Psychopharmacology Exam #2 - Drug-Induced Movement Disorder

Question 1 of 54

1

The following are early onset EPS symptoms

Select one or more of the following:

Dystonia
Akathisia
Parkinsonism
Tardive dyskensia

Explanation

Question 2 of 54

1

Which EPS symtom can appear within days

Select one of the following:

Dystonia
Akatsia
Parkinsonism
Tardive dyskinesia

Explanation

Question 3 of 54

1

Which EPS symptom can appear within weeks?

Select one of the following:

Dystonia
Akathisia
Parkinsonsism
Tardive dyskenia

Explanation

Question 4 of 54

1

Which EPS symptom can appear within months?

Select one of the following:

Dystonia
Akathisia
Parkinsonism
Tardive dyskinesia

Explanation

Question 5 of 54

1

Which EPS symtoms can take years to appear?

Select one of the following:

Dystonia
Akathisia
Parkinsonism
Tardive dyskensia

Explanation

Question 6 of 54

1

Select from the dropdown lists to complete the text.

Types of drug-induced movement disorders:
( Acute:, Withdrawal: ) Occur within a short duration of treatment onset or dose increase
( Chronic:, Tardive ) Symptoms persist throughout treatment
( Tardive, Withdrawal ): Delayed onset of symptoms
( Withdrawal:, Tardive ) Occur in the absence of treatment. May resolve

Explanation

Question 7 of 54

1

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

Select one of the following:

True
False

Explanation

Question 8 of 54

1

The mechanism for dystonia is

Select one or more of the following:

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

Explanation

Question 9 of 54

1

What are risk factors for dystonia

Select one or more of the following:

Young age
H/O ECT
Male gender
High potency neuroleptics - Haldol, Prolixin
Comorbid medical conditions

Explanation

Question 10 of 54

1

Types of dystonia

Drag an answer into the correct orange point.

Opisthotonos

Blepharospasm

Torticollis

Oculogyric crisis

Oro-mandibular

Explanation

Question 11 of 54

1

The MOA for akathisia, from the Greek meaning "inability to sit", is:

Select one of the following:

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

Explanation

Question 12 of 54

1

Which of the following agents cause akathisia

Select one or more of the following:

SSRI
Second generation antipsychotics
Antiemetics
CCB
Anti-anxiolytics

Explanation

Question 13 of 54

1

What are some differentials for akathisia

Select one or more of the following:

GAD
ADHD
Agitation
MDD

Explanation

Question 14 of 54

1

What are clinical presentation of akathisia

Select one or more of the following:

Restlessness
Breaking out into song & dance for no reason
Fidgety movements/leg swinging
Marching in place
Rocking from one foot to another
Picking

Explanation

Question 15 of 54

1

The risk factors for akathisia include

Select one or more of the following:

Advanced age
Affective disorder
Cognitive impairment
Female impersonator performer
Female
H/O akathisia
Iron deficiency
High dose/potency/neuroleptics

Explanation

Question 16 of 54

1

Pathophysiology of pseudoparkinsonism is:

Select one of the following:

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

Explanation

Question 17 of 54

1

Select from the dropdown lists to complete the text.

Parkinsonism = ( bradykesia, apraxic slowness )
Pseudoparkinsonism = ( bradykinesia, apraxic slowness )

Explanation

Question 18 of 54

1

Select from the dropdown lists to complete the text.

Parkinsonism = ( resting tremor, essential tremor, myoclonus )
Pseudoparkinsonism = ( resting tremor, essential tremor, myoclonus )

Explanation

Question 19 of 54

1

Select from the dropdown lists to complete the text.

Parkinsonism = ( lead pipe rigidity, paratonic rigidity )
Pseudoparkinsonism = ( lead pipe rigidity, paratonic rigidity )

Explanation

Question 20 of 54

1

Select from the dropdown lists to complete the text.

Parkinsonism = ( postural instability, frontal ataxia )
Pseudoparkinsonism = ( postural instability, frontal ataxia )

Explanation

Question 21 of 54

1

Select from the dropdown lists to complete the text.

Parkinsonism = ( Slow, shuffling gait with festination, Slow, shuffling apraxic gait )
Pseudoparkinsonism = ( Slow, shuffling gait with festination, Slow, shuffling apraxic gait )

Explanation

Question 22 of 54

1

What are risk factors for pseudoparkinsonism?

Select one or more of the following:

Female
Male
Advanced age
Central DA receptor binding agents, Metclopramide, phenothiazines
AIDS
Cancer

Explanation

Question 23 of 54

1

Tardive dyskinesia

Select one or more of the following:

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

Explanation

Question 24 of 54

1

MOA for tardive dyskinesia

Select one or more of the following:

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

Explanation

Question 25 of 54

1

Which medications most commonly cause tardive dyskinesia?

Select one or more of the following:

Meoclopramide
Alpha adrenergic agonists
SGA
FGA

Explanation

Question 26 of 54

1

Clinical presention of tardive dyskinesia

Select one or more of the following:

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.

Explanation

Question 27 of 54

1

EPS can be caused by antiemetics, antieliptics, psychotropics, cardiovascular agents and Levodopa

Select one of the following:

True
False

Explanation

Question 28 of 54

1

EPS can be caused by antiemetics, antieliptics, psychotropics, cardiovascular agents and Levodopa

Select one of the following:

True
False

Explanation

Question 29 of 54

1

The following drugs cause all four movement disorders: dystonia, akathisia, Parkinsonism, tardive dyskinesia

Select one or more of the following:

Metoclopramide
Prochloraperazine
Amoxapine
Neuroleptics
SSRI
Levodopa

Explanation

Question 30 of 54

1

How often should the Abnormal Involuntary Movement Scale (AIMS) be administered?

Select one of the following:

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

Explanation

Question 31 of 54

1

What are overall tips for treatment of EPS?

Select one or more of the following:

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

Explanation

Question 32 of 54

1

Dystonia put in order of line of treatment
First line = ❌
Second line = ❌
Third line = ❌
Fourth line - ❌

Drag and drop to complete the text.

anticholinergic agents

Baclofen

Benzo

Botox

Explanation

Question 33 of 54

1

This is a nice visual/review

Select one of the following:

True
False

Explanation

Question 34 of 54

1

Drug of choice for dystonia is

Select one of the following:

Beta-blockers, anticholinergics, benzodiazepines, 5-HT2A receptor antagonist, mirtazapine
Anticholinergics (benztropine, diphenhydramine, trihexyphenidyl)
Clonzaepam, ginkgo biloba

Explanation

Question 35 of 54

1

Drugs of choice for akathisia include

Select one of the following:

Anticholinergics (benztropine, diphenhydramine, trihexyphenidyl)
Beta-blockers, benzodiazepines, 5-HT2A receptor antagonist, mirtazapine
Clonazepam, ginkgo biloba

Explanation

Question 36 of 54

1

Mirtazapine (Remeron)

Select one or more of the following:

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

Explanation

Question 37 of 54

1

Visual for treatment of akathisia

Select one of the following:

True
False

Explanation

Question 38 of 54

1

Which drugs are used to treat pseudoparkinsonism?

Select one or more of the following:

Cogentin (benztropine)
Symmetrel (amantadine)
Benzodiazepines
Mirtazapine (Remeron)
Diphenhydramine (Benadryl)

Explanation

Question 39 of 54

1

MOA for amantadine (Symmetrel) is

Select one of the following:

Dopamine agonist
Dopamine antagonist
5-HT2 agonist
5-HT2 antagonist

Explanation

Question 40 of 54

1

Side effects for benztropine (Cogentin) include

Select one or more of the following:

Dry mouth
Hypotension
Diarrhea
Constipation
Cognitive impairment
Sialorrhea

Explanation

Question 41 of 54

1

Side effects for amantadine (Symmetrel) include:

Select one or more of the following:

Hypotension
Hypertension
Agitation
Sedation
Worsening s/s of psychosis

Explanation

Question 42 of 54

1

Which drugs are used in the treatment of tardive dyskinesia

Select one or more of the following:

Diltiazem
Baclofen
Galantamine
Clonazepam
Ginkgo biloba

Explanation

Question 43 of 54

1

What is the first FDA approved medication for Tardive Dyskinesia

Select one of the following:

Velbeazine (Ingrezza)
Benztropine (Cogentin)
Trihexphenidyl (Artane)
Amantadine (Symmetrel)

Explanation

Question 44 of 54

1

What is the MOA for valbenazine (Ingrezza)?

Select one of the following:

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)

Explanation

Question 45 of 54

1

Fill the blank space to complete the text.

Acute dystonia is considered a medical emergency.
Must seek treatment immediately. May require IV diphenhydramine

Explanation

Question 46 of 54

1

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

Select one of the following:

True
False

Explanation

Question 47 of 54

1

Select from the dropdown list to complete the text.

High fat meals may ( decrease, increase ) absorption of valbenazine (Ingrezza)

Explanation

Question 48 of 54

1

Common adverse side effects of valbenazine (Ingrezza) include:

Select one or more of the following:

Fatigue
HA
Constipation
Diarrhea
UTI
Somnolence

Explanation

Question 49 of 54

1

Warnings for valbenazine (Ingrezza) include:

Select one or more of the following:

Somnolence
QTc prolongation
Pregnancy/breastfeeding
Hypertension

Explanation

Question 50 of 54

1

Valbenazine should not be used in:

Select one of the following:

Severe renal impairment (< 30 mL/min)
CHF
Cirrhosis
Pancreatitis

Explanation

Question 51 of 54

1

Select from the dropdown lists to complete the text.

Strong 3A4/2D6 inhibitors: ( Increase, Decrease ) valbenazine concentration
Strong 3A4 inducer: ( Increase, Decrease ) valbenazine concentration

Explanation

Question 52 of 54

1

Select from the dropdown list to complete the text.

Valbenazine (Ingrezza) interacts with MAOIs by ( increasing, decreasing ) the monamine NT in the synapse

Explanation

Question 53 of 54

1

Select from the dropdown lists to complete the text.

Valbenazine (Ingrezza) interacts with digoxin and ( increase, decreases )s the digoxin concentration by p-glycoprotein ( inhibtion, inducer )

Explanation

Question 54 of 54

1

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

Select one of the following:

True
False

	Created by Melanie Grynsztejn over 6 years ago

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

Psychopharmacology Exam #2 - Drug-Induced Movement Disorder

Question 1 of 54

The following are early onset EPS symptoms

Select one or more of the following:

Explanation

Question 2 of 54

Which EPS symtom can appear within days

Select one of the following:

Explanation

Question 3 of 54

Which EPS symptom can appear within weeks?

Select one of the following:

Explanation

Question 4 of 54

Which EPS symptom can appear within months?

Select one of the following:

Explanation

Question 5 of 54

Which EPS symtoms can take years to appear?

Select one of the following:

Explanation

Question 6 of 54

Select from the dropdown lists to complete the text.

Explanation

Question 7 of 54

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

Select one of the following:

Explanation

Question 8 of 54

The mechanism for dystonia is

Select one or more of the following:

Explanation

Question 9 of 54

What are risk factors for dystonia

Select one or more of the following:

Explanation

Question 10 of 54

Types of dystonia

Drag an answer into the correct orange point.

Explanation

Question 11 of 54

The MOA for akathisia, from the Greek meaning "inability to sit", is:

Select one of the following:

Explanation

Question 12 of 54

Which of the following agents cause akathisia

Select one or more of the following:

Explanation

Question 13 of 54

What are some differentials for akathisia

Select one or more of the following:

Explanation

Question 14 of 54

What are clinical presentation of akathisia

Select one or more of the following:

Explanation

Question 15 of 54

The risk factors for akathisia include

Select one or more of the following:

Explanation

Question 16 of 54

Pathophysiology of pseudoparkinsonism is:

Select one of the following:

Explanation

Question 17 of 54

Select from the dropdown lists to complete the text.

Parkinsonism = bradykesia apraxic slowness( bradykesia, apraxic slowness ) Pseudoparkinsonism = bradykinesia apraxic slowness( bradykinesia, apraxic slowness )

Explanation

Question 18 of 54

Select from the dropdown lists to complete the text.

Parkinsonism = resting tremor essential tremor, myoclonus( resting tremor, essential tremor, myoclonus ) Pseudoparkinsonism = resting tremor essential tremor, myoclonus( resting tremor, essential tremor, myoclonus )

Explanation

Question 19 of 54

Select from the dropdown lists to complete the text.

Parkinsonism = lead pipe rigidity paratonic rigidity( lead pipe rigidity, paratonic rigidity ) Pseudoparkinsonism = lead pipe rigidity paratonic rigidity( lead pipe rigidity, paratonic rigidity )

Explanation

Question 20 of 54

Select from the dropdown lists to complete the text.

Parkinsonism = postural instability frontal ataxia( postural instability, frontal ataxia ) Pseudoparkinsonism = postural instability frontal ataxia( postural instability, frontal ataxia )

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

Parkinsonism = ( bradykesia, apraxic slowness )
Pseudoparkinsonism = ( bradykinesia, apraxic slowness )

Parkinsonism = ( resting tremor, essential tremor, myoclonus )
Pseudoparkinsonism = ( resting tremor, essential tremor, myoclonus )

Parkinsonism = ( lead pipe rigidity, paratonic rigidity )
Pseudoparkinsonism = ( lead pipe rigidity, paratonic rigidity )

Parkinsonism = ( postural instability, frontal ataxia )
Pseudoparkinsonism = ( postural instability, frontal ataxia )

Dystonia put in order of line of treatment
First line = ❌
Second line = ❌
Third line = ❌
Fourth line - ❌