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A 53-year-old man presents for evaluation and treatment of a tremor. He reports 6 years of progressively worsening tremor in his hands that interferes with his handwriting and performance of fine motor tasks. He works in construction, and the tremor has impaired his ability to use a screwdriver accurately. The tremor improves transiently with alcohol. He has a strong family history of tremor and a medical history of asthma and diabetes. On examination, he has a bilateral 6-Hz to 8-Hz postural tremor in his upper extremities. No rigidity, bradykinesia, or gait instability is evident<br><br>Which of the following medications is most appropriate for this patient?
Explanation
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This patient most likely has essential tremor. He has the typical symmetric postural tremor with a strong family history and response to alcohol. The medications with class A evidence for essential tremor include propranolol and primidone. Propranolol is not an ideal choice in this patient because of his underlying asthma and diabetes. Although primidone may cause sedation, proper low dosing at bedtime (especially in younger patients) is less likely to lead to this side effect. Gabapentin and topiramate can be used as second-line agents, with mixed success. Trihexyphenidyl, an anticholinergic medication, can be used for the tremor of Parkinson disease.
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Reference
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Edwards MJ, Deuschl G. Tremor syndromes. Continuum (Minneap Minn). 2013 Oct19(5 Movement Disorders)1213-24. doi 10.121201.CON.0000436153.01167.a6. PMID 24092287.
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Option 1
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Is Correct (Option 1):
Gabapentin
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Option 2
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Is Correct (Option 2):
Primidone
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Option 3
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Is Correct (Option 3):
Propranolol
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Option 4
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Is Correct (Option 4):
Trihexyphenidyl
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