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Retired NBME 23 Answers

nbme23/Block 1/Question#23 (reveal difficulty score)
A 35-year-old man comes to the physician ...
Anticholinergic agent ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ / ๐Ÿ“–
tags: neuro parkinsons

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 +8  upvote downvote
submitted by โˆ—mcl(671)
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To expand on this, what we think happens with Parkinson's disease (and parkinsonianism) is an imbalance between dopamine and acetylcholine. It makes more sense if you look at this diagram, paying particular attention to the indirect pathway. Loss of dopaminergic (DA) neurons from the substantia nigra (SNc) results in constant activation of those ACh secreting neurons, which ultimately results in inhibition of thalamus from initiating movements. Therefore, using anticholinergics help with parkinsonianism secondary to haldol.

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mcl  Also, you don't wanna use sinemet since that would be counterproductive +2
drzed  Whaaat? How could increasing levels of dopamine in a psychotic patient possibly be a bad thing? +1
fatboyslim  I'm not sure if you're being sarcastic or not haha but just in case: antipsyhcotics are used in psyhosis/psychotic patients because they decrease dopamine levels, which in turn decreases psychotic events. If the antipsychotic dose is too high, the patient will essentially have Parkinson-like symptoms because the dopamine release has been inhibited too much. They will get extrapyramidal symptoms which are 'ADAPT' (Acute Dystonia, Akathisia, Parkinsonism, Tardive dyskinesia). In these cases, we want to restore the dopamine/acetylcholine balance, and that's why we either wanna INCREASE dopamine (by giving Amantadine) or DECREASING acetylcholine's effects (by giving Benztropine or Diphenhydramine) :D +1



 +6  upvote downvote
submitted by โˆ—thomasalterman(181)
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Trihexphenidyl and Benztropine are antimuscarinics that can treat the resting tremor and rigidity of parkinsonism.

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mousie  haloperidol induced Parkinson's... ? adding a anticholinergic can counter these adverse effects of the antipsychotic .. ? +3
fulminant_life  @mousie yeah it balances the dopamine-cholinergic imbalance caused by the antipsychotics +
kai  +So antipsychotics induce Extrapyramidal side effects which is drug induced Parkinson = low Dopamine High Ach, and you would treat this with anticholinergic (Benztropine).This is neurologic. +Antipsychotics also produce non-neurologic, systemic anti-cholinergic effects like dry mouth, sedation, hypotension etc +
an1  UW asked this too, benztropine is the drug of choice +



 +1  upvote downvote
submitted by โˆ—abhishek021196(119)
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One of the tx strategies for drug induced Parkisonism or otherwise is to Curb excess cholinergic activity. Done by Benz-tropine, trihexyphenidyl (Antimuscarinic; improves tremor and rigidity but has little effect on bradykinesia in Parkinson disease). Park your Mercedes-Benz.

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