What is the correct answer?


Topic: Essential Tremor
Subject: Medicine
A 75 year old white male complains of a tremor which has been progressive over the past 2 years. The tremor interferes with writing, pouring liquids, and eating soup. He has no other medical problems. He abstains from alcohol and tobacco products. Physical examination is remarkable for an action tremor of the upper extremities and a head tremor. No rigidity or gait disorder is noted. Of the following agents, which one is most appropriate as initial drug therapy for this problem?

A. Alprazolam (Xanax)

B. Clonazepam (Klonopin)

C. Carbamazepine (Tegretol)

D. Propranolol (Inderal)

Correct Answer :

D. Propranolol (Inderal)

Essential tremor is the most likely cause of a disabling action tremor in this age group. A resting tremor, rigidity, and other associated problems are seen with Parkinsons disease. Propranolol and primidone are the agents of choice. Alprazolam may have beneficical effects, but it is not a first-line agent because of the risk of sedation and habituation. Clonazepam has not been found to be effective in this disorder. Low doses of theophylline have been found to be somewhat beneficial, but it is considered a second-line agent for essential tremor. Selective Beta-blockers such as metoprolol are not as effective as propranolol.

Related Questions

Topic: Alzheimer's DiseaseSubject: MedicineWhich one of the following… Topic: Glasgow Coma ScaleSubject: MedicineA 27 year old man is brought… Topic: Alzheimer's DiseaseSubject: MedicineWhich one of the following… Topic: Fragile X SyndromeSubject: MedicineYou are asked to see a mentally… Topic: Foot DropSubject: MedicineDuring the physical exam of a patients… Topic: Temporal ArteritisSubject: MedicineA 70-year-old woman returns… Topic: Essential TremorSubject: MedicineA 66 year old white female consults… Topic: Guillain-Barr� syndromeSubject: MedicineA 43-year-old man presents… Topic: Osmotic DemyelinationSubject: MedicineOsmotic demyelination can… Topic: Organophosphate poisoningSubject: MedicineWhat is the mechanism… Topic: Normal Pressure HydrocephalusSubject: MedicineA previously alert,… Topic: Normal Pressure HydrocephalusSubject: MedicineAn 81-year-old female… Topic: AmnesiaSubject: MedicineWhich of the following medications may… Topic: Alzheimer's DiseaseSubject: MedicineA 62 year old woman has demonstrated… Topic: Delirium TremensSubject: MedicineYou see a 49-year-old man in the… Topic: Tension headache.Subject: MedicineA woman presents with chief complaint… Topic: Subarachnoid HemorrhageSubject: MedicineA 25-year-old male presents… Topic: Brain DeathSubject: MedicineA 30 year old man has been on life… Topic: AnalgesicsSubject: MedicineA 74-year-old black female has moderately… Topic: SeizureSubject: MedicineA 52-year-old man with a history of seizure… Topic: Korsakoff's PsychosisSubject: MedicineIn a patient with recent… Topic: Delirium TremensSubject: MedicineA patient with delirium tremens… Topic: SeizureSubject: MedicineA 52-year-old male with a history of seizure… Topic: Trigeminal NeuralgiaSubject: MedicineA 55-year-old man complains… Topic: SeizureSubject: MedicineA 68-year-old man with a history of urolithiasis,… Topic: Adverse Drug EffectSubject: MedicineA 68-year-old man with a history… Topic: Brain DeathSubject: MedicineA 35 year old man has been on life… Topic: Essential TremorSubject: MedicineWhich one of the following is… Topic: Mini Mental Status Exam (or MMSE)Subject: MedicineA 63-year-old… Topic: Trigeminal NeuralgiaSubject: MedicineA man complains that recently…