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shelf pharm > Parkinsons and antipsychotics > Flashcards

Parkinsons and antipsychotics Flashcards

1
Q

what is the goal of parkinsons treatment?

A

increase DA and decrease ACh

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2
Q

levadopa mechanism and use

A

central aspect of the treatment. prodrug converted to dopamine by aminoacid decarboxylase. usually administered with carbidopa.

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3
Q

SE of levadopa

A

dyskinesias, on-off effects, psychosis, hypotension, vomit

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4
Q

tolcapone and entacapone

A

inhibit COMT and enhance levodopa uptake.

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5
Q

SE of tolcapone and entacapone

A

hepatotoxic

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6
Q

selegiline mechanism and use

A

MAOb selective inhibitor initial treatment and adjunctive to levodopa.

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7
Q

what is a positive about selegiline

A

there is no tyramine interaction

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8
Q

SE of selegiline

A

dyskinesias, psychosis, insomnia

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9
Q

why does selegiline cause insomnia

A

because it is metabolized into an amphetamine

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10
Q

bromocriptine mechanism and use

A

dopamine receptor agonist used to treat hyperprolactinemia and acromegaly.

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11
Q

SE of bromocriptine

A

dyskinesia and psychosis

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12
Q

benztropine/trihexyphebnidyl/diphenhydramine mechanism

A

decrease the ACh function, they are antimuscarinic.

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13
Q

what are benztropine/trihexyphebnidyl/diphenhydramine good at? and bad at?

A

they decrease tremor and rigidity. but have little effect on bradykinesia.

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14
Q

SE benztropine/trihexyphebnidyl/diphenhydramine

A

atropine like

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15
Q

amantidine mechanism and use

A

antiviral that blocks muscarinic receptors and increases dopamine release.

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16
Q

SE of amantidine

A

atropine like and livedo reticularis (know this most of all)

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17
Q

what are the side effects of antipsychotic drug

A

dyskinesias or extrapyramidal symptoms. acute EPS, TD, dysphoria, endocrine dysfunction (temp regulation issues can cause neuroleptic malignant syndrome), prolactinemia and eating behaviors (weight gain)

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18
Q

what are acute EPS

A

pseudoparkinsonism, dystonia, akathisia (turns into TD)

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19
Q

how do we manage EPS

A

with antimuscarinics such as benztropine or diphenhydramine

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20
Q

chronic EPS does what

A

is tardive dyskinesia. often irreversible. due to the upregulation of the receptors from the blockade

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21
Q

what do we use to the neuroleptic malignant syndrome

A

dantrolene and bromocriptine

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22
Q

chorpromazine

A

typical antipsychotic, m block and alpha block.

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23
Q

SE of chorpromazine

A

EPS, sedation, corneal deposits

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24
Q

thioridizine

A

typical AS, strongest m block and alpha block. this gives it the unique ability to treat its own EPS symptoms giving it less EPS.

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25
Q

SE thioridizine

A

less EPS, sedation, torsades, retinal deposits, convulsions,

26
Q

fluphenazine

A

typical AS, little M block and alpha block.

27
Q

SE of fluphenazine

A

lots of EPS and little sedation

28
Q

haliperidol

A

typical AS, little M block and alpha block.

29
Q

SE of Haliperidol

A

lots of EPS, little sedation. likely TD and malignant hypertermia

30
Q

clozapine

A

atypical with M block and alpha block. blocks D2c and 5HT2 receptors. there is NO reported TD with this drug

31
Q

SE of clozapine

A

EPS unlikely, sedation is less. increased salivation (serotonin), seizures and weight gain. agranulocytosis need weekly blood tests.

32
Q

what are the three most associated symptoms with antimuscarinics

A

convulsions, coma, cardiotoxic

33
Q

olanzapine

A

less m block and alpha block. blocks 5HT2 receptors and improves negative symptoms.

34
Q

SE of olanzapine

A

less EPS. sedation.

35
Q

aripiprazole

A

partial agonist of the D2 receptor, blocks 5HT2 receptors. still blocks m and alpha

36
Q

SE of aripiprazole

A

EPS more likely but not terrible. sedation, but not certain.

37
Q

what is the goal of drugs to treat depression

A

increase NE and serotonin

38
Q

phenelzine and tranylcypromine

A

inhibition of MAOa and MAOb. used for atypical depression.

39
Q

what must you watch out for when treating with MAOai

A

no cheese, etc.

40
Q

interactions for phenelzine and tranylcypromine

A

increase in NE hypertensive crises increase in BP arrhythmia, excitation and hyperthermia. (drugs to watch for are releasers (tyramine, alpha-agonist, TCA, levodopa)) Serotonin symptoms-sweating, rigidity, myoclonus, hyperthermia, ANS instability, seizures (watch out for SSRIs, TCA, meperidine).

41
Q

amitriptyline/imipramine/clomipramine

A

these are tricyclic antidepressants. nonspecific blockade of 5HT and NE uptake. use in major depression, panic or phobic disorder, OCDs, neuropathic pain.

42
Q

SE of amitriptyline/imipramine/clomipramine

A

muscarinic and alpha blockade. (toxicity 3 C’s). torsades. QT prolongation

43
Q

what is a specific amitriptyline therapy

A

neuropathic pain. (same as carbamazepine)

44
Q

what is a specific treatment for imipramine

A

enuresis

45
Q

what is a specific therapy for clomipramine

A

OCD

46
Q

interactions for amitriptyline/imipramine/clomipramine

A

hypertensive crises with MAOi, serotonin syndrome with SSRI, MAOi, meperidine

47
Q

name some SSRIs

A

fluoxetine, parozetine, sertaline, citalopram, fluvoxamine

48
Q

mechanism of the SSRIs

A

blockade of the 5HT reuptake.

49
Q

use of the SSRIs

A

major depression, OCD, bulimia, anxiety disorders, premenstrual syndrome. for anxiety must give with benzo

50
Q

SE for the SSRIs

A

anxiety, agitation, bruxism, sexual dysfunction (anorgasmia), weight loss.

51
Q

what is a toxicity for the SSRIs

A

serotonin syndrome

52
Q

what are the drug interactions for the SSRIs

A

MAOi (serotonin syndrome), meperidine and TCAs.

53
Q

trazadone

A

sedative associated with cardiac arrhythmias, priapism.

54
Q

venlafaxine

A

nonselective reuptake blocker devoid of ANS SE.

55
Q

bupropion

A

dopamine reuptake inhibitor used in smoking sensation.

56
Q

mirtazapine

A

alpha 2 antagonist. weight gain -used in anorexia.

57
Q

varenicline

A

partial agonist of the nicotinic receptors. can cause depression.

58
Q

lithium

A

DOC for bipolar disorder. prevents recycling of PIP2 and drives down cAMP.

59
Q

SE of lithium

A

narrow therapeutic range, tremor, flu-like symptoms, bad seizures, hypothyroid/goiter, nephrogenic DI (drives down ADH).

60
Q

does lithium do anything to the developing fetus>

A

yes it is a teratogen. it causes the ebstein anomaly or tricuspid valve malformation

61
Q

risperidone

A

atypical AS. blocks 5HT2 receptors. improves negative symptoms

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