PDA III Exam 2 s/e and DI

L-dopa

Acute: N/v, hypotension, arrhythmias

^DA mediated, peripheral

Chronic: abnormal involuntary movement, nightmares, hallucinations

^central

Tolcapone

- acts in periphery and CNS

- hepatotoxic (requires liver function monitoring)

- given every 2-3 days

Entacapone

- acts in periphery

- given w/ each L-DOPA dose

Opicapone

- acts in periphery

- given w/ each L-DOPA dose

Selegiline

- no HTN crisis

- loses selectivity at high doses

- d/i: meperidine, TCAs, SSRIs, Tyramine

Amantadine

- L-DOPA ajunct

- not that useful

benztropine, trihexyphenidyl

anticholinergic; antagonists at muscarinic receptors

Chlorpromazine

- sedation

- orthostatic hypotension

- anti-SLUDGE

- some EPS

Thioridazine

- sedation

- orthostatic hypotension

- anti-SLUDGE

- some EPS, tardive dyskinesia

- some thermoregulatory effects

- some endocrine changes (hyperprolactinemia, reduced libido))

Fluphenazine

- EPS, tardive dyskinesia

- minimal sedation

- minimal ANS effects

- some thermoregulatory effects

- some endocrine changes (hyperprolactinemia, reduced libido))

Thiothixene

- EPS, tardive dyskinesia

- minimal sedation

- minimal ANS effects

- some thermoregulatory effects

- some endocrine changes (hyperprolactinemia, reduced libido))

Haloperidol

- EPS, tardive dyskinesia

- minimal sedation

- minimal ANS effects

- some thermoregulatory effects

- some endocrine changes (hyperprolactinemia, reduced libido))

Clozapine

- no prolactin secretion

- strong antimuscarinic action

- weight gain

- inc. blood sugar

- QTc prolongation

- dose related seizure risk

- sedation

- Serious: agranulocytosis

- minimal EPS/tardive dyskinesia

Risperidone

- insomnia, anxiety

- agitation

-EPS at moderate/high doses

- less weight gain than clozapine

- some/minimal anticholinergic effects, orthostatic hypotension

- inc. prolactin

- most typical of atypicals

- NO sedation

Olanzapine

- inc. weight

- diabetes mellitus (hyperglycemia)

- inc. cholesterol

- minimal EPS/tardive dyskinesia (effects seen at high doses)

Quetiapine

- not as efficacious on negative symptoms

- inc. weight (hyperglycemia)

- cataracts

- minimal EPS/tardive dyskinesia

Ziprasidone

- c/i: prolong Qt interval, MI, arrhythmias

- no effect on weight

- no effect on glucose

Aripiprazole

- minor s/e: headache, agitation, insomnia, anxiety

Brexpiprazole

- weight gain

- akathisia

cariprazine

- akathisia

- insomnia

- weight gain

COBENFY: xanomeline and trospium

x: SLUDGE (diarrhea rats)

t: prevent SLUDGE