Antiparkinsonian Agents, Anticholinergic Agents

Question 1

Increases the risk of psychosis
Effective in the urgent treatment of Neuroleptic malignant syndrome (NMS)

Answer 1

bromocriptine (Parlodel)

Question 2

Used for: Dystonia, Parkinsonism, Akinesia, Akathisia

Answer 2

benztropine (Cogentin)

Question 3

Cogentin
1-2 mg BID
PO/IM/IV

Answer 3

benztropine

Question 4

__________ is responsible for:
S - salivation
L – lacrimation (tearing of the eyes)
U - urination
D - diarrhea
G – gastrointestinal motility
E - emesis

Answer 4

Acetylcholine

Question 5

is a chronic progressive, degenerative disorder of the CNS
Symptoms:
resting tremor
bradykinesia
rigidity
postural instability
Risk Factors:
Age
Genetics
Sex
Exposure to Toxins

Answer 5

Parkinsons disease

Question 6

Part of the Extrapyramidal Nervous System
Controls motor movement

Answer 6

Nigrostriatal pathway

Question 7

Dopamine in Nigrostriatal pathway:
Decrease in Dopamine
Results in: __________

Answer 7

Parkinson Disease and EPS

Question 8

Dopamine in Nigrostriatal pathway:
Chronic Blockage of D2 Receptors
Results in: __________

Answer 8

Hyperkinetic Movement Disorder (Tardive Dyskinesia)

Question 9

______ of d2 receptors or ____ dopamine levels – difficulty controlling voluntary and involuntary muscle movement

Answer 9

Loss; low

Question 10

___________ nervous system nerve fibres that are responsible brainstem to motor fibres of spinal cord (unconscious, reflexive or responsive control of musculature – muscle tone, balance, posture, locomotion)

Answer 10

Extrapyramidal

Question 11

There is a reciprocal relationship between __________ and _________

Answer 11

Dopamine; Acetylcholine

Question 12

Normal Functioning = Dopamine controls ____________ release

Answer 12

acetylcholine

Question 13

widening the blood vessels in the cardiovascular system allowing blood to flow more easily.

Answer 13

Vasodilator

Question 14

Blocking Dopamine (=decrease d2) causes an increase in ______
Increasing d2=decrease in Ach

Answer 14

ACh

Question 15

_____ – receptor sites found in NIGROSTRIATAL pathways, dicephalon, medulla
Also found in peripheral nervous system – (rest and digest – parasympathetic)

Answer 15

CNS

Question 16

________ receptor sites – found in parasympathetic nervous system

Answer 16

Cholinergic

Question 17

Increase in acetylcholine activity = increase in ___________ side effects (nigrostriatal pathway)

Answer 17

extrapyramidal

Question 18

_________ acetylcholine activity by reducing Dopamine increases the risk of EPS

Answer 18

Increasing

Question 19

_____ potency antipsychotics have a high risk of EPS because of potency of dopamine blocking – hence increase in acetylcholine release – lower risk of anticholinergic effects

Answer 19

High

Question 20

______ potency antipsychotics have a lower risk of EPS because potency of dopamine blocking is not as high and therefore not as much acetylcholine is released - but a much higher risk of _________ effects

Answer 20

Low; anticholinergic

Question 21

Increase dopamine activity in the brain
E.g. bromocriptine (Parlodel)

Answer 21

Dopamine Receptor Agonists

Question 22

Prevent the breakdown of brain dopamine by inhibiting the brain enzyme monoamine oxidase B

Answer 22

MAO-B Inhibitors

Question 23

Inhibit the action of acetylcholine in the brain and affect the parasympathetic nervous system.
E.g. benztropine (Cogentin)

Answer 23

Anticholinergic Drugs

Question 24

Both compete or inhibit histamine from binding at receptors
Anticholinergic antagonist (works on those receptors as well)

Answer 24

Antihistaminergic

Question 25

Competes to bind at adrenergic receptors and has an antagonist effect on certain serotonin receptors Also used to reduce symptoms of Tardive Dyskinesia E.g. Propranolol (Inderal)

Answer 25

ß Blocker

Question 26

Antiparkinsonian drugs: Absorption well absorbed in the _____

Answer 26

GI Tract

Question 27

Antiparkinsonian drugs: Distribution _______ distributed throughout the body

Answer 27

widely

Question 28

Antiparkinsonian drugs: Metabolism ______

Answer 28

liver

Question 29

Antiparkinsonian drugs: Excretion ______ & _______ cross the placenta and enter the breast milk

Answer 29

urine and bile

Question 30

Antiparkinsonian drugs _____ EPS but they can cause their own side effects

Answer 30

reduce

Question 31

Prophylactic prescription of antiparkinsonian drugs often occurs (________ PRN orders when antipsychotics are first prescribed)

Answer 31

Benztropine

Question 32

Rating scales (____) should be used to monitor clients side effects while on antipsychotic medication

Answer 32

AIMS

Question 33

Antipsychotics may cause emergency medical situations. These emergency medical situations will require immediate response and treatment.

Answer 33

Acute Emergency

Question 34

__________ (Oculogyric crisis, torticollis, opisthotonos) Tx: Benztropine or Diphenhydramine (PO/IM/IV)

Answer 34

Dystonic Reactions

Question 35

____________ Tx: Immediate discontinuation of antipsychotic Bromocriptine (PO)

Answer 35

Neuroleptic Malignant Syndrome

Question 36

Diphenhydramine (______) is often confused with dimenhydrinate (_______).

Answer 36

Benadryl; Gravol

Question 37

____________ Parkinson's Drugs side effects: Dry Mouth Blurred Vision Constipation Stomach Irritation (nausea, vomiting) Tachycardia Urinary Retention, Hesitancy Paralytic Ileus

Answer 37

Autonomic

Question 38

____________ Parkinson's Drugs side effects: Confusion Giddiness Listlessness Depression Visual Hallucinations (EMERGENCY)

Answer 38

Behavioral

Question 39

Congestive Heart Failure, Decreased libido & Raynaud’s Syndrome arrythmias

Answer 39

Propranolol

Question 40

________ also causes sedation

Answer 40

Diphenhydramine

Question 41

Orthostatic Hypotension, Livido Reticularis (vascular condition that causes purple mottling to the skin) & Abnormal Dreams

Answer 41

Amantadine

Question 42

_______ causes fewer anticholinergic effects but may cause euphoria and increased tremor

Answer 42

Biperiden

Question 43

______ Withdrawal Symptoms: Nausea, vomiting Dyskinesia Restlessness Sweating Anxiety Depression Diarrhea Dysphoria

Answer 43

Anticholinergic

Question 44

Anticholinergics need to be titrate down over ______ or _______. Clients who are being titrated down need to be constantly assessed for EPS

Answer 44

weeks; months

Question 45

impairment of voluntary movements

Answer 45

Dyskinesia

Question 46

state of unease or general dissatisfaction with life

Answer 46

Dysphoria

Question 47

There is a risk for anticholinergic agents to be misused. Some clients find the effects on mood, memory and perceptions pleasurable. Clients can feel greater sociability or euphoria on higher than normal doses. This can also cause toxicity (either by purposeful misuse or by the client being prescribed to many drugs with an anticholinergic effect).

Answer 47

Anticholinergic Crisis

Question 48

“Hot as a hare, blind as a bat, mad as a hatter, dry as a bone”

Answer 48

Anticholinergic Crisis

Question 49

Dilated pupils Increased thirst Urinary retention Paralytic ileus Unsteady gait Dry flushed skin Tachycardia Constipation Decreased appetite and intake

Answer 49

Anticholinergic Crisis

Question 50

___________ Inhibitors – Donepezil (Aricept), Galantamine, and Rivastigime - used to slow the symptom progression of Alzheimer's – combination will produce an antagonistic action

Answer 50

Cholinesterase

Question 51

Other ___________ – may cause additive anticholinergic effects and enhance adverse/toxic reactions

Answer 51

Anticholinergics

Question 52

_____________ ex Chlorpromazine When used with anticholinergic agents there is a risk of potentially fatal paralytic ileus and an increased risk of toxic psychoses.

Answer 52

Phenothiazines

Question 53

Drug of choice for children over the age of 6 and more that 9 kg

Answer 53

diphenhydramine