Nervous System - Pharmacology

Question 1

L-Dopa/Carbidopa

Answer 1

Levodopa is converted to Dopamine

Carbidopa inhibits peripheral dopa decarboxylase (DDC) allowing a greater proportion of L-Dopa to enter the CNS where it is converted to dopamine by central DDC

Question 2

SSRIs

Answer 2

Fluoxetine, Paroxetine, Sertraline, Citalopram

First line for depression and generalized anxiety disorder; also used in panic disorder, OCD, social phobia, PTSD

5-HT-specific reuptake inhibitors; increase 5-HT in synaptic cleft

Adverse effects: Sexual dysfunction, GI distress

DDIs: Serotonin Syndrome (hyperthermia, confusion, myoclonus, flushing, diarrhea, cardiovascular collapse, seizures) with MAOIs, SNRIs

Question 3

Antipsychotics

Answer 3

Haloperidol, Chlorpromazine, other -azine drugs

D2 receptor blockers; indicated for schizophrenia (positive sx), psychosis, acute mania, Tourette Syndrome

Side effects:
EPS (dystoni, akathisia, bradykinesia/parkinsonism, tardive dyskinesia)
Anti-cholinergic (dry mouth, constipation)
Anti-alpha 1 (hypotension)
Anti-histamine (sedation)
Hyperprolactinemia, galacorrhea
Neuroleptic Malignant Syndrome

Question 4

Atypical antipsychotics

Answer 4

Olanzapine, Quetiapine, Aripiprazole, Clozapine, Risperidone

Higher 5HT/D2 blocking ratio; indicated for schizophrenia (positive and negative sx), Bipolar Disorder, OCD, anxiety disorder, depression, mania

Side effects:
Fewer EPS and anticholiergic sx
Weight gain
Agranulocytosis (Clozapine - requires weekly WBC monitoring)
Hyperprolactinemia, lactation, gynecomastia, irregular menstruation, fertility issues (Risperidone)

Question 5

Buproprion

Answer 5

NDRI used in the treatment of depression (Wellbutrin) and for smoking cessation (Zyban)

Lower incidence of sexual side effects and weight gain than SSRIs

Adverse effects: Agitation, insomnia, seizures; contraindicated in patients with hx of seizures or eating disorder

Question 6

Memenatine

Answer 6

NMDA receptor antagonist

Used in the treatment of Alzheimer’s Disease to decrease excitotoxicity

Adverse Effects: Dizziness, confusion, hallucinations

Question 7

Rivastigmine / Galantamine

Answer 7

AChE inhibitors used in the treatment of Alzheimer’s Disease to increase levels of ACh in the CNS

Adverse effects: Nausea, dizziness, insomnia