Psychopharmacology Exam #2 - Drug-Induced Movement Disorder

Melanie Grynsztejn
Quiz by Melanie Grynsztejn, updated more than 1 year ago
Melanie Grynsztejn
Created by Melanie Grynsztejn over 3 years ago
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Description

Quiz on Psychopharmacology Exam #2 - Drug-Induced Movement Disorder, created by Melanie Grynsztejn on 23/03/2018.

Resource summary

Question 1

Question
The following are early onset EPS symptoms
Answer
  • Dystonia
  • Akathisia
  • Parkinsonism
  • Tardive dyskensia

Question 2

Question
Which EPS symtom can appear within days
Answer
  • Dystonia
  • Akatsia
  • Parkinsonism
  • Tardive dyskinesia

Question 3

Question
Which EPS symptom can appear within weeks?
Answer
  • Dystonia
  • Akathisia
  • Parkinsonsism
  • Tardive dyskenia

Question 4

Question
Which EPS symptom can appear within months?
Answer
  • Dystonia
  • Akathisia
  • Parkinsonism
  • Tardive dyskinesia

Question 5

Question
Which EPS symtoms can take years to appear?
Answer
  • Dystonia
  • Akathisia
  • Parkinsonism
  • Tardive dyskensia

Question 6

Question
Types of drug-induced movement disorders: [blank_start]Acute:[blank_end] Occur within a short duration of treatment onset or dose increase [blank_start]Chronic:[blank_end] Symptoms persist throughout treatment [blank_start]Tardive[blank_end]: Delayed onset of symptoms [blank_start]Withdrawal:[blank_end] Occur in the absence of treatment. May resolve
Answer
  • Acute:
  • Withdrawal:
  • Chronic:
  • Tardive
  • Tardive
  • Withdrawal
  • Withdrawal:
  • Tardive

Question 7

Question
Dopamine system pathways include: Mesolimbic: arousal, memory, behavior Mesocortical: cognition, socializaiont Tuberoinfundibular: regulation of prolactin Nigrostriatal: modulation of EPS
Answer
  • True
  • False

Question 8

Question
The mechanism for dystonia is
Answer
  • Dopamine deficiency in the basal ganglia and striatum
  • Overactive cholinergic system
  • Dopaminergic/serotonergic or dopaminergic/cholinergic imbalance in the nucleus accumbens
  • Blockade of the striatal dopamine receptors

Question 9

Question
What are risk factors for dystonia
Answer
  • Young age
  • H/O ECT
  • Male gender
  • High potency neuroleptics - Haldol, Prolixin
  • Comorbid medical conditions

Question 10

Question
Types of dystonia
Answer
  • Opisthotonos
  • Blepharospasm
  • Torticollis
  • Oculogyric crisis
  • Oro-mandibular

Question 11

Question
The MOA for akathisia, from the Greek meaning "inability to sit", is:
Answer
  • Dopamine deficiency in the basal ganglia and striatum
  • Dopaminergic/serotonergic or dopaminergic/cholinergic imbalance in the nucleus accumbens, Overstimulation of locus coeruleus.
  • Blockade of the striatal dopamine receptors
  • Striatal dopaminergic hypersensitivity

Question 12

Question
Which of the following agents cause akathisia
Answer
  • SSRI
  • Second generation antipsychotics
  • Antiemetics
  • CCB
  • Anti-anxiolytics

Question 13

Question
What are some differentials for akathisia
Answer
  • GAD
  • ADHD
  • Agitation
  • MDD

Question 14

Question
What are clinical presentation of akathisia
Answer
  • Restlessness
  • Breaking out into song & dance for no reason
  • Fidgety movements/leg swinging
  • Marching in place
  • Rocking from one foot to another
  • Picking

Question 15

Question
The risk factors for akathisia include
Answer
  • Advanced age
  • Affective disorder
  • Cognitive impairment
  • Female impersonator performer
  • Female
  • H/O akathisia
  • Iron deficiency
  • High dose/potency/neuroleptics

Question 16

Question
Pathophysiology of pseudoparkinsonism is:
Answer
  • Dopamine deficiency in the basal ganglia and striatum
  • Dopaminergic/serotonergic or dopaminergic/cholinergic imbalance in the nucleus accumbens
  • Blockade of the striatal dopamine receptors and depletion of pre-synaptic celft
  • Striatal dopaminergic hypersensitivity and cholinergic deficiency in the basal ganglia

Question 17

Question
Parkinsonism = [blank_start]bradykesia[blank_end] Pseudoparkinsonism = [blank_start]apraxic slowness[blank_end]
Answer
  • bradykesia
  • apraxic slowness
  • bradykinesia
  • apraxic slowness

Question 18

Question
Parkinsonism = [blank_start]resting tremor[blank_end] Pseudoparkinsonism = [blank_start]essential tremor, myoclonus[blank_end]
Answer
  • resting tremor
  • essential tremor, myoclonus
  • resting tremor
  • essential tremor, myoclonus

Question 19

Question
Parkinsonism = [blank_start]lead pipe rigidity[blank_end] Pseudoparkinsonism = [blank_start]paratonic rigidity[blank_end]
Answer
  • lead pipe rigidity
  • paratonic rigidity
  • lead pipe rigidity
  • paratonic rigidity

Question 20

Question
Parkinsonism = [blank_start]postural instability[blank_end] Pseudoparkinsonism = [blank_start]frontal ataxia[blank_end]
Answer
  • postural instability
  • frontal ataxia
  • postural instability
  • frontal ataxia

Question 21

Question
Parkinsonism = [blank_start]Slow, shuffling gait with festination[blank_end] Pseudoparkinsonism = [blank_start]Slow, shuffling apraxic gait[blank_end]
Answer
  • Slow, shuffling gait with festination
  • Slow, shuffling apraxic gait
  • Slow, shuffling gait with festination
  • Slow, shuffling apraxic gait

Question 22

Question
What are risk factors for pseudoparkinsonism?
Answer
  • Female
  • Male
  • Advanced age
  • Central DA receptor binding agents, Metclopramide, phenothiazines
  • AIDS
  • Cancer

Question 23

Question
Tardive dyskinesia
Answer
  • If identified early can be reversed
  • is not reversible
  • increased risk with increased use
  • increased use does not cause increases risk
  • early onset
  • late onset

Question 24

Question
MOA for tardive dyskinesia
Answer
  • Striatal dopaminergic hypersensitivity
  • Cholinergic deficiency within basal ganglia
  • Oxidative stress and cell injur
  • Genetic susceptibility
  • Glutamate-induced excitotoxicity
  • GABA mediated neuronal dysfunction
  • Blockade of the striatal dopamine receptors

Question 25

Question
Which medications most commonly cause tardive dyskinesia?
Answer
  • Meoclopramide
  • Alpha adrenergic agonists
  • SGA
  • FGA

Question 26

Question
Clinical presention of tardive dyskinesia
Answer
  • Choreiform - characterized by jerky, involuntary movements, chiefly of the face and extremities
  • Athetoid - characterized by slow, involuntary, convoluted, writhing movements of the fingers, hands, toes, and feet and in some cases, arms, legs, neck and tongue
  • Stereotypic - petitive, nonfunctional motor behavior (e.g., hand waving or head banging), that markedly interferes with normal activities or results in bodily injury.

Question 27

Question
EPS can be caused by antiemetics, antieliptics, psychotropics, cardiovascular agents and Levodopa
Answer
  • True
  • False

Question 28

Question
EPS can be caused by antiemetics, antieliptics, psychotropics, cardiovascular agents and Levodopa
Answer
  • True
  • False

Question 29

Question
The following drugs cause all four movement disorders: dystonia, akathisia, Parkinsonism, tardive dyskinesia
Answer
  • Metoclopramide
  • Prochloraperazine
  • Amoxapine
  • Neuroleptics
  • SSRI
  • Levodopa

Question 30

Question
How often should the Abnormal Involuntary Movement Scale (AIMS) be administered?
Answer
  • Baseline then every week x4 then every 3 months
  • Baseline then every week x2 then every 12 months
  • Baseline then every week x2 then every 6 months

Question 31

Question
What are overall tips for treatment of EPS?
Answer
  • Stop offending agen (if possible)
  • Reduce the dose
  • Switch to a second generation antipsychotic
  • Treat prophylactically
  • A wing and prayer and refer to anyone else

Question 32

Question
Dystonia put in order of line of treatment First line = [blank_start]anticholinergic agents[blank_end] Second line = [blank_start]Baclofen[blank_end] Third line = [blank_start]Benzo[blank_end] Fourth line - [blank_start]Botox[blank_end]
Answer
  • anticholinergic agents
  • Baclofen
  • Benzo
  • Botox

Question 33

Question
This is a nice visual/review
Answer
  • True
  • False

Question 34

Question
Drug of choice for dystonia is
Answer
  • Beta-blockers, anticholinergics, benzodiazepines, 5-HT2A receptor antagonist, mirtazapine
  • Anticholinergics (benztropine, diphenhydramine, trihexyphenidyl)
  • Clonzaepam, ginkgo biloba

Question 35

Question
Drugs of choice for akathisia include
Answer
  • Anticholinergics (benztropine, diphenhydramine, trihexyphenidyl)
  • Beta-blockers, benzodiazepines, 5-HT2A receptor antagonist, mirtazapine
  • Clonazepam, ginkgo biloba

Question 36

Question
Mirtazapine (Remeron)
Answer
  • Used in low doses to treat akathisa
  • Used in low doses to treat dystonia
  • Alpha-adrenergic receptor antagonist
  • Alpha-adrenergic receptor agonist
  • Antagonizes 5-HT2 and 3 receptors

Question 37

Question
Visual for treatment of akathisia
Answer
  • True
  • False

Question 38

Question
Which drugs are used to treat pseudoparkinsonism?
Answer
  • Cogentin (benztropine)
  • Symmetrel (amantadine)
  • Benzodiazepines
  • Mirtazapine (Remeron)
  • Diphenhydramine (Benadryl)

Question 39

Question
MOA for amantadine (Symmetrel) is
Answer
  • Dopamine agonist
  • Dopamine antagonist
  • 5-HT2 agonist
  • 5-HT2 antagonist

Question 40

Question
Side effects for benztropine (Cogentin) include
Answer
  • Dry mouth
  • Hypotension
  • Diarrhea
  • Constipation
  • Cognitive impairment
  • Sialorrhea

Question 41

Question
Side effects for amantadine (Symmetrel) include:
Answer
  • Hypotension
  • Hypertension
  • Agitation
  • Sedation
  • Worsening s/s of psychosis

Question 42

Question
Which drugs are used in the treatment of tardive dyskinesia
Answer
  • Diltiazem
  • Baclofen
  • Galantamine
  • Clonazepam
  • Ginkgo biloba

Question 43

Question
What is the first FDA approved medication for Tardive Dyskinesia
Answer
  • Velbeazine (Ingrezza)
  • Benztropine (Cogentin)
  • Trihexphenidyl (Artane)
  • Amantadine (Symmetrel)

Question 44

Question
What is the MOA for valbenazine (Ingrezza)?
Answer
  • Blocks alpha-adrenergic receptors and antagonizes 5-HT2 and 3 receptors
  • Reversible inhibition of vesicular monoamine transporter 2 (VMAT2), a transporter that regulates monoamine uptake from the cytoplasm to the synaptic vesicle for storage and release
  • Increase in synthesis and release of dopamine, and inhibition of dopamine uptake.
  • Selective M1 muscarinic acetylcholine receptor antagonist. It is able to discriminate between the M1 (cortical or neuronal) and the peripheral muscarinic subtypes (cardiac and glandular)

Question 45

Question
Acute [blank_start]laryngeal[blank_end] dystonia is considered a medical emergency. Must seek treatment immediately. May require IV diphenhydramine
Answer
  • laryngeal

Question 46

Question
Velbenazine is extensively metabolized by hydrolysis to form active metabolite and by oxidative metabolism to form mono-oxidized valbenazine and other minor metabolites
Answer
  • True
  • False

Question 47

Question
High fat meals may [blank_start]decrease[blank_end] absorption of valbenazine (Ingrezza)
Answer
  • decrease
  • increase

Question 48

Question
Common adverse side effects of valbenazine (Ingrezza) include:
Answer
  • Fatigue
  • HA
  • Constipation
  • Diarrhea
  • UTI
  • Somnolence

Question 49

Question
Warnings for valbenazine (Ingrezza) include:
Answer
  • Somnolence
  • QTc prolongation
  • Pregnancy/breastfeeding
  • Hypertension

Question 50

Question
Valbenazine should not be used in:
Answer
  • Severe renal impairment (< 30 mL/min)
  • CHF
  • Cirrhosis
  • Pancreatitis

Question 51

Question
Strong 3A4/2D6 inhibitors: [blank_start]Increase[blank_end] valbenazine concentration Strong 3A4 inducer: [blank_start]Decrease[blank_end] valbenazine concentration
Answer
  • Increase
  • Decrease
  • Increase
  • Decrease

Question 52

Question
Valbenazine (Ingrezza) interacts with MAOIs by [blank_start]increasing[blank_end] the monamine NT in the synapse
Answer
  • increasing
  • decreasing

Question 53

Question
Valbenazine (Ingrezza) interacts with digoxin and [blank_start]increase[blank_end]s the digoxin concentration by p-glycoprotein [blank_start]inhibtion[blank_end]
Answer
  • increase
  • decreases
  • inhibtion
  • inducer

Question 54

Question
Deutetrabenazine (Austedo) is used for the treatment of chorea and schizophrenia/schizoaffective disorder. It is metabolized by CYP2D6
Answer
  • True
  • False
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