PLMD)*
    • ​​when sleep fragmentation and daytime fatigue coexist with PLMS
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21
Q

When is iron replacement (Ferrous sulfate) suggested as treatment for Restless Leg Syndrome?

A

**suggested if the serum ferritin level is lower than 75 mcg/L**

(Serum ferritin concentration lower than 45 to 50 mcg/L associated with an increased severity or RLS)

22
Q

T/F: It is important to advise your patients to take Ferrous sulfate with milk

A

FALSE

The milk binds with the iron

It is better to take Ferrous Sulfate on an empty stomach and w/ orange juice

23
Q

Restless leg syndrome being treated with iron replacement:

Ferritin levels should be checked after ____ to _____ months of therapy

A

3-4

24
Q

The following clinical factors would make you lean towards prescribing which specific therapy for tx of Restless Leg Syndrome?

  1. Sleep disturbance disproportionate to other sxs of RLS
  2. Comorbid insomnis
  3. Painful restless legs
  4. Comorbid pain syndrome
  5. H/o or current impulse control disorder
  6. Comorbid generalized anxiety disorder
A

Alpha-2-delta ligand

25
Q

The following clinical factors would make you lean towards prescribing which specific therapy for tx of Restless Leg Syndrome?

  1. Increased risk for falls
  2. Severe sxs of RLS
  3. Excess weight, metabolic syndrome or obstructive sleep apnea
  4. Comorbid depression
A

Dopamine agonist

26
Q

Restless Leg Syndrome:

What drugs should you avoid if the pt has hx of or current alcohol/substance abuse?

A

Avoid drugs that are hepatically metabolized

27
Q

Restless Leg Syndrome:

  • What drugs should be avoided if there is a pregnancy risk?
  • What drug should be considered?
A
  • Avoid dopaminergic agents and alpha-2-delta ligands
  • Consider use of iron
28
Q

If you have a pt w/ Restless leg syndrome who also has Impaired renal function, which 2 drugs should be avoided/dose adjusted?

A

Avoid pramipexole

Avoid or dose adjust alpha-2-delta ligands

29
Q

If you have a pt w/ Restless leg syndrome who also has hepatic impairment, which drug should be avoided and which medication patch should you use caution with prescribing?

A

Avoid ropinirole

Use caution w/ rotigotine patch

30
Q

What medication is used to tx intermittent RLS not requiring daily therapy?*

A

Levodopa (Dopaminergic agent)

31
Q

Which medication can be helpful for RLS associated w/ specific triggers including lengthy travel by auto or airline, or spectator events with prolonged sitting*

A

Carbidopa-Levodopa

32
Q

Treatment for intermittent RLS:

*Levodopa doses greater than ______mg per day should be avoided*

A

200

33
Q

What group of medications is used to treat mild cases of RLS, particularly in younger patients***

A

Benzodiazepines

(clonazepam-best studied, but can also use diazepam)

34
Q

What are the ADEs of Benzodiazepines such as clonazepam, a medication used to tx intermittent RLS in younger patients?

A

nocturnal unsteadiness and drowsiness or cognitive impairment in the morning**

35
Q

T/F: Benzodiazepine abuse appears to be low in Restless Leg Syndrome?

(in red on slide)

A

True

(Greater abuse potentials in older people)

36
Q

Which 2 dopamine agonists can be used to tx persistent RLS?

A

1. Pramipexole**

2. Ropinirole**

37
Q

Tx for persistent RLS:

What is the typical time of onset for Pramipexole and Ropinirole (dopamine agonists)?

A

90-120 minutes after intake

38
Q

What is the concerning ADE of Pramipexole and Ropinirole, drugs used to tx persistent RLS.

A

*Increased risk of impulse control disorders*

(gambling, compulsive eating/shopping, compulsive inappropriate hypersexuality)

39
Q

Which two alpha-2-delta calcium channel ligands are used to tx persistent RLS?

A

1. Gabapentin*

2. Pregabalin*

40
Q

Which 2 medications have the following uses:

  1. comorbid painful peripheral neuropathy or an unrelated chronic pain syndrome–> so good for pts with DM
  2. comorbid insomnia or sleep disturbance that is disproportionate to other RLS symptoms*
A

Gabapentin, Pregabalin

(alpha-2-delta calcium channel ligands)

41
Q

Which 2 meds used to tx persistent RLS have the following “caution”:

  • preferred over dopamine agonists in patients with impulse control disorders
  • increased risk of suicidal thoughts and behavior
A

Gabapentin, Pregabalin

(alpha-2-delta calcium channel ligands)

42
Q

What are the 4 tx options for persistent RLS?

A

Dopamine agonists

  • Pramipexole
  • Ropinirole

Alpha-2-delta calcium channel ligands

  • Gabapentin
  • Pregabalin
43
Q

How do you tx Refractory RLS?

A

Opioids

(codeine, tramadol, methadone, oxycodone, hydrocodone)

44
Q

The following is the proposed MOA of which group of drugs used to tx refractory RLS:

Interaction b/w spinal opioid and dopamine receptors

A

Opioids

45
Q

What is the main adverse rxn of Dopamine agonists and how do you monitor this?

A

ADE- Compulsive behaviors

Monitor frequency and quantity of eating, gambling, shopping, other reward disorders

46
Q

What is the main ADE of Levodopa/carbidopa and how do you monitor?

A

ADE: Symptom augmentation

  1. Monitor location and timing of RLS symptoms
47
Q

What is the main ADE of Gabapentin/Pregablin and how do you monitor?

A

ADE- Dizziness

Monitor for subjective dizziness, falls (ex: Romberg test)

48
Q

What is the main ADE of Sedative hypnotics (clonazepam, temazepam, zolpidem,etc) and how do you monitor?

A

ADE: carry over sedation

Monitor morning sleepiness, grogginess

49
Q

What are the 2 main ADEs of opiods and how do you monitor for this?

A

ADEs: Tolerance, Constipation

Monitor RLS symptoms and response to ongoing therapy

50
Q

What are the 2 main ADEs of oral iron therapy and how do you monitor?

A

ADEs: GI upset, constipation

Monitor for constipation

(prophylactic stool softeners may be necessary)

51
Q

The following are screening questions to identify ______ in patients on dopaminergic therapy for RLS:

  • Do RLS sxs appear earlier than when the drug was 1st started?
  • Are higher doses of the drug now needed, or do you need to take the drug earlier in the day to control sxs?
  • Has the intensity of sxs worsened since starting the drug?
  • Have sxs spread to other body parts (eg, arms) since starting the drug?
A

augmentation

52
Q

What is a main complication of dopaminergic therapy in RLS and results in an overall increase in symptom severity with increasing doses of medication

A

Augmentation

MJ- Pharm Exam 3 (17 decks)

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