Parkinsons and Psychiatric Drugs Flashcards by Joanna Rivera

What is the drug of choice for parkinsonism?

LEVODOPA - CARBIDOPA

MOA: Levodopa is a dopamine precursor and carbidoba inhibits peripheral metabolism of DOPA decarboxylase

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What is the phenomenon which manifests as alternating periods of improved mobility and akinesia, occurring over a few hours to days during treatment?

On-Off Phenomenon

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What is the partial agonist at dopamine D3 receptors used in treatment of parkinsons disease during off periods?

Apomorphine

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What is the phenomenon which manifests as deterioration of drug effect in between medication doses due to progressive destruction of nigostriatal neurons?

Wearing off phenomenon

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What is the drug that blocks L-dopa metabolism by inhibiting COMT in periphery which is used as the drug of choice for wearing off phenomenon?

Entacapone

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What is the difference between Entacapone and Tolcapone

Entacapone acts only on the periphery while Tolcapone acts both on the CNS and periphery

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What are the side effects of Levodopa-carbidopa?

Emesis, Dyskinesia (Choreoathetosis), Behavioral changes, on off phenomenon, wearing off phenomenon, postural hypotension

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What is the side effect of Apomorphine?

Severe nausea

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What is the drug given as premedication to avoid severe nausea when giving Apomorphine?

Trimethobenzamide (an anti-emetic)

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What is a partial agonist of D2 receptors used in the treatment of parkinsons? What are the side effects of giving this drug?

Bromocriptine

Side effects: Erythromelalgia (due to intermittent blockage of vessels) and pulmonary fibrosis

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What drugs is classified as a MAO Type B inhibitors which are used in the treatment of parkinsons?

Selegiline and Rasagiline

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What is an anti-parkinsonism drug which antagonizes the effects of adenosine at adenosine A2 receptors which is also used in the treatment of influenza? Side effect?

Amantadine

Side Effect: Livedo reticularis and peripheral edema

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What drugs can cause livedo reticularis

Amantadine
Hydroxyurea
Minocycline
Gemcitabine
Quinidine

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What is a partial agonist of Dopamine D3 receptors used in the treatment of Parkinsons and Restless leg syndrome? What are its side effects?

Pramipexole

SE: compulsive gambling, hypersexuality, overeating, uncontrollable tendency to fall asleep

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What is a typical antipsychotic which blocks D2 receptors» 5HT2 receptors which causes failure of ejaculation, postural hypertension, marked sedation, CORNEAL AND LENS DEPOSITS?

Chlorpromazine

Class: phenothiazine

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What is the only antipsychotic which has fatal overdose and has the strongest autonomic effects?

Thioridazine
Class: Phenothiazine
Similar Drugs: Fluphenazine, Perphenazine, Prochlorperazine, Trifluoroperazine

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What antipsychotic drug that can be used as an anti-emetic?

Prochlorperazine

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Which among the typical antipscyhotics which has the weakest autonomic effects and is least sedating?

Haloperidol
Droperidol
Class: Butyrophenone

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Which among the typical antipschotics which is used in the treatment of Huntington’s disease and Tourette’s syndrome?

Haloperidol

Droperidol

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What is the difference between atypical and typical antipsychotics?

Typical antipsychotics blocks D2 receptors&raquo_space; 5HT2 receptors
Atypical antipsychotics blocks 5HT2 receptors
&raquo_space; D2 receptors

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What are examples of atypical antipsychotic drugs?

Clozapine, olanzapine Quetiapine, Risperidone, Ziprasidone, Aripiprazole

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What is the only anti-psychotic drug that reduces the risk of suicide?

Clozapine

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What atypical antipsychotic drug that causes weight gain, hyperglycemia, hyperlipidemia, myocarditis, agranulocytosis, seizures, ileus and hypersalivation (sialorrhea)?

Clozapine

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Drugs that causes agranulocytosis

Clozapine
Colchicine
Co-trimoxazole
Aminopyrine
Phenylbutazone
PTU
Indomethacin
Tocainide

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What is the antipsychotic drug that causes hypnagogic hallucinations, sleep paralysis, cataracts and priapism?

Quetiapine

Aside from clozapine, give an antipsychotic drug that also causes weight gain, hypoglycemia and hyperlipidemia

Olanzapine

What is the only antipsychotic drug that is approved for schizophrenia in the youth?

Risperidone

What is the anti-psychotic drug that can cause postural hypertension and torsade de pointes?

Ziprasidone

What is the anti-psychotic drug that has no atropine-like effects, little or no tendency to cause hyperglycemia, hyperprolactinemia or weight gain and causes increased mortality in elderly patients with dementia-related psychosis

Ziprasidone

Which among the antipsychotic drugs is least sedating? It has also no atropine-like effects, little or no tendency to cause hyperglycemia, hyperprolactinemia and weight gain?

Aripiprazole

What is the drug of choice for bipolar disorder which acts by decreasing cAMP and inhibiting inositol-1-phosphatase?

Lithium

What congenital anomaly does Lithium cause?

Ebstein's anomaly

What are the other side effects of Lithium?

Thyroid enlargement, Nephrogenic diabetes insipidus, edema, acneiform skin eruptions, Leukocytosis and bradycardia.

What mood stabilizer is contraindicated in patients with sick sinus syndrome?

Lithium

What is the treatment for lithium toxicity? | Threshold for toxicity: 2 meqs

Hemodialysis

What are the symptoms of neuroleptic malignant syndrome?

Fever, encephalopathy, vitals unstable, elevated CPK, Rigidity

What is the treatment for neuroleptic malignant syndrome?

Dantrolene

What are examples of tricyclic antidepressants

``` Imipramine Clomipramine Despiramine Amitryptyline Nortryptilline ```

What are the signs of TCA overdose?

Coma, Convulsions, Cardiotoxicity

What is the treatment for TCA overdose?

Administration of bicarbonate (if QRS duration>100msec or a ventricular arrhythmia is present) - reverses cardiotoxicity

What is the drug of choice for depression?

``` Selective Serotonin Reuptake Inhibitors (SSRIs) Fluoxetine Escitalopram Paroxetine Sertraline Citalopram Fluvoxamine ```

What are the drugs that causes erectile dysfunction

``` SSRIs Opiates Risperidone Ethanol Propranolol Estrogens Spironolactone Finasteride Hydrochlorothiazide ```

Examples of Serotonin-Norepinephrine Reuptake Inhibitor

Venlafaxine Duloxetine Desvenlafaxine

What is the antidepressant drug used in the treatment of fibromyalgia

Venlafaxine

What is the side effect of venlafaxine? Duloxetine?

Venlafaxine: Hypertension Duloxetine: hepatotoxicity

What are the SSRIs that are Cytochrome P450 inhibitors?

Fluoxetine | Fluvoxamine

What is the SNRI that is a cytochrome P450 inhibitor

Venlafaxine

Examples of antidepressants that block 5HT2 receptor?

Trazodone | Nefazodone

What are the side effects of serotonin antagonists?

Orthostatic hypotension Priapism (Trazodone) Hepatotoxicity (Nefazodone)

Drugs that cause priapism

``` Trazodone Papaverine Sildenafil Quetiapine Warfarin Bupropion ```

What drug is a heterocyclic antidepressant which is a strong norepinephrine reuptake inhibitor and weak serotonin reuptake inhibitor and blocks dopamine D2 receptors?

Amoxapine

What are the side effects of Amoxapine?

``` Autonomic effects Akathisia Parkinsonism Amenorrhea-galactorrhea syndrome Seizures Cardiotoxicity ```

Which antidepressant which lowers seizure threshold?

Amoxapine

Which antidepressant that increases amine release from nerve endings by antagonism of presynaptic alpha2 adrenoreceptors and blocks 5HT2 receptors

Mirtazapine

What are the side effects of Mirtazapine?

Weight gain and marked sedation

Which antidepressant that inhibits neuronal reuptake of dopamine and norepinephrine and increases dopamine and norepinephrine activity?

Bupropion

What is the side effect of Bupropion?

Lowers seizure threshold

What are the two antidepressants that lower the seizure threshold?

Bupropion and Amoxapine

What are examples of monoamine oxidase inhibitors that are used as antidepressants?

Phenelzine Selegiline Tranylcypromine

What happens when monoamine oxidase inhibitors are taken with cheese?

Hypertensive crisis | due to tyramine, an indirect-acting sympathomimetic present in cheese

What are the signs and symptoms of serotonin syndrome?

``` Fever Agitation Tremor Clonus Hyperreflexia Diaphoresis ```

What is the treatment for Serotonin syndrome

1st line treatment: Sedation, paralysis, intubation and ventilation Other treatment: Cooling, Cryproheptadine and Chlorpromazine

What are the symptoms of malignant hyperthermia

``` Fever Acidosis Rhabdomyolysis Trismus Clonus Hypertension ```

What is the treatment for malignant hypertension?

Dantrolene