Parkinson and psychosis Flashcards
What goes wrong in the nigrostriatal tract in Parkinson’s pt?
Decrease DA—>movement disorder
What goes wrong in the mesolimbic mesocortical tract in schizo pt?
Increase DA—>reinforce behaviors
Treating what diseases can cause Parkinson and schizo like symptoms?
Treat Parkinson with dopamine—>schizo like symptoms
Treat schizo with anti dopamine—>Parkinson like symptoms
What does tuberoinfundibular tract do?
DA inhibit prolactin
What is DA’s role in chemorecetpor trigger zone?
Stimulate DA—>emesis
DA antagonist—>antiemetic
Where are D1 and D2 receptors located and what protein are they coupled with?
D1—>renal—>Gs
D2—>CNS—>Gi
D2A—>nigrostriatal
D2C—>mesolimbic
What is the treatment approach for Parkinson?
Increase DA and decrease ACh
What are the 2 ways to treat pseudoparkinson caused by schizo treatment?
Switch drugs or use an antimuscarinic
What are the side effects of levodopa?
Dyskinesia (most common) Psychosis (most common) HoTN (dopamine vasodilate) Vomiting On-off effects On--->improve mobility with dyskinesia (abnormal movement) Off--->marked akinesia
Why do we use carbidopa with levodopa?
Carbidopa blocks peripheral AAAD (convert levodopa to dopamine)—>promote levodopa to go into CNS
What is tolcapone and entacapone’s role in Parkinson? and what do they give with?
COMT inhibitor—>prevent degradation of dopamine—>decrease On-off effect
They are usually given with levodopa to minimize on-off effect
What’s the affect of selegiline?
Inhibit MAO-B—>prevent degradation of dopamine—>increase dopamine half life—->treat parkinson
What is tolcapone’s side effect?
Hepatotoxic
Why does selegiline cause insomnia?
Selegiline is metabolized to amphetamine
What are some dopamine receptor agonists?
Bromocriptine/pramipexole/ropinirole/apomorphine/aripiprazole
What is bromocriptine used for?
NMS from antipsychotic drugs
Hyperprolactinemia
Acromegaly
What else can pramipexole and ropinirole used for?
Restless leg syndrome
What are the muscarinic blockers used for Parkinson’s?
Benztropine and trihexyphenidyl
What is the mechanism of amantadine for Parkinson’s? and what is its side effect?
Block muscarinic receptor and increase dopamine release
Livedo reticularis
What drugs are used to treat Tourette syndrome?
Halopridol and pimozide
What is Tourette syndrome?
Involuntary tics of multiple muscles/at least one 1 vocal tic
Hyperkinetic
What are the typical and atypical antipsychotic?
Typical—>(zines) haloperidol/chlorpromazine/thioridazine/fluphenazine
Atypical—>(idone and apines) clozapine/olanzapine/risperidone/aripiprazole
What is acute EPS (extrapyramidal symptoms) and chronic EPS? and what do we use to treat them?
Movement disorder from antipsychotic drugs
Acute—>pseudoparkinson/dystonia/akathisia (agitation/distress)
Treat with anti M like benzatropine
Chronic—>tardive dyskinesia (irreversible)
What is the mechanism of atypical antipsychotic?
D2 and 5HT2 blockers
What are the high and low potency of typical antipsychotic and what are their side effects?
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
Which typical antipsychotic has the side effect of torsades and retinal deposits?
Thioridazine
What is clozapine’s side effect?
Agranulocytosis
What are the general side effects for atypical antipsychotic?
Metabolic syndrome—>weight gain/hyperglycemia/hyper lipid
Especially quetiapine
What is NMS (neuroleptic malignant syndrome? How do we treat it?
Temp regulation problems—>muscle rigidity and increase temp
Dantrolene (block Ca2+ in muscle) and bromocriptine
Anti M increase or decrease seizure threshold?
Decrease
What is premenstrual dysphoric disorder and what is used to treat it?
PMDD—>depression during periods
Treat with SSRIs
