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Clin Med B 2 > trigger - movement > Flashcards

trigger - movement Flashcards

1
Q

Exacerbated by extreme temps and hunger

A

essential tremor

also exacerbated by emotion and fatigue

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2
Q

improved by alcohol

A

Essential tremor

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3
Q

has to be present for 3 years in order to dx

A

essential tremor:

Isolated tremor consisting of bilateral UE action without other motor abnormalities
3y in duration
W or w/o tremors in other locations
Absence of other neurologic signs

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4
Q

worsened with caffeiene

A

enhanced physiologic tremor

restless leg syndrome too!

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5
Q

treatment for intermittent ET

A

1st-line: Propranolol and Primidone (slower onset)
2nd-line: xanax or klonopin

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6
Q

tx for persistent ET

A

1st-line: propanolol or primidone daily. or both! (combo)
2nd-line: gabapentin, pregabalin, topiramate.
2nd-line: Neurologist for botox A or surgical intervention via deep brain stim or thalamotomy

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7
Q

caused by damage to the pons, midbrain, thalamus or cerebellum.

A

intention/kinetic tremor

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8
Q

only treatment is to refer to neuro for surgery

A

intention tremor

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9
Q

WORSE by attempting voluntary movement

A

dystonia

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10
Q

Involuntary contraction of both agonist and antagonist muscles

A

dystonia

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11
Q

MC 30-50

A

torticollis

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12
Q

T or F: blepharospasms can be bilateral or unilateral

A

false: they are unilateral, synchronus and symmetric

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13
Q

irregular and involuntary voice breaks, pt feels like they have to yell

A

spasmodic dysphonia

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14
Q

how to treat adults with generalized dystonias

A

all pts = trial of carbidopa/levodopa

1st-line: Clonazepam (GABA)

Second-line: Baclofen (GABA agonist) or trihexyphenidyl (anticholinergic which increases dopamine release)

Alternative second-line: VMAT2 inhibitor (-benazine and off-label use)

Last resort: DBS

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15
Q

what is the tx for generalized dystonias in children

A
  1. trihexyphenadyls
  2. baclofen or BZDs
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16
Q

Treated w NSAIDS and soft cervical collar

A

infantile torticollis

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17
Q

MC in:
white women
preggo
fmhx
middle aged/older

A

restless leg syndrome

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18
Q

MC with iron deficiency anemia

A

restless leg

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19
Q

risks include alcoholism, DM, amyloidosis, motor neuron disease

A

restless leg

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20
Q

worsened by antihistamines, metoclopramide, antipsychotics and antidepressants

A

restless leg syndrome

also worse w caffeine and sleep deprivation

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21
Q

when do you initiate pharm for restless leg and what are the pharm options for tx!

A

> or equal to 3 nights/week

  • gabapentin, pregablin or gebapentin encarbamil(ER) (ER is given when they have sx throughout hte daytime.)
  • Pramipexole, ropinrole, rotigotine patch
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22
Q

risk of impulse control disorder and augmentation

A

dopamine agonists (pramipexole, ropinirole, rotigotine)

23
Q

what drug requires drug holidayrs

A

dopamine agonists (pramipexole, ropinirole, rotigotine) becuase of risk of augmentation

24
Q

what are the indication for treating tourettes and what do you treat them with.

A

Affecting ADLs, and daily life in general.
Causes pain, discomfort, or injury

FDA approved: Haldol, primozide, aripiprazole
Non-FDA approved: VMAT2 inhibitor (tetrabenazine), clonidine, guanfacine

25
Q

hypotonia w hyperreflexia

A

huntingtons disease

26
Q

presents w Wt loss and cachexia

A

huntingtons dz

27
Q

Slowly progressing disease characterized by tremor, bradykinesia, rigidity, and postural instability

A

parkinsons disease

28
Q

lewy bodies and decreased dopamine producing neurons

A

parkinsons

leads to high acetylcholine and low dopamine

29
Q

alleviated by voluntary movemen

A

tremors in parkinsons

30
Q

tapping over the bridge of the nose and produces sustained blink

what is the name of this test and who is it positive in

A

myerson sign

+ in parkinsons

31
Q

what is the treatment for a young patient with a tremor in parkinsons

A

benzotropine and trihenxyphenidyl

32
Q

what is the treatment for mild parkinsons symptoms

A

amantadine
seligiline, rasagiline, safanamide

33
Q

what is the treatment for moderate parkinsons symptoms

A

dopamine agonists (pamiprexole, roperinole, rotigotine) for younger

carbidopa/levodopa for older

34
Q

for severe parkinsons what is indicated

A

carbidopa/levodopa
+/- etacapone or tolcapone

35
Q

how do you treat dementia in parkinsons

what about psychosis

A

Ach inhibitors and memantine

atypical antipsycotics (quetipine)

36
Q

which part of the cerebellum is asociated with ataxia of gait, balance and, ocular

A

midline cerebellar lesions

37
Q

What kind of ataxia is associated with Dysdiadochokinesis, dysmetria, limb ataxia, tremor, speech

A

hemispheric cerebeller lesions

38
Q

assocaited with loss of hand/eye coordinaiton, nystagmus, and unclear speech

A

motor/cerebellar ataxia

also with:
Imbalance and coordination
Ataxic gait (drunk)
Unclear (scanning) speech
Nystagmus => visual blurring
Loss of hand coordination
Intention tremor

39
Q

abnormal vibratory sense, stomping gait and positive romberg

A

sensory/proprioceptive ataxia

40
Q

deviation of gait to affected side, nystagmus, NV, dizziness

A

vestibular ataxia

41
Q

what do dopamine agonists treat

A

moderate parkinsons disease
restless leg syndrome

these are pamiprexole, ropinirole, and rotigotine

42
Q

SE of viral infection and syncope

A

ropinirole

Syncope
Somnolence
Dizziness
Fatigue
N/V
Viral infection
Dyskinesias

43
Q

DDI with cipro, estrogens, and CNS depressants

A

ropinirole

Alcohol
Dopamine antagonists
CNS depressants
Estrogens
Cipro

44
Q

dopamine agonist w SE of hypotension

A

rotogotine

DDI is anti-HTN

45
Q

inhibits release of dopamine, noradrenaline and seratonin

A

VMAT2 inhibitors

tetrabenazine

46
Q

hepatically metabolized

A

tetrabenazine
ropinirole
amantadine
entacapone

47
Q

when are VMAT2 inhibitors used

A

2nd line for tourettes

non FDA approved for generalized dystonias in adults

48
Q

CI in active SI, uncontrolled depression or MAOI use in 14d

A

tetrabenazine (VMAT2’s)

49
Q

can cause NMS

A

tetrabenazine

50
Q

DDI with tramadol

A

amantadine

51
Q

SE of disturbance of cardiac rhythm

A

amantadine

also:
Restlessness
Confusion
Skin rashes
Edema
Disturbances of cardiac rhythm

52
Q

CI in melanoma and narrow angle glaucoma

A

carbidopa/levodopa

53
Q

avoid this med on a high protiein diet

A

carbidopa/levodopa

Clin Med B 2 (44 decks)

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