Parkinsonism, Antipsychotics, Antidepressants, Opioids, Drugs of Abuse Flashcards by Henry Revillo

Drugs causing Parkinsonism

Typical antipsychotics
Reserpine
MPTP ( methylphenyltetrahydropyridine)

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Primary drug for Parkinson’s, MOA?

Levodopa-Carbidopa

Levodopa is a dopamine precursor. Carbidopa inhibits peripheral metabolism via dopa decarboxylase

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On-off phenomena

Alternating periods of improved mobility and akinesia

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Wearing-off phenomena

Deterioration of drug effects in between medication doses

Due to progressive destruction of nigrostriatal neurons that occur with disease progression

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Partial agonist at dopamine D2 in brain

Bromocriptine

Pergolide

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Partial agonist at dopamine D3 receptors in brain

Pramipexole

Ropinirole

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Used in off periods, alcoholism, opiate addiction. MOA?

Apomorphine
Partial D3 agonist
Antagonist at 5-HT and alpha adrenoceptors
Premedicate with trimethobenzamide to prevent severe nausea

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MAO type B inhibitor

Decrease degradation of dopamine

Selegiline

Rasagiline

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COMT inhibitor

Prolongs response to levodopa

Entacapone

Tolcapone

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Antiparkinsonism and antiviral drug.

MOA?

Amantadine

Adenosine antagonist

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Anticholinergic antiparkinsonism drugs

Benztropine
Biperiden
Trihexyphenidyl
Orphenadrine
Blocks muscarinic receptors on cells in the striatum

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MOA of typical antipsychotics. Examples?

Block of D2 receptors&raquo_space; 5-HT2 receptors
Chlorpromazine
Thioridazine
Haloperidol

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Primary signs of Parkinsonism

Tremors 
Rigidity 
Akinesia
Postural instability 
TRAP!

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Locations of D2 receptors

Putamen, nucleus accumbens, cerebral cortex, hypothalamus

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Pleasure center

Nucleus accumbens

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Toxic effect of antipsychotics in endocrine system

Hyperprolactinemia- amenorrhea, galactorrhea, infertility, impotence

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Perioral tremor, manifests around 4 mos-4 years

Rabbit syndrome

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Used in rabbit syndrome

Benztropine

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Typical antipsychotic with increased risk of corneal and lens deposits

Chlorpromazine

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Typical antipsychotics with increased risk for retinal deposits

Thioridazine

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Only antipsychotic with fatal overdose

Thioridazine

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Used in schizophrenia, huntington’s disease, tourette’s syndrome.
Least sedating among typical antipsychotics

Haloperidol

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MOA of atypical antipsychotics

Block of 5-HT2 receptors&raquo_space;D2 receptors

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Only antipsychotic that reduces risk of suicide.

SE include agranulocytosis, hypersalivation, hyperglycemia, weight gain, ileus, seizures.

Clozapine

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Used in anorexia nervosa, depression, schizophrenia

Olanzapine

Atypical antipsychotic whose SE include priapism, somnolence, fatigue, sleep paralysis, hypnagogic hallucinations.

Quetiapine

Only antipsychotic approved for schizophrenia in the young

Risperidone

Antipsychotic whose SE include QT prolongation, Torsades, postural hypotension.

Ziprasidone

Least sedating among atypical antipsychotics. Used in autism, cocaine dependence, depression, schizophrenia and other psychotic disorders.

Aripiprazole

Atypical antipsychotics

``` Clozapine Olanzapine Quetiapine Risperidone Ziprasidone Aripiprazole ```

Features of neuroleptic malignant syndrome? | Drug that can cause it?

``` Haloperidol FEVER Fever Encephalopathy Vitals unstable Elevated CPK Rigidity ```

Treatment of bipolar disorder. Has slow onset of action.

Lithium

Teratogenic effect of lithium

Eibstein anomaly- low implanted tricuspid valve

Treatment for overdose of lithium

Hemodialysis

Threshold of toxicity of lithium

2 mEq/L

Amine hypothesis of mood

Brain amines, NE and serotonin, are neurotransmitters in pathways that function in the expression of mood

Classification of antidepressants

``` Tricyclic antidepressants Selective serotonin reuptake inhibitors Serotonin-norepinephrine reuptake inhibitors Serotonin receptor antagonists Heterocyclic antidepressants Monoamine oxidase inhibitors ```

TCAs. MOA?

Imipramine, amitriptyline | Block Norepinephrine and serotonin receptors

TD and LD of TCAs

7 and 15 mg/kg

Features of TCA toxicity

Coma Convulsions Cardiotoxicity

Used in TCA overdose

Bicarbonate

SSRIs

``` Fluoxetine Paroxetine Citalopram Escitalopram Sertraline Fluvoxamine ```

Halflife of SSRIs

1 week

Drugs that can cause erectile dysfunction

``` A SORE PEnis can't Fuck Hard! SSRIs Opiates Risperidone Ethanol Propanolol Estrogen Spironolactone Finasteride Hydrochlorothiazide ```

Serotonin syndrome

``` FAT CHD Fever Agitation Tremor Clonus Hypereflexia Diaphoresis ```

SNRIs

Venlafaxine Duloxetine Desvenlafaxine

Serotonin antagonist, can cause priapism

Trazodone

Drugs that can cause priapism

``` Trazodone Papaverine Sildenafil Quetiapine Alprostadil Warfarin Bupropion Tigas PeniS Co, AyaW Bumaba! ```

Can cause nightmares

mirtazapine (tetracyclic antidepressant)

Used in smoking cessation. MOA?

Bupropion | Inhibits neuronal reuptake of dopamine and NE.

Can cause hypertensive crisis when taken with tyramine.

Phenelzine. MAO type a and b inhibitor.

Tx for serotonin syndrome

Antiseizure drugs, muscle relaxants, serotonin blockers (cryptoheptadine)

Opioid with shortest halflife? Longest?

Remifentanil 3-4 mins | Buprenorphine 4-8 hours

Opioid receptor for inhibition of respiration

mu. Greater affinity for endorphins

Opioid receptor for development of tolerance

delta | Greater affinity for enkephalins

Opioid receptor for slowed gastrointestinal transit

Kappa | Greater affinity for dynorphins

Opioid side effects

``` ARMED Chinese Analgesia Respiratory depression Miosis Euphoria Drowsiness Constipation ```

Most potent opioid

Ohmefentanyl

Opioid that exerts hemodynamic effects on pulmonary circulation

Morphine

Full agonist opioids

Morphine Fentanyl Meperidine Methadone

Strong agonist at mu and kappa receptors. Used in labor analgesia

Meperidine

Used in opioid dependence and opioid withdrawal

Methadone

Opioids: Partial agonists

Hydrocodone Oxycodone Dextromethorphan Codeine

Opioid for cough suppression

Dexteomethorphan

Reduces craving in alcohol dependence

Nalbuphine | Naltrexone

Opioid antagonist

Naloxone Naltrexone Nalmefene

Opioid overdose triad

Pupillary constriction Comatose state Respiratory depression

Street name for methylene dioxymetamphetamine MDMA

Ecstasy

MDMA overdose presentation

``` Severe hypertension Hyperthermia Delirium Psychomotor agitation Profound hyponatremia ```

Cocaine overdose presentation

Mydriasis, vasoconstriction, thrombus formation, psychomotor agitation, severe hyperthermia, crack lung (hemorrhagic alveolitis)

Angel dust

Phencyclidine

Special K

Ketamine

Hallucinogenic agents

Lysergic acid diethylamide Mescaline Psilocybin

Partially purified cannabis sativa, more potent form

Hashish

Parkinsonism, Antipsychotics, Antidepressants, Opioids, Drugs of Abuse Flashcards

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