Ch. 13 Dopamine

Question 1

Dopamine Prescursors- substate for Dopamine synthesis (crosses BBB by enzyme AADC)

Answer 1

Levodopa (parkinsons)- best when tx w/ carbidopa (inhibits DOPA cecarboxylase); Dyskinesea in 5 yrs

Question 2

Dopamine Receptor Agonist- bind to and activate postsynaptic dopamine receptors directly

Answer 2

Pramipexole, Ropinirole (Parkinsons, RLS)- delays onset of “off” periods

Question 3

Inhib. Of Levodopa or Dopamine metabolism= More in synapse (Inhibs MAO-B, or COMT- inhib breakdown of levodopa by COMT in periphery)

Answer 3

Rasagiline, Selegiline (more toxic= used less), AR: bundle branch block, GI hemorrhage; can augment Levodopa

Question 4

COMT inhibitors

Answer 4

Tolcapone (more liver toxic; lipid soluble- cross BBB), Entacapone; (Parkinson)

Question 5

Misc Antiparkinson Med- antagonize of excitatory NMDA receptors; or muscurinic receptor antagonist

Answer 5

Amantadine, Trihexyphenidyl, Benztropine

Question 6

Misc Parkinson and Influenza A med

Answer 6

Amantadine (Tx: Levodopa induced dyskinnesias)- AR: NMS

Question 7

Misc Parkinson Meds (3)

Answer 7

Amantadine, Trihexyphenidyl, Benztropine- Tx: tremor from parkinson; AR: angle-closure glaucoma, worsen memory, Urinary retention

Question 8

Antipsychotics- antagonize mesolimbic, D2 receptors (block dopamine–> increased cAMP)

Answer 8

Phenothiazines (8), Butyrophenones (2), Other typicals (3)

Question 9

Phenothiazines (typical antipsychotics)

Answer 9

Chlorpromazine, thioridazine, Mesoridazine, Perphenazine, Fluphenazine, Thiothixene, Trifluoperazine, Chlorprothixene

Question 10

Use for Pheothiazine

Answer 10

Psychotic disorder; NV (chlorpromazine, perphenazine)

Question 11

Low Potent phenothiazines (“Cheating Thieves are low”)

Answer 11

Chlorpromazine, Thioridazine (cause fewer extrapyramidal effects)

Question 12

High Potent Phenothiazines (“Try to Fly high”)

Answer 12

Trifluoperazine, Fluphenazine (delivered IM 3-4wks) (fewer sedative effects, cause less postural hypotension)

Question 13

AR of Phenothiazines

Answer 13

Parkinsons, Neuroleptic Malignant syndrome

Question 14

Butyrophenones:

Answer 14

Haloperidol, Droperidol (psychoses, Tourettes, N/V)- Haloperidol delivered IM 3-4 wks (good for non-compliant)

Question 15

Other typicals (Tx: psychotic disorder, Tourettes)

Answer 15

Loxapine, Molindone, Pimozide (tourettes)- More specific dopamine receptor antagonist= less sedation and hypotension

Question 16

Atypical Antipsychotics (Antag. D2, 5-HT2 receptors)

Answer 16

Risperidone, Clonazepine, Olanzapine, Quetiapine, Ziprasidone, Aripiprazole, Paliperidone, Iloperidone

Question 17

TX: Psychotic disorder & Bipolar (All have EPS & Anticholinergic)

Answer 17

Risperidone (Long QT), Olanzapine (D4 Rec. Antag)(Wt. gain), Quetiapine, Ziprasidone (AR: mild EPS, Long QT), Aripiprazole

Question 18

Tx: Schizophrenia

Answer 18

Clozapine (D4 Rec. Antag)- AR: Agranulocytosis (must do weekly WBC checks)- “Must watch Clozapine Clozely”)

Question 19

Tx: Schizophrenia & Schizoeffective

Answer 19

Paliperidone (AR: Agranulocytosis, Tachyarrhythmia, ischemia, death, hyperprolactinemia)

Question 20

Tx: Schizophrenia

Answer 20

Iloperidone (AR: CVA, ischemic attack, prolonged QT)