Parkinson and psychosis

Question 1

What goes wrong in the nigrostriatal tract in Parkinson’s pt?

Answer 1

Decrease DA—>movement disorder

Question 2

What goes wrong in the mesolimbic mesocortical tract in schizo pt?

Answer 2

Increase DA—>reinforce behaviors

Question 3

Treating what diseases can cause Parkinson and schizo like symptoms?

Answer 3

Treat Parkinson with dopamine—>schizo like symptoms

Treat schizo with anti dopamine—>Parkinson like symptoms

Question 4

What does tuberoinfundibular tract do?

Answer 4

DA inhibit prolactin

Question 5

What is DA’s role in chemorecetpor trigger zone?

Answer 5

Stimulate DA—>emesis

DA antagonist—>antiemetic

Question 6

Where are D1 and D2 receptors located and what protein are they coupled with?

Answer 6

D1—>renal—>Gs
D2—>CNS—>Gi
D2A—>nigrostriatal
D2C—>mesolimbic

Question 7

What is the treatment approach for Parkinson?

Answer 7

Increase DA and decrease ACh

Question 8

What are the 2 ways to treat pseudoparkinson caused by schizo treatment?

Answer 8

Switch drugs or use an antimuscarinic

Question 9

What are the side effects of levodopa?

Answer 9

Dyskinesia (most common)
Psychosis (most common)
HoTN (dopamine vasodilate)
Vomiting
On-off effects
On--->improve mobility with dyskinesia (abnormal movement)
Off--->marked akinesia

Question 10

Why do we use carbidopa with levodopa?

Answer 10

Carbidopa blocks peripheral AAAD (convert levodopa to dopamine)—>promote levodopa to go into CNS

Question 11

What is tolcapone and entacapone’s role in Parkinson? and what do they give with?

Answer 11

COMT inhibitor—>prevent degradation of dopamine—>decrease On-off effect
They are usually given with levodopa to minimize on-off effect

Question 12

What’s the affect of selegiline?

Answer 12

Inhibit MAO-B—>prevent degradation of dopamine—>increase dopamine half life—->treat parkinson

Question 13

What is tolcapone’s side effect?

Answer 13

Hepatotoxic

Question 14

Why does selegiline cause insomnia?

Answer 14

Selegiline is metabolized to amphetamine

Question 15

What are some dopamine receptor agonists?

Answer 15

Bromocriptine/pramipexole/ropinirole/apomorphine/aripiprazole

Question 16

What is bromocriptine used for?

Answer 16

NMS from antipsychotic drugs
Hyperprolactinemia
Acromegaly

Question 17

What else can pramipexole and ropinirole used for?

Answer 17

Restless leg syndrome

Question 18

What are the muscarinic blockers used for Parkinson’s?

Answer 18

Benztropine and trihexyphenidyl

Question 19

What is the mechanism of amantadine for Parkinson’s? and what is its side effect?

Answer 19

Block muscarinic receptor and increase dopamine release

Livedo reticularis

Question 20

What drugs are used to treat Tourette syndrome?

Answer 20

Halopridol and pimozide

Question 21

What is Tourette syndrome?

Answer 21

Involuntary tics of multiple muscles/at least one 1 vocal tic
Hyperkinetic

Question 22

What are the typical and atypical antipsychotic?

Answer 22

Typical—>(zines) haloperidol/chlorpromazine/thioridazine/fluphenazine
Atypical—>(idone and apines) clozapine/olanzapine/risperidone/aripiprazole

Question 23

What is acute EPS (extrapyramidal symptoms) and chronic EPS? and what do we use to treat them?

Answer 23

Movement disorder from antipsychotic drugs
Acute—>pseudoparkinson/dystonia/akathisia (agitation/distress)
Treat with anti M like benzatropine

Chronic—>tardive dyskinesia (irreversible)

Question 24

What is the mechanism of atypical antipsychotic?

Answer 24

D2 and 5HT2 blockers

Question 25

What are the high and low potency of typical antipsychotic and what are their side effects?

Answer 25

High potency (Try to Fly High)--->Trifluoperazine, Fluphenazine, Haloperidol--->cause EPS (aka pseudoparkinson) Low potency (Cheating Thieves are low)--->Chlorpromazine, Thioridazine--->anti M/histamine/alpha 1 blockade

Question 26

Which typical antipsychotic has the side effect of torsades and retinal deposits?

Answer 26

Thioridazine

Question 27

What is clozapine's side effect?

Answer 27

Agranulocytosis

Question 28

What are the general side effects for atypical antipsychotic?

Answer 28

Metabolic syndrome--->weight gain/hyperglycemia/hyper lipid | Especially quetiapine

Question 29

What is NMS (neuroleptic malignant syndrome? How do we treat it?

Answer 29

Temp regulation problems--->muscle rigidity and increase temp Dantrolene (block Ca2+ in muscle) and bromocriptine

Question 30

Anti M increase or decrease seizure threshold?

Answer 30

Decrease

Question 31

What is premenstrual dysphoric disorder and what is used to treat it?

Answer 31

PMDD--->depression during periods | Treat with SSRIs