Neuropharmacology and antipsychotics

Parkinsons disease

Disorder characterized by imbalance between dopamine and ACh causing dyskinesia

Parkinsons disease treatment

Levodopa, levodopa/carbidopa. selegiline, benztropine

Levodopa MOA

Dopamine precursor, used to increase dopamine production

Levodopa adverse effects

confusion, involuntary movements, GI distress, hypotension, and cardiac dysrhythmias

Levodopa/Carbidopa MOA

Increases the bioavailability of levodopa in CNS; inhibits conversion to dopamine and reduces CV response

Pramipexole MOA

dopamine agonist that activates receptors; also treats restless leg syndrome

Selegiline MOA

Selective inhibition of MOA-B; helps to preserve dopamine

Benztropine MOA

Restore balance between acetylcholine and dopamine by blocking muscarinic receptors (anticholinergic)

Alzheimers Disease

Neurodegenerative disease causing progressive memory loss; reduced cholinergic transmission

Alzheimers Disease treatment

Cholinesterase inhibitors: Donepezil

Gultamate regulators: memantine

Donepezil MOA

cholinesterase inhibitor prevents ACh breakdown, enhancing CNS neuron transmission

Donepezil adverse effects

Cholinergic effects- nausea, vomit, diarrhea, dizzy, headache

Memantine MOA

NMDA receptor antagonist to treat moderate to severe alzheimers

Memantine adverse effects

dizziness, headache, confusion, constipation

1st Gen Antipsychotics MOA

blocks dopamine, ACh, histamine and NE receptors; D-2 blockade in mesolimbic area

1st Gen Antipsychotic examples

Chlorpromazine (Thorazine) & Haloperidol (Haldol)

Acute dystonia

acute sustained contraction of muscles, usually of the head and neck

Acute dystonia treatment

Anticholinergic drug Benztropine (Cogentin) or diphenhydramine

Parkinsonism treatment

Treat with Anticholinergics (Benztropine, diphenhydramine) or Amantadine

Akathisia treatment

treat with anticholinergics, benzodiazepines, and beta blockers

NMS treatment

treat with Dantrolene

2nd Gen Antipsychotic examples

Clozapine (Clozaril)

Risperidone (Risperdal)

Quetiapine (Seroquel)

Clozapine moa

blocks dopamine and serotonin receptors

2nd Gen Antipsychotic

cause dopamine and serotonin blockade; fewer side effects (better tolerated)

1st gen antipsychotic adverse effects

EPS (akathisia, Acute dystonia, Tardive dyskinesia) Parkinsonism, NMS

Tardive Dyskinesia treatment

reduce dosage; swithc to 2nd gen antipsychotic

2nd gen antipsychotic adverse effects

agranulocytosis, weight gain, diabetes, dyslipidemia, seizures