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Neuro 3 > tremors > Flashcards

tremors Flashcards

1
Q

essential tremors

A
  • Most common movement disorder usually affecting both upper extremities
  • AD
  • presents ages 35-45
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2
Q

clinical signs of essential tremors

A

The tremor is postural (occurring with voluntary maintenance of position against gravity), intentional, of hands, forearms, head, voice and lips

Worse with stress and intentional movement

Tone and reflexes are normal
Parkinsonian features such as rigidity and bradykinesia absent

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3
Q

essential tremors are shortly relieved with

A

etoh, increased GABA

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4
Q

pt doesn’t have an essential tremor if…

A
  • Other abnormal neurologic signs
  • The presence of known causes of enhanced physiologic tremor, including current or recent exposure to drugs that are known to cause tremor or a drug-withdrawal state
  • Historic or clinical evidence of psychogenic tremor
  • Convincing evidence of sudden onset or evidence of stepwise deterioration
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5
Q

tx of choice for essential tremor

A

propranolol
MOA: Inhibits peripheral B-2 receptors on muscles
S/E: ???hypotension, brady, HF, fatigue, depression, weight gain, male impotence

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6
Q

2nd line tx for essential tremor

A

Primidone
MOA: Barbiturate
S/E: Sedation, ataxia, dizziness

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7
Q

drastic measure to improve essential tremor if meds don’t work?

A

thalamotomy

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8
Q

common meds that induce tremors

A
  • Lithium
  • Theophylline
  • Depakote
  • Cyclosporine
  • caffeine
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9
Q

Syndrome that possesses the features of abnormal involuntary movements of the tongue, lips, face, trunk, and extremities.
Associated with long-term treatment with neuroleptic medications.

A

tardive dyskinesia, May begin during treatment with neuroleptics or within 4 weeks of d/c meds

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10
Q

what should you give to a tardive dyskinetic pt

A

benadryl + reglan

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11
Q

how to manage tourette’s

A

-behavioral therapy

Tetrabenazine
MOA: Dopamine receptor blocker

Clonidine
MOA: Alpha Adrenergic agents (A2)

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12
Q

alpha 1 vs alpha 2

A

alpha 1-vasoconstrict

alpha 2-vasodilate

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13
Q

MC form of neuropathy

A

idiopathic

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14
Q

mgmt of neuropathy

A 
lidocaine patch (first line)
MOA: Na channel blocker

Capsaicin (Topical)
MOA: Derived from red chili pepper- decreases pain sensation by depleting substance P
S/E: Burning and hyperalgesia (30% of patients D/C due to that)

Gabapentin

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15
Q

A sensorimotor disorder that presents with sensation between the ankle and the knee that is unpleasant and compels them to move it while person is at rest

A

resless leg syndrome

associated w/Fe def anemia

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16
Q

these can increase RLS symptoms

A

Antipsychotics, Neuroleptics, Antihistamines, Antiemetic, Caffeine, Alcohol, Nicotine, SSRIs

17
Q

how to manage RLS

A

L-Dopa, synthetic dopamine

ropinirole/pramipexole/bromocriptine
MOA: dopamine agonist

these cause muscle relaxation

18
Q

how to tx resistant RLS

A

opioids

benzos

19
Q

Neurodegenerative disorder of the extrapyramidal system(movement) involving the substantia nigra

A

Parkinson’s, decreased dopamine leads to failure to inhibit ach

20
Q

big three signs of parkinson’s

A
  • Tremor
  • Rigidity
  • Bradykinesia with progressive postural instability
21
Q

how does Parkinson’s present

A

Worse with rest and emotional stress
Tremor better with intent (voluntary movement)
“Pill rolling” with head usually not affected
Starts with one side  becomes generalized

22
Q

myerson sign

A

Tapping the bridge of the nose causes a sustained blink

23
Q

Progressive Postural Instability

Pull Test

A

Stand behind patient and pull the shoulders

Parkinson  Fall or take steps back

24
Q

how to manage Parkinson’s

A

levodopa/carbidopa
MOA: Levodopa is converted to dopamine
Carbidopa reduces the amount of Levodopa needed  Reduced symptoms of Levodopa
S/E: Hypotension Nausea, Dyskinesia and wearing off effect with long term use

25
Q

what should you put younger parkinsons pts on?

A

Bromocriptine, Pramiprexole, & Ropinirole

MOA: Stimulates dopamine receptors directly

26
Q

Used in patients that are less than 70 years old with tremor as their predominant symptom of PD

A

Benztropine
MOA: Anticholinergic- Blocks excitatory cholinergic effect
S/E: ???dry mouth, constipation, dry eye, urinary retention, tachy, dilation, bronchodilation
CI:???glaucoma, BPH

27
Q

amantadine

A

MOA: Increases presynaptic dopamine release

28
Q

MAO-B Inhibitors

A

Increases dopamine in striatum

29
Q

entacapone

A

MOA: Inhibits Catechol-O-Methyltransferase,
preventing dopamine breakdown
S/E: Brown urine diarrhea increased risk of fulminant hepatitis with Tolcapone

Neuro 3 (3 decks)

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