Lecture 10 - Drug action in the CNS - Anxiolytics Flashcards

1
Q

What does it mean that they all treat mental disorders?

A

They all affect the central nervous system (CNS)

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2
Q

What does anxiety lead to?

A

Anticipatory FEAR response, which is often independent of external system

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3
Q

What constitutes the FEAR response?

A
  • Defensive behaviours
  • Autonomic reflexes
  • Alertness
  • Corticosteroid secretion - important in coordination of responses
  • negative emotions
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4
Q

Describe features of anxiety disorders

A
  • panic disorder, overwhelming fear with marked somatic symptoms
  • social anxiety disorder - struggle with human interaction
  • phobias
  • post traumatic stress disorder - reoccurring visions of traumatic events
  • obsessive compulsive disorder
  • generalised anxiety (no clear reason or focus)
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5
Q

Describe animal models of anxiety

A
  • elevated maze or cross - one side open - mouse placed inside and avoids the open side, as it is more dangerous
  • light/dark box - small rodents afraid of light - measure time in dark vs light - normal physiological action is to stay in dark (avoid predation_

These are called conflict tests

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6
Q

Describe the GABAa receptor

A
  • 5 subunits
  • multiple binding sites - not just GABA
  • GABAa receptors are targets for anxiolytics, hypnotics (& anti-convulsants, neurosteroids, some general anaesthetics)
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7
Q

Describe the breakdown of GABAa receptor subunits

A
  • 2 alpha subunits
  • 2 beta subunits
  • 1 other subunit (e.g. gamma)
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8
Q

Where does a benzodiazepine bind on GABAa receptors?

A

Elsewhere

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9
Q

What happen when an agonist binds to orthosteric site?

A

Activates the receptor

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10
Q

What happens when a molecule binds to an allosteric site?

A

It modifies response to agonist. Critical distinction - when agonist bound to allosteric site on receptor, on its own, in the absence of of agonist bound at orthosteric site, there is no response.

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11
Q

Describe properties of GABAa receptors

A
  • ionotropic receptors
  • made up of 5 subunits - influences pharmacology, location and function
  • mediate fast inhibitory transmission
  • post synaptic
  • chloride selective
  • activation leads to hyperpolarization and reduction in excitability
  • agonist at orthosteric site is muscimol, antagonist bicuculline, picrotocin
  • Agonist at ALLOSTERIC SITE - benzodiazepines such as Diazepam (positive allosteric modulator), antagonist at allosteric site is Flumazentil
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12
Q

What subunits can bind benzodiazepine?

A
  • alpha 1
  • alpha 2
  • alpha 3
  • alpha 5

only bind to neurons that have one of these subunits

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13
Q

Describe how animal models of anxiety has allowed identification of drug targets

A

In the a2 mutant mice, anxiolytic effects of diazepam are largely reduced, demonstrating the importance of a2 containing GABAa receptors in anxiety.

  • A single gene expressed in various parts of the brain, can be in control of a complete process, reducing fear
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14
Q

Explain how the physiological effects of Benzodiazepine agonists changes as concentrations increases

A
  • Sedation/anxiolytic
  • hypnosis
  • anterograde amnesia (can’t form new memories)
  • anti-convulsant
  • reduction of muscle tone (useful of surgery)
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15
Q

Describe how different subunit compositions cause different effects

A

Specific GABAaR subtypes responsible for mediating the diverse spectrum of BDZ pharmacological effects.
- e.g. the SEDATIVE actions are known to be mediated by A1-containing GABAaRs, whereas the ANXIOLYTIC actions are mediated by A2-containing GABAaRs.

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16
Q

What do a1-containing GABAaRs mediate?

A

Sedative actions

17
Q

What do a2-containing GABAaRs mediate?

A

Anxiolytic actions

18
Q

How are benzodiazepines are positive allosteric regulators of GABAa receptors?

A
  • increase activity of GABAa receptors
  • increase Cl- current across the membrane (but only in the presence of GABA)
  • Benzodiazepine AGONISTS selectively increase the size of GABAa responses
19
Q

What occurs when there benzodiazepine without the presence of an agonist at the orthosteric site?

A

Will not lead to a response

20
Q

Explain modulation of GABAa receptors by benzodiazepines vs barbiturates

A

Cells attached electrode, allows recording of single GABAa channel activity. Drugs can be added directly to the inside of the electrode.

  • Benzodiazepine agonists increase frequency of openings, whole barbiturates, another allosteric regulator, increases duration of openings
21
Q

What does Benzodiazepine do?

A
  • increase frequency of openings
22
Q

What do barbiturates do?

A
  • increase duration of openings
23
Q

What is phenobarbital used for

A

It isn’t prescribed as an anxiolytic, however it is used to put pets down by shutting down the CNS (central nervous system)

24
Q

What occurs to the orthosteric site when bound by drug vs agonist

A

Orthosteric site - bound by drug = closed
Orthosteric site - bound by agonist = open

25
Q

What do PAMs (Positive allosteric modulators) d0?

A

PAM stabilize the receptor in state with INCREASED AFFINITY FOR GABA, effectively causes leftward shift in concentration response curve

26
Q

What do NAMs (Negative allosteric modulators) do?

A

NAM stabilize the receptor in such a state that has reduced affinity for GABA and therefore effectively remains closed/harder to open

27
Q

Explain how drugs can act as negative allosteric regulators

A

Was seen to increase memory, however was also a pro-convulsant

28
Q

How does the pharmacokinetics of Benzodiazepines determine their therapeutic uses?

A
  • short acting compounds mainly used as sleeping tablets
  • intravenous diazepam used to treat status epilepticus
  • some benzodiazepines are metabolised to produce active intermediates with very long half-life (e.g. Diazepam)
  • 1 tablet of Diazepam can stay in body for 60 hours
29
Q

Describe the use of Zolpidem

A
  • Half life of 2 hours (can be used to treat insomnia)
30
Q

What are the adverse effects of Benzodiazepine agonists?

A

Tolerance - decreased responsiveness to a drug following continuous exposure
- may be overcome by increasing dose
- changed responsiveness of CNS with benzodiazepines, mechanism unknown
- metabolic tolerance common with barbiturates

Misuse
Physical dependence characterized by withdrawal
- increased anxiety, insomnia, CNS excitability, convulsions
- more problematic with drugs with short half-lives - e.g. triazolam may cause daytime anxiety when used to treat sleep disorders
- withdrawal may be alleviated by using slower acting drug

  • sleepiness, impaired psychomotor function, amnesia
  • additive effects with other CNS depressants - fatal in overdose (e.g. benzodiazepine + alcohol).
31
Q

Describe the drugs used to treat anxiety

A

Benzodiazepines - use is now limited
- acute anxiety
- co-administered with anti-depressants during stabilization period

Propranolol (beta-blocker)

Anti-depressants - SSRIs (selective serotonin reuptake inhibitors e.g. sertraline) useful for generalised anxiety, phobias, PTSD and OCD

Buspirone (5HT1A partial agonist) - generalised anxiety not phobias

Atypical antipsychotics - generalised anxiety & PTSD e.g. olanzapine

Anti-epileptic drugs - generalised anxiety e.g. pregabalin

32
Q

What are new developments for anxiolytics?

A

EpiVario - mixing psychotherapy & small molecule drugs

Stop long-term memory consolidation from occurring

33
Q

What are drugs used to treat insomnia?

A
  • drug choice depends on underlying cause and whether short-term or chronic (short acting benzodiazepines - e.g. lorazepam and Z-drugs e.g. zolpidem)
  • melatonin receptor agonists
  • orexin receptor antagonists
  • over the counter sleep aids - H1 receptor antagonists i.e. Anti-Histamines