Remaining Movement Disorders Flashcards
1
Q
What is the most common of the movement disorders?
A
Essential tremor
2
Q
What is essential tremor?
A
rapid oscillating movements with constant frequency and variable amplitude
-alternating contractions of antagonist muscles
3
Q
What is 1st line treatment for essential tremor?
A
Propanolol-B2 Sandinista
4
Q
Why is propanolol used?
A
non selective beta blockers depress CNS
5
Q
T/F Non selective beta blockers are better at tx essential tremor than selective beta blockers
A
TRUE
6
Q
What are contraindication for use of Propanolol?
A
asthma, DM, and heart block
7
Q
What are ADE of propanlol?
A
Fatigue
Impotence
Lightheaded
Bradycardia
8
Q
What can be uses to tx ET in asthma patients?
A
atenolol
metropolol
9
Q
What is MOA of primidone?
A
Off label use anti-convulsant
-enhances GABA A receptors
10
Q
What is metabolite of primidone?
A
phenobarbital
11
Q
What are ADE of primidone? (4)
A
sedation
ataxia
dizziness
vertigo
12
Q
What is MOA of Topiramate? (3)
A
- enhances GABA
- blocks v-gated Na channels
- antagonizes AMPA/kainite glutamate receptors
13
Q
What is ADE of topiramate? (1)
A
difficulty concentrating
14
Q
What is MOA of gabapentin?
A
interacts with auxiliary units of Ca+2 channels
15
Q
What is ADE of gabapentin?
A
gait unsteadiness
16
Q
When should you consider use of gabapentin?
A
Last resort, when no other meds are working
17
Q
What is MOA of botulinum?
A
-blocks release of Ca+2 dependent Ach release and affects only presynpatic neuron at NMJ
18
Q
What is clinical use of Botulinum?
A
-reduce head and voice tremors
19
Q
What are ADE of botulinum?
A
- difficulty swallowing and breathing
- dose dependent hand weakness
20
Q
What is MOA of Benzodiazepines?
A
-enhances GABA activity
21
Q
Name 2 benzos used to treat ET?
A
- Clonazepam
- Alpralozam
22
Q
What is clinical use of benzos?
A
-ET aggravated by anxiety
23
Q
Why are benzos 2nd line tx?
A
dependence issues
24
Q
What are ADE of benzos? (1)
A
sedation
25
What is Huntington's disease?
loss of GABAnergic neurons?
26
Which drug depletes dopamine by blocking VMAT2 presynpatic transporter?
Tetrabenazine/Xenazine/Deutetrabenazine
Austedo
Reserpine
27
What are ADE of Tetrabenazine? (2)
- Depression
| - Hypotension
28
What are benefits of Deutetrabenazine?
- less risks
| - longer plasma half life, lower dosing
29
What is MOA of haloperidol?
-blocks D2 receptors more than serotonin receptors
30
What is clinical use of haloperidol?
-behavior disturbances
31
What is ADE of haloperidol?
extrapyramidal side effects
32
What is MOA of atypical anti-psychotics?
block 5HT/serotonin more than dopamine
33
Name 4 atypical anti-psychotics?
Risperidone
Clozapine
Olanzapine
Aripriprazole
34
What is clinical use of atypical anti-psychotics?
behavior disturbances
35
What is ADE of clozapine and olanzapine?
DM
| -high cholesterol
36
What is ADE of risperidone?
high prolactin
37
Which atypical anti-psychotics tx TS
Aripriprazole
38
What are the hallmark signs of TS?
motor and phonic tics
39
What is pathology of TS?
dis inhibition of motor and limbic system
40
Which drug is used to tx focal/ motor tics in TS?
Botulinum toxin
41
How do you treat mild non disabling tics in TS?
Habit Reversal Training (tic awareness and competing response)
42
Which drug is used to tx vocal and motor tics in TS?
Haloperidol
43
Which drug is used to treat severe motor and vocal tics after failing standards tx?
Pimozide/Orap
44
What is MOA of Pimozide?
dopamine antagonist
45
What are ADE of Pimozide?
decreased ocular accomodation
- akithisia
- sedation
46
What is difference between PLMS vs PLMD?
-PLMD: fatigue and sleep fragmentation occur wiht PLMS
47
Which meds can cause RLS? (4)
- caffeine
- anti-emetics metoclopramide
- bupropion
- centrally acting histamines
48
What level of Ferritin is associated with RLS?
Ferritin below <45-50mcg/L
49
How do you tx a patient with ferritin levels below 75mcg/L?
Give 325mcg 3x/day with Vitamin C (100-200mcg)
| -check after 4 months of therapy
50
How do you tx intermittent RLS?
Levydopa/Carbydopa not requiring daily use
51
When is Levydopa/Carbydopa also useful?
after long travel or spectator events with prolonged sitting
52
What levels should be avoided for Levydopa/Carbydopa?
stay below 200mg/day
53
What drug is used to tx intermittent RLS in younger patients?
Benzodiazepines
54
What is ADE of treating RLS with benzos?
morning cognitive impairment
55
Which dopamine agonist are used in persistent leg syndrome?
- Pramiprexole
| - Ropinirole
56
What are ADE of ropinirole?
- fatigue
- nasal stuffiness
- leg edema
- impulsive behavior issues
57
Which drugs are alpha 2 delta calcium channels ligands?What type of RLS type do they tx?
gabapentin
pregabalin
-persitent RLS
58
If a patient has impulse control issues which medication is preferred dopamine agonist or gabapentin?
-gabapentin
59
What is ADE of gabapentin/pregabalin?
insomnia
60
How do you tx refractory RLS? Would you refer to neurology?
- Opioids
| - Yes
61
What is MOA of opioids?
interaction with spinal opiods and dopamine
62
What are ADE of opiods? (2)
- constipation
| - tolerance
63
What is ADE of gabapentin? (1)
dizziness
64
What is ADE of oral zinc? (2)
GI upset, constipation
65
What is ADE of Levydopa/Carbidopa? (Dopamine Agonist)
augmentation of symptoms
66
What is Wilson's disease?
impaired metabolism of copper
| -copper builds up in liver, brain and cornea
67
Name 2 copper chelating agents?
- D-Pencilliamine
| - Trientiene
68
What is MOA of D-penicllinamine?
free sulfhydryl group acts as cooper binding moiety
69
How do you tx pyridoxal phosphate insufficiency from use of D-peniclliamine?
give pyridoxine 25mg/day
70
What are ADE of D-penicllinamine?
early: fever, lymphadenopathy, neutropenia, thrombocytopenia
late: proteinuria
71
What is MOA of trientiene? (3)
- 4 nitrogens bind cooper
- increases renal excretion
- obtains copper from less strongly bound sites in proteins and membranes
72
What are ADE with trientene? (3)
- chelates iron, can cause liver toxicity when Cu goes to low
- dont give iron, can cause nephrotoxicty
- can cause neuro worsening
73
What should you monitor for pt taking trientene?
- 24 hour copper urine
| - nonceruloplasmin bound copper <15mcg/daily
74
Oral zinc is used to tx what disease?
Wilson's disease
75
What is MOA of oral zinc?
reduces absorption in small intestine so it gets excreted in feces
zinc acetate>zinc gluconate>zinc sulfate
76
T/F zinc acetate has the best absorption?
True
77
What are ADE or oral zinc? (2)
- GI upset
| - elevated amylase and lipase but no injury to pancreatitis
78
What is tx for liver failure due to WD?
liver transplant
79
What is monitored for pt with WD?
CBC, serum ceruloplasmin, copper, urinalysis, LFT's
| -24 hour copper urine yearly
80
What is initial therapy for WD?
chelation therapy
81
What is Myasthenia Gravis?
weakness in skeletal muscle due to autoimmune attack of ACh receptors at post synaptic cleft
82
Name the two drugs used to treat Myasthenia?
- Neostigmine
| - Pyridostigmine
83
What is MOA of Neostigmine and Pyridostigmine?
blocks acetylcholinesterase to stop degradation of Ach
84
What is ALS? (3)
UMN -affected cortical neurons that provide afferent input to UMN
LMN-disease that affects the ventral horns of spinal cord
-gultamate re-uptake is abnormal (increased glutamate causes excitotoxic injury)
85
T/F Sensory, autonomic, sensory and oculomotor spared in ALS?
TRUE
86
What are signs of ALS?
- spasticity
- respiratory issues
- dysarthria: slow speech
87
Whats is MOA of Riluzole/Rilutek?
- inhibits glutamate release
- inactivates v-Na channels
- blocks intracellualr events that follow NT binding of receptor
88
What are pharmacodynamics of Rilutek?
- oral, high fat meals block absorption
| - CYP mediated liver metabolism
89
What are ADE of Riluzole/Rilutek?
```
Hypotension
Abdominal pain
Neurolagia and arthralgia tremor
Decreased lung function
Elevated serum transaminases
```
90
What is MOA of edaravone?
free radical scavenger
91
When do you tx with edaravone:
ALS pt with less than 2 yrs dx adn FVC >80%
92
What is ADE of edaravone?
- sulfites can cause asthma issues
| - injection site contusion
93
What are the 3 drugs that tx spasticity in ALS? (3)
- Baclofen
- Tinzaidine
- Clonazepam
94
What is ADE of baclofen?
sedation
95
What is MOA of baclofen?
GABA receptor agonist
| -restores lost inhibition by stimulating post synaptic GABA receptors
96
What is MOA of Tinzanidine?
alpha adrenergic A2 agonist
| -increases GABA release from inhibitory interneuron in spinal cord
97
What is ADE of Tinzanidine? (3)
- asthenia
- dizziness
- drowsiness
98
T/F Diazepam and Clonazepam are used to tx spasticity in ALS
True
99
T/F Benzos act by enhancing the inhibitory effect of GABA receptors to tx ALS spasticity
True
