Exam 3 - Histamine, Serotonin, Dopamine Flashcards
What is autocoid transmission? What are some autocoids?
Endogenous chemicals that cause brief local effects like itching when in non-neural tissue: histamine, serotonin, prostaglandins, leukotrienes
What are the effects of histamine in the nervous system? What receptors are involved?
Stimulates pain and itching via H1 and H3 receptors
What are the effects of histamine in the cardiovascular system?
Decreases BP via vasodilation which causes reflexive tachycardia
What are the effects of histamine in the stomach, lungs and GI system?
Stomach - secretion of HCl
Lungs - bronchoconstriction
GI smooth muscle - contraction
Describe the effects seen in the Triple Response? What mediator causes this?
Also called “Wheal and Flare”
* Causes a wheal to form that increases in size with allergens the patient is sensitive to
* Also causes a flare, redness around the wheal, caused by capillary enodthelium inflammation-vasodilation.
* Sensory nerve endings are also activated leading to itchiness
* Histamine
What are serotonin’s effects in the nervous system?
- Precursor to melatonin
- Vomiting reflex mediated in the area postrema
- Pain and itch
- Chemoreceptor reflex = bradycardia and hypotension
- Large effect on mood and mood disorders
- Migraines
What is serotonin’s effects in the respiratory system?
- Facilitates ACh release leading to bronchoconstriction
What is serotonin’s effects in the cardiovascular system?
- Contraction of vascular smooth muscle (not heart or skeletal)
- Leads to platelet aggregation
Released initially during bleeding to constrict blood vessels while clotting cascade is starting.
What is serotonin’s effects in the GI system?
What is important to know about serotonin production here?
- Increaes tone
- Facilitates peristalsis
- In excess causes diarrhea
90% of serotonin in the body is in the enterochromaffin cells
How do H1 antagonists work? What is their indication?
- Antagonize H1 receptors in the smooth muscle, endothelium, and brain - resemble antimuscarincs
- Prevention and treatment of allergic response and motion sickness
What are the 1st generation H1 antagonists and their effects?
These all can cross the BBB and cause drowsiness and generate anti-cholinergic activity
What are the 2nd generation H1 antagonists and their effects?
Do not cross the BBB, have much less drowsiness associated with them
What are the major differences between 1st and 2nd generation H1 antagonists?
2nd generation do not cross the blood brain barrier and do not cause much drowsiness or produce anticholinergic effects.
What are the uses for H2 antagonists?
Compare them to PPIs?
What are 2 drugs in this class?
- Treatment for indigestion by inhibition of HCl secretion
- PPI’s are more effective like nexium and omeprazole
- Rantidine (Zantac) and famotidine (Pepcid)
What is the source for serotonin in the brain?
Raphe nuclei in the brainstem
What are the 3 main 5-HT agonist targets and the drugs that affect them?
5-HT1A – Buspirone
5-HT1D/1B - Sumatriptan
What are the 2 main 5-HT antagonsist targets and the drugs in this class?
5-HT2A – Phenoxybenzamine, Cyproheptadine
5-HT3 (only ion channel serotonin receptor)- Ondansetron
What are the 4 main treatments for a migraine and it’s affects?
- Pain relief: ASA, NSAIDS, caffeine, opiods
- Triptans - block 5HT1B/1D
- Ergotamine - alpha 1 agonist, less effective than triptans
- Anti-emetics - chlorpromazine, ondansetron
What are the 6 main preventatives for a migraine?
- Sympatholytics: BB, CCB, ACEi
- Antidepressants - SSRI, TCA
- Anti-seizures: valproate, topiramate
- Botox
- MAB’s - Aimovig, anti CGRP
- Glucocorticoids - prednisone
“BAM, GAS!”
What is the indication and MOA of sumatriptan?
- Treatment of migraine headaches
- 5-HT1B/1D agonist in cranial blood vessels that prevents dilation and stretching of pain endings
What are the 3 hyperthermia disorders?
What causes them?
What are the treatments?
Serotonin syndrome:
1. Caused by excess serotonin from a long list of drugs that increase amount of serotonin at the synapse
2. Treatment is sedation with benzos, paralysis, and intubation/ventilation
Neuroleptic malignant syndrome:
1. Caused by dopamine blocking antipsychotics
2. Treatment is IV benadryl
Malignant hyperthermia
1. Caused the RyR being open for a long time causing muscle rigidity (volatile anesthetics, succinylcholine)
2. Treatment is Dantrolene
What dopaminergic pathway leads to reinforcement and addiction?
The mesolimbic pathway
What are the differences between anxiety and depression? List some of the different types.
Depression is considered a low energy state, while anxiety is considered a high energy state.
Depression: dysthymia (long lasting depression). psychosis, postpartum, SAD, bipolar
Anxiety: Generalized anxiety disorder, OCD, PTSD, social phobia
List the 4 categories of antidepressant medications in order of treatment severity (low to high)?
- SSRI
- SNRI
- TCA
- MAOI