Biochemistry



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Anti-parkinsons

-Benztropine

-Trihexyphenidil

-Decrease tremor and rigidity in PD

-Less effect on bradykinesia

-Decreased EPS dysfunction caused by DA antagonist

-Tremor

-Exacerbation of tardive dyskinesias

Anti-parkinsons

-Amantadine

-Weak actions possibly via M block

-Atropine like side effects and livedo reticularis (edema and skin mottling)



Antipsychotic


-Negative SS: amotivation, social withdrawal, flat affect, poverty of speech

-Positive SS: disorders, delusions, hallucinations, bizarre behavior

-Dopamine blockade may cause an increase in prolactin secretion

-Increased prolactin may cause amenorrhea and galactorrhea, gynecomastia

-Neuroleptic/malignant syndrome: muscle rigidity and hyperthermia associated with anti-muscarinic effects associated with older anti-psychotics. Dantroline or DA agonist may be useful for this disorder.

Antipsychotics

-Chlorpromazine

-Block D2 receptor, an older antipsychotic


-Antipsychotic

-Increased EPS dysfunction

-Ocular dysfunction

-Sedating

-Alpha blockade

-Lower seizure threshold

Antipsychotics

-Haloperidol

-High potency

-Inexpensive

-D2 blockade

-Antipsychotic

-Chemical restraint

-Major EPS side effects

-Less alpha and M block

-Tardive dyskinesia

Antipsychotics

-Clozapine

-Blocks D2 and 5HT receptors

-Newer antipsychotic

-Antispychotic

-No EP dysfunction or tardive dyskinesia

-Watch for agranulocytosis

-Requirement for weekly bloodtest

Antipsychotic

-Olanazapine

-Blocks 5HT2 receptors, improves negative symptoms

-Antispsychotic

-No tardive dyskinesia

-Improves negative symptoms, may cause alpha blockade

Antidepressants / MAO

-Phenelzine

-Tranulcypromine

-Inhibition of MAO type A and type B. Type B MAO metabolizes DA

-Theory is that via inhibition of metabolism, more catecholamines will be available in the brain

-Depression

-HTN crisis with tyramine, Neuptakeblockers, alpha agonists, and L dopa

-Hyperthermia, HTN, seizures with meperidine or dextromethorphan

-Serotonin sundrome

-Hypertension with wine and cheese consumption

Antidepressants/SSRI

-Prozac

-Zoloft

-5HT receptor antagonists. These drugs may also have a small amount of action at norepinepherine receptors. The first novel drugs for depression

-Depression

-Relatively safe

-Some may have p450 reactions

Antidepressant/Heterocyclic

-Buproprion (DA inhibitor)

-Nefazodone

-Trazodone

-Amoxapine and maprotiline block NE reuptake

-Nefazodone (Serzone) and trazodone block 5HT reuptake, but both drugs also act as antagonists at certain serotonin receptor subtypes

-Buproprion has minimal effects on NE or 5HT systems but may affect DA neurotransmission

-Depression

-Priapasm as a side effect of trazodone

Antipsychotic

-Lithium

-Cross blood brain barrier

-Inhibits dephosphorylation from IP to inositol

-Mood stabilizer

-Lithium may also cause decrease in camp

-May affect vasopressin receptors

Mood stabilization

Manic disorder


-Tremor, ataxia, choreoarthrosis

-Visual dysfunction, seizures, goiter

-Nephrogenic diabetes insipidus via uncoupling of vasopressin V2 receptors

-Neonatal toxicity

-Teratogenicity

Some drugs of abuse

-PCP: hallucinations and paranoia. Horizontal and vertical nystagmus. Seizures, amnesia. Symptomatic tx

-MDMA: ecstasy.. amphetamine like with strong 5HT pharmacologyand therefore hallucinogenic and generally neurotoxic.

ANTIMICROBIALS AND MECHANISM OF ACTION

1. Inhibition of bacterial cell wall synthesis: PCN, Ceph, Vanc


2. Inhibition of bacterial protein synth: aminoglycosides, CHPC, macrolides, TCN

3. Inhibition of nucleic synthesis: fluoroquinolones, rifampin

4. Inhibition of folic acid synthesis: SMX/TMP, pyrimethamne


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