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Psychopharmacology Exam #2 - Drug-Induced Movement Disorder

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Quiz on Psychopharmacology Exam #2 - Drug-Induced Movement Disorder, created by Melanie Grynsztejn on 23/03/2018.
Melanie Grynsztejn
Quiz by Melanie Grynsztejn, updated more than 1 year ago
Melanie Grynsztejn
Created by Melanie Grynsztejn over 6 years ago
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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
Image:
Dopamine Pathway (binary/octet-stream)
Answer
  • True
  • False

Question 8

Question
The mechanism for dystonia is
Image:
Dystonia (binary/octet-stream)
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
Image:
Types Of Dystonia (binary/octet-stream)
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
    Image:
    Chorea (binary/octet-stream)
  • Athetoid - characterized by slow, involuntary, convoluted, writhing movements of the fingers, hands, toes, and feet and in some cases, arms, legs, neck and tongue
    Image:
    Atheosis (binary/octet-stream)
  • Stereotypic - petitive, nonfunctional motor behavior (e.g., hand waving or head banging), that markedly interferes with normal activities or results in bodily injury.
    Image:
    Stereotypic (binary/octet-stream)

Question 27

Question
EPS can be caused by antiemetics, antieliptics, psychotropics, cardiovascular agents and Levodopa
Image:
Movement (binary/octet-stream)
Answer
  • True
  • False

Question 28

Question
EPS can be caused by antiemetics, antieliptics, psychotropics, cardiovascular agents and Levodopa
Image:
Mediation1 (binary/octet-stream)
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
Image:
Dystonia Treatment (binary/octet-stream)
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
Image:
Akathisa Algo (binary/octet-stream)
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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