MIDTERM 02 - Antiparkinsonian and Antipsychotic Drugs Flashcards
Hormone that acts as a CNS neurotransmitter, controlling emotion, movement, and reward mechanisms
Dopamine
Dopamine is derived from the amino acid __________
Tyrosine
Tyrosine is converted to levodopa by the enzyme __________, which is the rate-limiting step in dopamine synthesis
Tyrosine hydroxylase (TH)
Dopamine is a precursor of __________ and __________ (NE)
Norepinephrine, Epinephrine
__________ is converted to levodopa by the enzyme tyrosine hydroxylase (TH), which is the rate limiting step in dopamine synthesis
Tyrosine
Tyrosine is converted into __________ by the enzyme tyrosine hydroxylase (TH), which is the rate-limiting step in dopamine synthesis
Levodopa
Tyrosine is converted into levodopa by the enzyme __________, which is the rate-limiting step in dopamine synthesis
Tyrosine hydroxylase (TH)
L-aromatic __________ converts levodopa to dopamine
Amino acid decarboxylase (AADC)
__________ itself does not cross the BBB
Dopamine
L-aromatic __________ converts levodopa to dopamine
Amino acid decarboxylase (AADC)
__________ crosses the BBB via the large neutral amino acid carrier
L-DOPA
Dopamine metabolism is via __________ or __________ (MC)
Monoamine oxidase (MAO), Catechol-O-methyltransferase (COMT)
2 forms of MAO
MAO-A, MAO-B (more related to Parkinson’s)
Is a progressive neurodegenerative illness characterized by tremor, muscular rigidity, bradykinesia, and postural imbalane
Parkinson’s disease
Parkinson’s disease __________ dopamine and ___________ acetylcholine
Decreases, Increases
A prodrug that is metabolized to dopamine after penetrating the BBB
Levodopa
Coadministration of levodopa with the AADC inhibitor, __________, prevents decarboxylation of levodopa outside of the CNS
Carbidopa
2 irreversible, selective MAO-B inhibitors (SR)
Selegiline, Rasagiline
Causes psychomotor and cardiovascular adverse effects due to the metabolites, L-methamphetamine and L-amphetamine (Examples of MAO-B inhibitors)
Selegiline
Is more potent that selegiline (Examples of MAO-B inhibitors)
Rasagiline
Inhibits COMT in the CNS and periphery (Examples of COMT inhibitors)
Tolcapone
Only inhibits peripheral COMT; does not penetrate the BBB (Examples of COMT inhibitors)
Entacapone
Dopamine agonists are classified into __________ derivatives and __________ derivatives (EN)
Ergot, Non-ergot
Pergolide (Type of dopamine agonist)
Ergot derivative
Cabergoline (Type of dopamine agonist)
Ergot derivative
Bromocriptine (Type of dopamine agonist)
Ergot derivative
Apomorphine (Type of dopamine agonist)
Non-ergot derivative
Pramipexole (Type of dopamine agonist)
Non-ergot derivative
Ropinirole (Type of dopamine agonist)
Non-ergot derivative
Rotigotine (Type of dopamine agonist)
Non-ergot derivative
Agents used for treating the tremor aspect of Parkinson’s disease
Anticholinergic agents
Benztropine, trihexyphenidyl, orphenadrine, and procyclidine are all examples of __________ agents
Anticholinergic
Demonstrated beneficial effects in the treatment of PD; also used in the prevention or treatment of influenza (Examples of anticholinergic agents)
Amantadine
Are psychogenic mental disorders involving a loss of contact with reality
Psychoses
The most common psychoses in which perception, thinking, communication, social functioning, and attention are altered
Schizophrenia
Is a particular kind of psychosis characterized mainly by a clear sensorium but a marked thinking disturbance
Schizophrenia
Hallucinations (Types of schizophrenia symptoms)
Positive
Delusions (Types of schizophrenia symptoms)
Positive
Disorganized speech and behavior (Types of schizophrenia symptoms)
Positive
Alogia (Types of schizophrenia symptoms)
Negative
Avolition (Types of schizophrenia symptoms)
Negative
Affective flattening (Types of schizophrenia symptoms)
Negative
Anhedonia (Types of schizophrenia symptoms)
Negative
Asociality (Types of schizophrenia symptoms)
Negative
Memory (Types of schizophrenia symptoms)
Cognitive deficits
Attention (Types of schizophrenia symptoms)
Cognitive deficits
Planning (Types of schizophrenia symptoms)
Cognitive deficits
Decision making (Types of schizophrenia symptoms)
Cognitive deficits
3 hypothesis related to schizophrenia pathophysiology (DSG)
Dopamine, Serotonin, Glutamate
Is the major excitatory neurotransmitter in the brain
Glutamate
__________ and __________ are noncompetitive inhibitors of the NMDA receptor that exacerbate both cognitive impairment and psychosis in patients with schizophrenia (PK)
Phencyclidine (PCP), Ketamine
Previously known as neuroleptic drugs, antischizophrenic drugs, or major tranquilizers; used is the symptomatic treatment of thought disorders, most notably schizophrenia
Antipsychotic drugs
Antipsychotics are grouped into __________ and __________ categories (TA)
Typical (1st generation), Atypical (2nd generation)
Both categories of antipsychotics share a common feature, a ____________ that is often hydrophobically substituted
Dopamine-like structure
Are better for treating positive signs than negative signs (Categories of antipsychotics)
Typical (1st generation)
Chlorpromazine and haloperidol are examples of __________ antipsychotics (Categories of antipsychotics)
Typical (1st generation)
Are better for treating negative signs; they target the D2 receptor and other receptors (Categories of antipsychotics)
Atypical (2nd generation)
Clozapine and risperidone are examples of __________ antipsychotics (Categories of antipsychotics)
Atypical (2nd generation)
Typical antipsychotics are also associated with a significant degree of __________
Extrapyramidal symptoms (EPS)
Some EPS associated with typical antipsychotics are defined as __________, which tend to occur within the first few weeks of treatment and decline over time
Acute dystonias
The EPS that are widely associated with typical antipsychotics is __________, which develops over months to years and is often irreversible
Tardive dyskinesia
Atypical antipsychotics are ________ to produce extrapyramidal symptoms (EPS)
Less prone
Atypical antipsychotics are __________ against negative symptoms
More active
Are also known as first-generation or conventional antipsychotics, classical neuroleptics, or major tranquilizers (Categories of antipsychotics)
Typical antipsychotics (1st generation)
Phenothiazines, thioxanthenes, butyrophenones, diphenylbutylpiperidines, and dihydroindolones are all examples of __________ antipsychotics
Typical
Tend to be associated with more EPS and less histaminic, alpha adrenergic, and anticholinergic side effects (Types of typical antipsychotics)
High-potency typical antipsychotics
Are associated with less EPS but more H1, α1, and muscarinic side effects (Types of typical antipsychotics)
Low-potency typical antipsychotics
Are marketed primarily for their antiemetic, antihistaminic, and anticholinergic effect (Examples of typical antipsychotics)
Phenothiazines
Prototype of phenothiazines
Chlorpromazine
Phenothiazines have a tricyclic structure (6-6-6 system) in which two benzene rings are linked by a __________ and a __________ atom (SAR of phenothiazines) (SN)
Sulfur, Nitrogen
The best position for substitution is the __________ (SAR of phenothiazines)
2-position
Activity increases as the electron-withdrawing activity of the 2-substituent __________ (SAR of phenothiazines)
Increases
The three-carbon chain between position __________ and the aliphatic amino nitrogen is critical for neuroleptic activity (SAR of phenothiazines)
10
Shortening or lengthening the three-carbon chain at position 10 drastically __________ the activity (SAR of phenothiazines)
Decreases
Phenothiazines with __________ carbon atoms separating the two nitrogen atoms lack antipsychotic efficacy (SAR of phenothiazines)
2
Shortening the chain to __________ carbons has the effect of amplifying the antihistaminic and anticholinergic activities (SAR of phenothiazines)
2
The amine in phenothiazines is always __________ (SAR of phenothiazines)
Tertiary
The R group in phenothiazines can be a __________ (SAR of phenothiazines)
Ring
-promazine indicates an __________ side chain (SAR of phenothiazines)
Aliphatic
-ridazine indicates a __________ side chain (SAR of phenothiazines)
Piperidine
-phenazine/-perazine indicates a __________ side chain (SAR of phenothiazines)
Piperazine
Promazine, chlorpromazine, and tiflupromazine has an __________ side chain (SAR of phenothiazines)
Aliphatic
Thioridazine and mesoridazine have a __________ side chain (SAR of phenothiazines)
Piperidine
Prochlorperazine, trifluoperazine, perphenazine, and fluphenazine have a __________ side chain (SAR of phenothiazines)
Piperazine
Several piperazine phenothiazines are __________ at a free hydroxyl with long-chain fatty acids to produce highly lipophilic and long-acting prodrugs (SAR of phenothiazines)
Esterified
Ranking of phenothiazine side chains according to anti-HAM effects
Aliphatic > Piperidine > Piperazine
Antihistaminic effect of phenothiazines
Sedation
Anti-adrenergic effect of phenothiazines
Orthostatic hypotension
2 antimuscarinic and anticholinergic effects of phenothiazines (DC)
Dry mouth, Constipation
Ranking of phenothiazide side chains according to potency
Piperazine > Piperidine > Aliphatic
The __________ the potency, the higher the EPS (SAR of phenothiazines)
Higher
Has a double bond on C10; is less potent that other phenothiazines (Examples of typical antipsychotics)
Thioxanthenes
Example of thioxanthene
Thiothixene
Are extremely potent antipsychotic agents; the EPS are extremely marked (Examples of typical antipsychotics)
Butyrophenones
Attachment of a tertiary amino group to the ___________ carbon of the butyrophenone skeleton is essential for neuroleptic activity (SAR of butyrophenones)
Fourth
Lengthening, shortening, or branching of the three-carbon propyl chain __________ neuroleptic potency (SAR of butyrophenones)
Decreases
Nitrogen is usually incorporated into a six-membered ring that is substituted in the __________ position (SAR of butyrophenones)
Para
The most potent butyrophenone compounds have a fluorine substituent in the __________ position of the benzene ring (SAR of butyrophenones)
Para
Replacement of the keto moiety __________ neuroleptic potency (SAR of butyrophenones)
Decreases
The keto (C=O) group is important but can be replaced to __________ group (SAR of butyrophenones)
p-F-phenyl
The __________ group can vary and assist activity (SAR of butyrophenones)
Y
__________ is an example of dihydroindolones (Examples of typical antipsychotics)
Molindone
Also known as second-generation antipsychotics; provide a greater reduction in both the positive and negative symptoms of schizophrenia (Categories of antipsychotics)
Atypical antipsychotics (2nd generation)
Additional tricyclic antipsychotic agents are the ___________, containing a seven-membered central ring (6-7-6 system)
Benzazepines
The newer __________ antipsychotics include dibenzodiazepines, dibenzoxazepines, thienobenzodiazepines, and dibenzothiazepines
Atypical
__________ antipsychotics provide a low production of EPS and a reduction of negative symptoms
Atypical
A dibenzodiazepine derivative; the first atypical antipsychotic (Examples of atypical antipsychotics - benzazepine and related analogs)
Clozapine
A dibenzoxazepine derivative; is actually a typical antipsychotic; is N-demethylated to yield amoxapine (an antidepressant drug) (Examples of atypical antipsychotics - benzazepine and related analogs)
Loxapine
Loxapine is N-demethylated to yield __________, an antidepressant drug
Amoxapine
A thienobenzodiazepine derivative (Examples of atypical antipsychotics - benzazepine and related analogs)
Olanzapine
A dibenzothiazepine derivative (Examples of atypical antipsychotics - benzazepine and related analogs)
Quetiapine
Risperidone and paliperidone are both __________ derivatives (Examples of atypical antipsychotics)
Benzisoxazole
Ziprasidone and lurasidone are both __________ derivatives (Examples of atypical antipsychotics)
Benzisothiazole
__________ is an example of arylpiperazine quinolinone derivative (Examples of atypical antipsychotics)
Aripiprazole
From the gastroprokinetic and antiemetic agent, metoclopramide (Examples of atypical antipsychotics - benzamides)
Remoxipride
Remoxipride is from the gastrokinetic and antiemetic agent, __________
Metoclopramide
Lithium carbonate, lithium citrate, and lithium chloride are examples of __________ (Examples of atypical antipsychotics - antimanic agents)
Lithium salts
2 antimanic agents also used as anticonvulsants (Examples of atypical antipsychotics - antimanic agents) (CV)
Carbamazepine, Valproic acid
Not used because it is hygroscopic and irritating to the GI tract; is an example of lithium salt (Examples of atypical antipsychotics - antimanic agents)
Lithium chloride