Parkinsonism, Antipsychotics, Antidepressants,OPIOIDS, Abuse drugs Flashcards
Parkinson disease is a neurodegenerative disease caused by degeneration of dopaminergic neurons in _____
Substantia nigra
Parkinson disease is also known as?
Paralysis Agitans
Primary signs of Parkinsonism
TRAP - tremor, rigidity, akinesia and postural instability
Drugs that causes drug-induced Parkinsonism by depleting dopamine level
- Antipsychotic drugs
- Reserpine
- MPTP - methylphenyltetrahydropyridine
Antiparkinsonism drug: used as primary treatment for Parkinsons
Levodop-Carbidopa
Mechanism of using Levodopa-Carbidopa in Parkinson?
Levodopa is a dopamine precursor
Carbidopa inhibits peripheral metabolism via dopa decarboxylase
Partial agonist of dopamine D2 receptors in the brain for Parkinson’s disease, Levodopa intolerance and Hyperprolactinemia
Bromocriptine
Partial agonist drug at the dopamine D3 receptors in brain for Parkinsonism contraindicated in patients with active peptic ulcer disease or myocardial infarction
Pramipexole - SIMD: Ropinirole
Antiparkinsonism drug: for off-periods of Parkinson’s disease, erectile dysfunction and Alzheimer’s disease that may cause severe nausea
Apomorphine
A premedication drug of Apomorphine to avoid or prevent severe nausea
Trimethobenzamide
A MAO type inhibitor drug for Parkinson that causes serotonin syndrome when used with SSRIs
Selegiline - decreases degradation of dopamine.
COMT inhibitor drug used for Parkinson that may cause sleep disturbance, orange urine, hepatotoxicity and neuroleptic malignant
Entacapone - SIMD: Tolcapone
Antiviral drug used for Parkinson and influenza, that may improve bradykinesia, rigidity and tremor
Amantadine
Drugs that causes livedo reticularis
Amantadine, hydroxyurea, minocycline, gemcitabine and quinidine
Anticholinergic drug for Parkinson and extrapyramidal symptoms caused by antipsychotics. May cause exacerbation of tardive dyskinesias that results from prolonged use of antipsychotic drugs
Benztropine
Disease caused by excess of dopamine in specific neuronal tracts in the brain
Schizoprenia
Target action of the older antipsychotic drugs
D2 receptors in caudate putamen, nucleus accumbens, cerebral cortex and hypothalamus
Dopaminergic tract: that regulates the mentation and mood
Mesocortical-mesolimbic tract
Dopaminergic tract: associated with extrapyramidal function
Nigrostriatal tract
Dopaminergic tract: associated with control of prolactin release
Tuberoinfundibular tract
Dopaminergic tract: associated with anticipatory motivational phase of copulatory behavior
Incertohypothalamic tract
Dopaminergic tract: associated with eating behavior
Medullary-periventricular tract
Typical antipsychotic drug: that may cause failure of ejaculation, postural hypotension and corneal and lens deposits
Chlorpromazine
Typical antipsychotic drug: that has strongest autonomic effects and only antipsychotic with fatal dose
Thioridazine
Typical antipsychotic drug: that has a major extrapyramidal dysfunction. Weakest autonomic effects with least sedating among typical antipsychotics
Haloperidol
ATypical antipsychotic drug: that may cause weight gain and hyperglycemia. And only antipsychotic drug that reduces the risk of suicide
Clozapine
ATypical antipsychotic drug: also for anorexia nervosa, depression and bipolar disorder that may cause weight gain, hyperglycemia and hyperlipidemia
Olanzapine
Atypical antipsychotic drug: also for manic phase of Bipolar disorder may cause hypnagogic hallucinations, cataracts and priapism
Quetiapine
Atypical antipsychotic drug: also for hiccups, and tourette syndrome. Only approved antipsychotic drug for pediatric age
Risperidone
Atypical antipsychotic drug: that may cause QT prolongation. With increased mortality in elderly patients with dementia related psychosis
Ziprasidone
Atypical antipsychotic drug: also for autism and cocaine dependence
Aripiprazole
Syndrome that presents with fever, encephalopathy, vitals unstable, elevated CPK and rigidity
Neuroleptic malignant syndrome
Drug for treatment of bipolar disorder, decreases manic behavior and reduces both the frequency and the magnitude of mood swings.
Lithium - protective effects against suicide and self-harm
Lithium as mood stabilizer may cause bradycardia and teratogen : Ebstein’s anomaly. It is usually contraindicated in?
Sick sinus syndrome
Treatment for lithium overdose
Hemodialysis
Threshold for lithium toxicity
2meq/L
Two neurotransmitters in pathways that function in expression of mood. Decrease of activity results in depression
NE and serotonin
Antidepressant drug: for major depressive disorder (backup) , phobias and enuresis. With additive effect with other depressants
Imipramine - TCAs
Features of Tricyclic Antidepressant overdose
Coma, convulsions and cardiotoxicity
Treatment for TCAs toxicities that reverses cardiotoxicity
Bicarbonate
Antidepressant drug: as first line for major depressive disorder may cause erectile dysfunction and withdrawal syndrome.
Flouxetine - and Fluvoxamine are CYP450 inhibitors
Drugs that causes erectile dysfunction
SSRIs, opiates, risperidone, ethanol, propanolol, estrogens, spironolactone, finasteride and hydrochlorothiazide
Antidepressant drug: for major depression, may cause hypertensive crisis. May cause serotonin syndrome when taken with SSRIs
Phenelzine - MOAs inhibitor
Life threatening syndrome when SSRIs are taken with MAO inhibitor that may present with severe muscle rigidity, myoclonus, hyperthermia and seizures
Serotonin Syndrome
First line treatment for neurologic malignant syndrome
Diphenhydramine
Which opioid has the shortest half life?
Remifentanil - 3-4mins
Opioid with the longest half life
Buprenorphine - 4-8 hours
Opioid receptor: inhibition of respiration
Mu receptor with highest affinity for endorphins
Opioid receptor: for development of tolorance
Delta receptor with affinity for enkephalins
Opioid receptor: slowed gastrointestinal transit
Kappa receptor with affinity to dynorphins
Opioid drug: for severe pain and may decrease preload in MI
Morphine - strong agonist on mu receptor, non selective
Opioid drug: for severe pain and breakthrough cancer pain. May be given transdermally or via lollipop.
Fentanly
Most potent opioid
Olimefentanyl
Opioid drug: for moderate to severe pain. Opioid of choice for pain relief in pancreatitis
Meperidine - does not cause miosis and biliary spasm
Opioid drug: for moderate to severe pain. Currently investigated for treatment for leukemia
Methadone - full agonist
Opioid drug: for cough suppression and may cause serotonin syndrome
Dextromethorphan - decreases sensitivity of cough receptors
Opioid drug: for mild to moderate pain. Withdrawn because of fatal cardiotoxicity, commonly used in suicide
Propoxyphene
Opioid drug: strong agonist in kappa receptor, for alcohol dependence and balanced anesthesia
Nalbuphine
Opioid drug: for opioid overdose. Precipitates abstinence syndrome in patients with opioid dependence
Naloxone
Opioid drug: for moderate pain. Fibromyalgia and neuropathic pain. Lowers seizure threshold and contraindicated for patients with history of seizures
Tramadol
May present as pupillary constriction, comatose and respiratory depression
Opioid overdose
Treatment for opioid toxicities
Naloxone
Triad of opioid toxicities
Pupillary constriction
Comatose state
Respiratory depression
Refers to a state characterized by signs and symptoms, frequently the opposite of those caused by a drug, when it is withdrawn from chronic use or when the dose is abruptly lowered
Dependence
Refers to compulsive drug-using behaviour in which the person uses the drug for personal satisfaction, often in the face of known risks to health
Addiction
Condition that refers to decreased response to a drug, necessitating a larger doses to achieve the same effect
Tolerance
Signs and symptoms that occur on discontinuation or withdrawal of a drug in a dependent person
Abstinence syndrome - withdrawal symdrome
Drug that causes euphoria and self-confidence. Chronic use may result to psychotic state, development of necrotizing arteritis leading to cerebral hemorrhage and renal failure.
Amphetamines - metamphetamines, dextroamphetamines
Also known as Ecstacy
Methylene dioxymethamphetamine