Chapter 13: Dopaminergics

Question 1

Name the atypical anti psychotics (8)

Answer 1

1. Clozapine
2. Quetiapine
3. Risperidone
4. Olanzapine
5. Ziprasidone
6. Aripiprazole
7. Paliperidone
8. Iloperidone

Question 2

Name the major typical anti psychotics

Answer 2

Haloperidol
Chlorpromazine
Fluphenazine
Trifluoperazine
Pimozide

Question 3

What typical anti psychotics can you use to treat Tourette’s?

Answer 3

Pimozide

Haloperidol

Question 4

Typical anti psychotics MOA?

Answer 4

Antagonize D2 receptors

Question 5

Major adverse effects of typical anti psychotics?

Answer 5

Neuroleptic malignant syndrome
Tardive dyskinesia
Anticholinergic sx (dry mouth, urinary retention, constipation)
Alpha antagonist sx (orthostatic hypotension)

Question 6

Which drugs can be given intramuscularly every 3-4 weeks for poorly compliant patients?

Answer 6

Haloperidol

Fluphenazine

Question 7

What is neuroleptic malignant syndrome?

Answer 7

Assc. with typical anti psychotics (less so with atypicals)

= catatonia, stupor, fever, autonomic instability, myoglobinemia, death

Question 8

____ potency typical antipsychotic drugs tend to have fewer sedative effects and cause less postural hypotension

Answer 8

HIGH potency

think that for high potency drugs you don’t have to give as much

Question 9

Typical anti psychotics potentiate the action of ______ and _______

Answer 9

benzodiazepines

centrally acting antihistamines

Question 10

Can you give typical anti psychotics to pts with Parkinson’s?

Answer 10

NO - will worsen symptoms

Question 11

Is haloperidol high or low potency?

Answer 11

High

Question 12

Which typical anti psychotic can be used to treat nausea and vomiting?

Answer 12

droperidol

Question 13

Which typical anti psychotic has more specific dopamine receptor antagonism (less effect on alpha receptors), and results in LESS sedation and hypotension?

Answer 13

Pimozide

Question 14

Which kind of anti psychotics treat only the positive symptoms of schizophrenia?

Answer 14

typical

Question 15

MOA of atypical anti psychotics?

Answer 15

Antagonists at D2 and 5-HT2 receptors

Clozapine and olanzapine also D4 antagonist

Question 16

Major side effects of risperidone?

Answer 16

Prolonged QT
Anticholinergic symptoms
Can cause high prolactin levels

Question 17

What atypical anti psychotic is considered 2nd line due to the risk of agranulocytosis?

Answer 17

Clozapine

Question 18

What is the MOA of clozapine?

Answer 18

antagonist at:
D1-D5
5-HT2
H1
Muscarinic receptors

Question 19

What drug can be used to treat acute agitation associated with bipolar disorder? What is its major adverse effect?

Answer 19

Olanzapine (also aripiprazole)

Weight gain - can adversely effect diabetes

Question 20

What anti psychotics do NOT have a risk of tardive dyskinesia?

Answer 20

Clozapine and quetiapine

Question 21

What atypical anti psychotic could potentially cause cataracts?

Answer 21

Quetiapine

Question 22

What is the MOA of levodopa? What must you give with it, and why?

Answer 22

dopamine precursor that can cross the BBB

co admin with carbidopa - carbidopa blocks AADC so that levodopa isn’t turned into levodopa before crossing BBB

Question 23

Major adverse effects of levodopa?

Answer 23

Dyskinesia within 5 years

Question 24

Do not use levodopa in patients with ______

Answer 24

narrow angle glaucoma, bc levodopa can increase intra-ocular pressure

Question 25

What is the on-off phenomena?

Answer 25

Continued use of levodopa results in tolerance and sensitization; periods of increased rigidity alternating with dyskinetic mov't

Question 26

Pramipexole and Ropinirole MOA?

Answer 26

Dopamine receptor agonists

Question 27

What is the first line treatment for initial Parkinson tx?

Answer 27

Dopamine receptor agonists Pramipexole Ropinirole

Question 28

What drugs can cause impaired impulse control? What is this called?

Answer 28

Dopamine receptor agonists - pramipexole and ropinirole Dopamine dysregulation syndrome

Question 29

What are the major adverse effects of pramipexole and ropinirole? Are these drugs ergot or non ergot?

Answer 29

``` somnolence (non ergots) dizziness hallucinations dream disorder dopamine dysregulation syndrome ```

Question 30

What drugs inhibit MAO-B and prevent dopamine breakdown? What is the clinical application?

Answer 30

Rasagiline Selegiline --> improve motor function in Parkinson's --> augment levodopa effectiveness

Question 31

Selegiline is broken down into _______ and thus can cause ______? What about rasagiline?

Answer 31

amphetamine insomnia and confusion (esp in elderly) Rasagiline does not break down into toxic metabolites

Question 32

Tolcapone and entacapone MOA?

Answer 32

inhibit COMT (thus prevents peripheral dopamine breakdown)

Question 33

Where are the effects, respectively, of tolcapone and entacapone in the body?

Answer 33

Both are COMT inhibitors, but tolcapone crosses BBB (lipid soluble) Entacapone works only peripherally

Question 34

COMT inhibitors can be used with what drug in order to increase the half life of levodopa?

Answer 34

Carbidopa

Question 35

Which dopaminergic drug can cause serious liver damage/should NOT be used in patient with liver disease/rare but fatal hepatotoxicity?

Answer 35

Tolcapone

Question 36

What is the MOA of amantadine? Clinical use?

Answer 36

NMDA antagonist | Influenza A, Parkinson's

Question 37

What drug can be used to treat levodopa-induced dyskinesias?

Answer 37

amantadine

Question 38

What drug is specifically good at treating Parkinson's TREMORS? What is the MOA?

Answer 38

Trihexyphenidyl Benztropine = musc receptor antagonists (when you get TRI (3) BENZ (cars) you begin to tremor)

Question 39

SE of trihexyphenidyl and benztropine?

Answer 39

angle closure glaucoma/increased intraocular pressure psychosis hyperpyrexia paralytic ileus

Question 40

Which is the more widely used COMT inhibitor?

Answer 40

Entacapone