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3b_Boards - SketchyPharm > (6) Neuro & Psych: Antipsych/Parkinsons (5.1-5.3) > Flashcards

(6) Neuro & Psych: Antipsych/Parkinsons (5.1-5.3) Flashcards

1
Q

Suffix: First-generation antipsychotics

A

“-azine”

(Don’t confuse the “-zine” of H1 receptor blockers with the “-azine” of typical antipsychotics)

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2
Q

Name a first-generation antipsychotic without the suffix “-zine”

A

Haloperidol

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3
Q

MOA: First-generation antipsychotics

A

Inhibit central D2 receptors

(Its primary mechanism of action)

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4
Q

What are the high potency first-generation antipsychotics?

A

(1) Trifluoperazine/Fluphenazine
(2) Haloperidol

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5
Q

What are the low potency first-generation antipsychotics?

A

(1) Thioridazine
(2) Chlorpromazine

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6
Q

Indications (4) : First-generation antipsychotics

A

(1) Schizophrenia
(2) Acute psychosis
(3) Acute aggression/agitation
(4) Tourette’s syndrome

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7
Q

Do first-generation antipsychotics have a short or long half-life?

A

Long

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8
Q

Other than D2 receptors, what receptors do first-generation antipsychotics inhibit?

A

(1) Muscarinic receptors
(2) α1 receptors
(3) H1 receptors
* (Note: this occurs predominantly in the LOW potency first-generation antipsychotics)*

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9
Q

What type of side effects are more common in first-generation antipsychotics compared to second generation?

A

Extra pyramidal symptoms

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10
Q

What type of extrapyramidal symptoms can occur within minutes of starting a high potency first-generation antipsychotics?

A

Acute dystonia

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11
Q

What type of extrapyramidal symptoms can occur within days of starting a high potency first-generation antipsychotics?

A

Akathisia

(movement disorder characterized by a subjective feeling of inner restlessness accompanied by mental distress and an inability to sit still)

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12
Q

What type of extrapyramidal symptoms can occur within weeks of starting a high potency first-generation antipsychotics?

A

(1) Drug-induced Parkinson
(2) Tardive dyskinesia

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13
Q

Name 2 endocrine abnormalities that can occur secondary to high potency first-generation antipsychotic use

A

(1) ↓ Dopamine ⇒ ↑ Prolactin
(2) ↑ Prolactin ⇒ ↓ GnRH

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14
Q

Adverse Effects - Non-endocrine (3) : Typical antipsychotics

A

(1) Neuroleptic malignant syndrome
(2) Torsades de pointes
(3) Seizures

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15
Q

What are the symptoms of neuroleptic malignant syndrome?

A

(1) Lead-pipe rigidity
(2) Autonomic instability
(3) Rhabdomyolysis

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16
Q

What is the distinctive side effect of Thioridazine?

A

Retinal deposits

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17
Q

What is the distinctive side effect of Chlorpromazine?

A

Yellow corneal deposits

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18
Q

Do first-generation antipsychotics better treat positive or negative symptoms of schizophrenia?

A

Positive symptoms of schizophrenia

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19
Q

Name 6 atypical antipsychotics

A

(1) Quetiapine
(2) Olanzapine
(3) Risperidone
(4) Aripiprazole
(5) Ziprasidone
(6) Clozapine

20
Q

MOA: Atypical antipsychotics

A

(1) Central D2-receptor antagonist
(2) 5-HT2A receptor antagonist

21
Q

Do atypical psychotics treat the positive or negative symptoms of schizophrenia?

A

Both

22
Q

Indications (3) : Atypical antipsychotics

A

(1) Schizophrenia
(2) Resistant depression
(3) OCD (with SSRI)

23
Q

Which atypical antipsychotic has been used to treat Tourettes?

A

Risperidone

24
Q

Other than D2 and 5-HT2A receptors, what receptors do atypical antipsychotics block?

A

(1) H1 receptors
(2) α1 receptors
(3) Muscarinic

25
Q

Which atypical antipsychotic most strongly blocks muscarinic receptors?

A

Clozapine

26
Q

What side effects distinguish atypical antipsychotics from first-generation?

A

(1) Weight gain
(2) Dyslipidemia
(3) Hyperglycemia
* (These occur in Second Generation, not first generation)*

27
Q

What are the potential adverse effects most associated with Clozapine?

A

(1) Agranulocytosis
(2) Myocarditis/cardiomyopathy
(3) Seizures

28
Q

Which atypical antipsychotic is most associated with extrapyramidal side effects?

A

Risperidone

29
Q

Are atypical antipsychotics associated with neuroleptic malignant syndrome?

A

Yes

(Although less than first generation)

30
Q

What adverse cardiac effect is associated with atypical antipsychotics?

A

Torsades de pointes

31
Q

What is the immediate precursor to dopamine?

A

L-DOPA

(Which is able to cross the BBB)

32
Q

Adverse Effects - Acute therapy (4) : L-DOPA

A

Due to increased PERIPHERAL Dopamine:

  • (1) GI distress
  • (2) Cardiac arrhythmia
  • (3) Orthostatic hypotension

Due to increased CENTRAL Dopamine:

(4) Neuropsychiatric symptoms
* (↑ Dopamine in chemotrigger zone outside BBB ⇒ Nausea. Antipsychotics can be used to treat CNS symptoms)*

33
Q

Adverse Effects - Chronic therapy (2) : L-DOPA

A

(1) Response fluctuations (Wearing-off effect)
(2) Dyskinesias (i.e., choreoathetosis)

34
Q

Contraindication: L-DOPA

A

Psychosis

35
Q

MOA: Carbidopa

A

Peripheral DOPA decarboxylase inhibitor

(⇒ ↓ Peripheral adverse effects + ↑ Bioavailability)

36
Q

What drug can be used to alleviate the peripheral side effects of L-DOPA?

A

Carbidopa

37
Q

Name 3 enzymes which metabolize peripheral L-DOPA

A

(1) DOPA decarboxylase
(2) COMT
(3) MAO

38
Q

Suffix: COMT inhibitor

A

“-capone”

39
Q

What’s the difference between Tolcapone and Entacapone?

A

Entacapone is NOT active in CNS

(Notice Tall Al Capone is in the vault ∴ can cross BBB)

40
Q

Which Parkinson’s drug is associated with liver failure?

A

Tolcapone

(∴ Entacapone is usually preferred)

41
Q

MOA: Ropinirole

A

D2 receptor agonist

42
Q

MOA: Pramipexole

A

D3 receptor agonist

43
Q

Indications - Non-endocrine (2) : Dopamine receptor agonists

A

(1) Parkinsons
(2) Restless leg syndrome
* (Usually, initial therapy for Parkinson’s, as they are less likely to produce an on-off effect)*

44
Q

What drug can exacerbate impulse control disorders?

A

Ropinirole

(“Just think ‘rock and roll’ Ropinirole!”)

45
Q

MOA: Amantadine (in treating Parkinson’s)

A

(1) ↑ Endogenous release
(2) Inhibiting reuptake
* (Very similar to amphetamines, it even sounds similar)*

46
Q

Which symptom of Parkinson’s is NOT treated by centrally acting antimuscarinics?

A

Bradykinesia

3b_Boards - SketchyPharm (32 decks)

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