#9 Movement Disorders 10-27-06

Front 1

tremor?

Back 1

rhythmic/oscillatory movement around a joint

Front 2

resting tremor

Back 2

1) parkinson's dz
2) rigidity
3) impairment of volitional move.

Front 3

essential tremor

Back 3

postural tremor

Front 4

intentional tremor

Back 4

1) brain stem/cerebellar lesion
2) alcohol/drug toxicities

Front 5

chorea

Back 5

involuntary muscle jerks, unpredictable
1) hereditary
2) volitional activity impairement

Front 6

athetosis

Back 6

slow, writhing abnoramal move.

Front 7

dystonia

Back 7

postural abnormality - asso. with sustained, abnormal move.

Front 8

tics

Back 8

sudden, abnormal "coordinated" move.

Front 9

choronic, multiple tics?

Back 9

Gilles de la Tourrette's syndrome

Front 10

symptoms of Parkinson's dz

Back 10

1) tremor
2) bradykinesia
3) rigidity
4) characteristic gait/ postural abnormality

Front 11

characteristics of parkinson's

Back 11

1) choronic
2) progressive
3) begins in middle/late life
4) affects all ethnic group
5) equal gender distribution

Front 12

frequency population over 65 yrs

Back 12

1 per 100 persons

Front 13

neuronal loss in parkinson's

Back 13

loss of "substantia nigra pars compacta cells" cause reduced "nigral-striatal dopamine input" to the putamen

Front 14

D-1 mediated direct pathway

Back 14

loss of an striatal excitatory dopamine input

Front 15

D-2 mediated, indirect pathway

Back 15

loss of an striatal inhibitory dopamine input

Front 16

cause of parkinson's?

Back 16

unknown

Front 17

possible causes of parkinson's?

Back 17

1) environmental toxin
2) endogenous toxins

Front 18

clinical manifestations of parkinson's

Back 18

1) tremor
2) rigidity
3) bradykinesia - akinesia (severe)
4) flat affect
5) blepharoclonus
6) blepharospasm
7) drooling
8) voice: hypophonic, poorly modulted
9) small, tremulous handwriting
10) festinating gait
11) tapping over the glabella
12) depression
13) impaired cognitive function (dementia in advanced cases)

Front 19

Dopamine

Back 19

1) does not cross BBB
2) ineffective if administered peripherally

Front 20

L-Dopa

Back 20

1) crosses the BBB
2) metabolic precursor dopamine
3) enters neuronal cells and is decarboxylated to dopamine

Front 21

D1 receptor

Back 21

1) anedyl cyclase stimulation
2) increase cAMP levels
3) located in substantia nigra zona compacta

Front 22

D2 receptor

Back 22

1) adenyl cyclase inhibition
2) decreases cAMP levels
3) postsynaptic localization on striatal neurons

Front 23

Levodopa (Dopar)is given with?

Back 23

carbidopa (Lodosyn) = dopa decarboxylase inhibitor

Front 24

Levodopa is given with Carbidopa to decrease?

Back 24

peripheral decarboxylation of levodopa

Front 25

L-dopa is most effective in diminishing?

Back 25

bradykinesia (improves all parkinson's dz symptoms)

Front 26

SE of levodopa

Back 26

1) GI prob.

Front 27

dyskinesias include

Back 27

1) chorea
2) ballismus
3) athetosis
4) dystonia
5) myoclonus
6) tics
7) tremor

Front 28

other medications for parkinson's

Back 28

1) Selegiline (Deprenyl)
2) Amantadine (Symmetrel)
3) Anticholinergics

Front 29

Selegiline (Deprenyl)

Back 29

1) selective monoamine oxidase B inhibitor
2) prolongs L-dopa effect

Front 30

Amantadine (Symmetrel)

Back 30

1) antiviral drug
2) may influence dopamine release, reuptake, synthesis

Front 31

anticholinergics

Back 31

1) improve rigidity, tremor
2) not used as much now

Front 32

anticholinergics

Back 32

1) Bentropine (Cogentin)
2) Biperiden (Akineton)
3) Orphenadrine (Norflex)
4) Procyclidine (Kemadrin)
5) Trihexyphenidyl (Artane)

Front 33

physiologic postural tremor (normal) is increased by?

Back 33

1) thyrotoxicosis
2) isoproterenolol (Isuprel)
3) Epinephrine
4) anxiety
5) fatigue

Front 34

drug-induced normal physiologic tremor?

Back 34

1) bronchodilators
2) tricyclic antidepressants
3) lithium
4) possible beta2 receptor mediation

Front 35

essential tremor

Back 35

1) postural tremor
2) possible beta 1 receptor mediation

Front 36

medications for essential tremor

Back 36

1) beta blockers
2) Primidone (Mysoline) = anticonvulsants
3) Alprazolam (Xanax)

Front 37

intentional tremor

Back 37

1) caused by toxic rx to alcohol and other drugs (phenytoin)

Front 38

Huntington's disease

Back 38

1) dominant
2) inherited
3) progressive chorea in dementia
4) adult onset

Front 39

chorea

Back 39

dopamine/Ach/GABA basal ganglia imbalance (too much dopamine?)

Front 40

anti-dopaminergic agents to reduce chorea

Back 40

1) Reserpine
2) Phenothiazines
3) Butyrophenones (Haloperidol)

Front 41

cause of chorea

Back 41

1) thyrotoxicosis
2) hypoCa
3) lupus erythematosus
4) hepatic cirrhosis
5) polycythemia vera rubra

Front 42

drug-induced chorea

Back 42

1) L-dopa
2) antimuscarinics
3) lithium
4) phenytoin
5) oral contraceptives
6) amphetamine

Front 43

tx for ballismus

Back 43

dopamine-blocking agents
1) Perphenazine
2) Haloperidol

Front 44

tx for athetosis and dystonia

Back 44

1) not usually satisfactory
2) Diazepam
3) high-dose antimuscarinic agents
4) L-dopa
5) Baclofen
6) Phenothiazines
7) Amantadine

Front 45

tx for tics, Tourette's syndrome

Back 45

Haloperidol

Front 46

phenothiazines cause

Back 46

acute dyskinesia/dystonia

Front 47

Tardive dyskinesia

Back 47

1) consequence of long-term antipsychotic drug tx

Front 48

newer antipsychotic agents that do not appear to cause tardive dyskinesia

Back 48

1) Olanzapine
2) Risperidone

Front 49

Wilson's disease

Back 49

1) recessive, inherited copper metabolism error
2) reduced serum copper/ceruloplasmin
3) > copper concentration in brain and viscera

Front 50

tx for Wilson's disease

Back 50

1) Penicillamine (Dimethylcysteine) = copper chelating agent
2) Trientine (Syprine) = chelating
3) Zinc accetate = > copper excretion
4) zinc sulfate = < copper absorption