Applied neuropharmacology Flashcards

1
Q

Sequence of events that occur during synaptic transmission (9)

A

1) Synthesis and packaging of neurotransmitter (usually) into vesicles in presynaptic terminals
2) Na+ action potential invades terminal
3) Activates voltage gated Ca2+-channels
4) Triggers Ca2+-dependent exocytosis of pre-packaged vesicles of transmitter
5) Transmitter diffuses across cleft and binds to ionotropic and/or metabotropic receptors to evoke postsynaptic response
6) Presynaptic autoreceptors inhibit further transmitter release (negative feedback)
7) Transmitter is (usually) inactivated by uptake into glia or neurones
8) Or transmitter is (unusually) inactivated by extracellular breakdown
9) Transmitter is metabolised within cells

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2
Q

What transmitter is the exception to the rule: transmitter is usually inactivated by uptake into glia or neurons

A

ACh because it is inactivated by extracellular breakdown (broken down by cholinesterase in the synaptic cleft)

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3
Q

Pharmacological manipulation to REDUCE synaptic transmission (7)

A
  1. Block the voltage gated Na+ channels – eg local anaesthetics, would block all action potentials, not too useful.
  2. Block the voltage gated Ca2+ channels – eg those clever spider toxins, would block all transmitter release, not too useful.
  3. Block the release machinery, eg botox, would block all transmitter release, not too useful.
  4. Block the postsynaptic receptors, eg receptor antagonists, competitive or non-competitive. Selectivity helps. Lots of examples of that.
  5. Activate those presynaptic inhibitory receptors. (the autoreceptors – to inhibit transmitter release by turning off Ca channels and stopping intracellular Ca release)
  6. Increase breakdown of transmitter
  7. Increase uptake of transmitter
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4
Q

Pharmacological manipulation to INCREASE synaptic transmission

A
  1. Increase synthesis by flooding the cells with the appropriate precursors to encourage neurotransmitter release
  2. Activate post-synaptic receptors with an agonist - though that is not so useful because they get activated all the time
  3. Better to use an allosteric drug that does activate the receptor on its own, but potentiates the effects of the endogenous transmitter, eg benzodiazepines and barbiturates on GABA receptors.
  4. Block breakdown of transmitter – e.g. anticholinesterases on ACh
  5. Block the uptake of transmitter
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5
Q

Name some neurotransmitters (6)

A
ACh
Monoamines - noradrenaline, dopamine
Amino acids - glutamate, GABA
Purins - ATP
Neuropeptides - endorphins
Nitric oxide
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6
Q

Dopamine is anatomically distributed in what 3 places

A

Brain stem
Basal ganglia
Limbic system & frontal cortex

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7
Q

Main function of dopamine

A

Voluntary movement

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8
Q

What pathways are dopamine involved in (4)

A

Mesocortical
Nigrostriatal
Tubero-infundibular
Mesolimbic

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9
Q

Parkinson’s is caused by

A

Degeneration of dopamine/dopamine deficiency in the substantial nigra of the basal ganglia

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10
Q

What enzyme converts tyrosine –> dihydroxyphenyalanine (DOPA)

What enzyme then converts DOPA –> dopamine

A

Tyrosine hydroxylase

Aromatic amino acid decarboxylase (AAAD)

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11
Q

Can dopamine made outside the brain cross the BBB

A

No

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12
Q

Can tyrosine and DOPA cross the BBB to enter the brain

A

Yes

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13
Q

How can dopamine synthesis be modulated in vivo

A

Can pharmacologically block AAAD outside the brain to allow more DOPA to cross BBB and enter brain

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14
Q

What type of receptors does dopamine act on

A

Metabotropic (g-protein coupled)

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15
Q

Dopamine is broken down in how many different 2 pathways + but both commonly involve which 2 enzymes

A

2

Monoamine-oxidase-B (MAO-B)
Catechol-O-methlytransferase (COMT)

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16
Q

Why are MAO-B and COMT inhibitors used in parkinson’s

A

To prevent dopamine from being broken down too fast

17
Q

List classes of drugs used in Parkinson’s (2)

A

Dopaminergic drugs

  • DA precursor
  • DA agonists

Enzyme inhibitors

  • peripheral AAAD inhibitors
  • MAOB inhibitors
  • COMT inhibitors
18
Q

Name types of enzyme inhibitors used in parkinson’s (3)

A
  • peripheral AAAD inhibitors
  • MAOB inhibitors
  • COMT inhibitors
19
Q

Name types of dopaminergic drugs (2) + examples of each type

A

DA precursor - levodopa + carbidopa

DA agonists

  • non-ergot - pramipexole, ropinirole
  • apomorphine
20
Q

Name the DA precursor

A

Levodopa + carbidopa

21
Q

Name some DA agonists (3)

A

Non-ergots

  • pramipexole
  • ropinirole

Apomorphine

22
Q

Name some peripheral AAAD inhibitors (must be given with levodopa to prevent levodopa being metabolised too fast) (2)

A

Carbidopa

Benserazide

23
Q

Name 2 MAOB inhibitors

A

Rasagiline

Selegiline

24
Q

Name a COMT inhibitor

A

Entacapone

25
Q

Effects of dopaminergic drugs (i.e. DA precursor and DA agonists)

  • improve what (3)
  • worsen/cause what (4)
A

Improve ‘TRA’ of ‘TRAP’

Causes:

  • nausea
  • vomiting
  • psychosis
  • dyskinesias
26
Q

Effects of dopamine antagonists (NOT USED FOR PARKINSON’S)

  • improve what (3)
  • worsen/cause what (2)
A

Improve

  • nausea
  • vomiting
  • psychosis

Worsen/cause

  • parkinsonism
  • tardive dyskinesias - stiff jerking
27
Q

Although DA antagonists improve vomiting, they cause what

A

Parkinsonism

28
Q

Name the only DA antagonist that can be used in Parkinson’s because it doesn’t cross the BBB

A

Domperidone

29
Q

Function of domperidone (DA antagonist)

A

Anti-emetic