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B&B Week 7 Flashcards > Lecture 39: Principles of Psychopharmacology > Flashcards

Lecture 39: Principles of Psychopharmacology Flashcards

1
Q

What are the psychiatric drugs?

A
  1. Antipsychotic
  2. Antidepressant
  3. Mood stabilizer
  4. Benzodiazepines
  5. Anti-Dementia
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2
Q

What is psychopharamacology?

A

Study of drug-induced changes in BEHAVIOR and mood/sensation

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3
Q

What do all psychiatric medication share in properties?

A

Lipophilic
Can cross the blood brain barrier
Most were discovered b serenditpidty and their MOA is largely unknown!!

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4
Q

What is the monoamine hypothesis?

A

Theory that depression is a result of DEPLETION of monoamines, specifically serotonin, NE and dopamin

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5
Q

Where do serotonergic neurons originate from?

A

Raphe nuclei in midbrain

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6
Q

What are the psychiatric conditions related to serotonin?

A

Eating Disorders
OCD
Anxiety
Mood

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7
Q

Where do noradrenergic neurons originate from?

A

Locus coeruleus

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8
Q

What is NE’s primary function?

A

Alertness (which you would need when running away from a tiger)
NOT attention
Attention carried out by dopamine

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9
Q

What are psychiatric conditions related to NE?

A

Pain disorders
ADHD
Anxiety disorders
Mood disorders

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10
Q

Where do dopaminergic neurons origninate from?

A
  1. Ventral tegmental area
    • midbrain and cortical projection
  2. Substantia nigra
  3. Tuberoinfundibulum
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11
Q

What is dopamine’s primary function?

A

ATTENTION

Reward

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12
Q

What are psychiatric conditions related to dopamine?

A

Schizophrenia
ADHD
Mood disorders
Addictions

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13
Q

What behaviors does glutamate mediate?

A
  1. Seizures
  2. Psychosis
  3. learning and memory
  4. mood
  5. can cause cell death
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14
Q

What drugs block NMDA receptors?

A
  1. Ketamine
  2. Phencyclidine (PCP)
    - mimic schizophrenic symptoms
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15
Q

What psychiatric conditions are related to glutamate?

A
  1. Schizophrenia
  2. Alzheimer’s Disease
  3. Mood disorders
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16
Q

What are examples of drugs that bind GABA chloride channels?

A
  1. Benzos
  2. Barbiturates (anticonvulsants)
    Which makes sense because seizures are due to the excitatory/inhibitory balance being out of whack
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17
Q

What does GABA mediate?

A

Anxiety, memory, sleep and consciousness, seizures, muscle tone, pain

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18
Q

What psychiatric conditions are related?

A

Anxiety disorders
Insomnia
Alcohol withdrawal
Pain disorders

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19
Q

What is the significance of histamine?

A

Biogenic amine involved in appetite, weight and sleep

H1 receptors are altered by certain psychiatric medications and modulate hypothalamic neurons

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20
Q

What is the mechanism that all ANTIPSYCHOTICS share? Significance?

A

Antagonist of the D2 receptor
Antipsychotic = LESS dopamine
Led to dopamine hypothesis of schizophrenia (leading and most prominent)

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21
Q

What agents can increase dopamine and lead to psychosis?

A
  1. cocaine

2. amphetamines

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22
Q

What causes the negative symptoms of schizophrenia? What are negative symptoms?

A

Overabundance of dopamine Mesocortical pathway

Negative symptoms = social isolation, poor hygiene

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23
Q

What is the mesocortical pathway?

A

The pathway that connects the ventral tegmentum to the cerebral cortex, particularly the frontal lobe

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24
Q

What causes the positive symptoms of schizophrenia? What are the symptoms?

A

Overabundance of dopamine in the mesolimbic pathway
Positive symptoms
1. Delusions
2. Perceptual disturbances

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25
Q

What is the mesolimbic pathway?

A

The pathway that connects the ventral tegmentum to the nucleus accumbens, amygdala and hippocampus

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26
Q

What happens if you block dopamine transmission in nigrostriatum?

A

Dystonia
Movement disorders
Parkinson like disorders
Akathisia (syndrome characterized by unpleasant sensations of inner restlessness)
Tardrive dyskinesia (slow repetitive disorders)
Neuroleptic Malignant Syndrome (muscle rigidity, fever, delirium)

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27
Q

What happens if you block dopamine in the tuberoinfundibular pathway?

A

Prolactin effects
Galactorrhea
Gynecomastia

28
Q

What is the tuberoinfundibular pathway?

A

Arcuate nucleus in hypothalamus dopamine projections to the median eminence (of anterior pituitary gland)

29
Q

What is a neuroleptic?

A

A major tranquilizer

An antipsychotic

30
Q

What are the side effects of antipsychotics?

A
  1. Lower seizure threshold
    Seizes earlier
  2. Prolongs QTc prolongation
  3. used as TRANQUILIZERS
31
Q

What are the two types of antipsychotics?

A
  1. First generation
    Example: Haldol, chlorpromazine
  2. Second generation
    Example: Abilify
32
Q

What are the 2 classes of first generation antipsychotics?

A
  1. High Potency
  2. Low Potency
    How effective agent is at blocking D2 receptor
33
Q

What are the characteristics of the HIGH POTENCY first generation antipsychotics?

A 
Example: Haloperidol
Does not need high dose for same effect
Has LESS side effects of
	i. antihistamine effects
	ii. antiadrenergic effects
	iii. anticholinergic effects
34
Q

What are the characteristics of the LOW POTENCY first generation antipsychotics?

A 
Example: chlorpromazine
Needs higher dose for same effect
Has MORE side effects of
	i. antihistamine effects
	ii. antiadrenergic effects
	iii. anticholinergic effects
35
Q

What are the common side effects of antipsychotics?

A 
Antihistamine effect
	i. weight gain
	ii. sedation
Anticholinergic (muscarinic) effect
	i. delirium
	ii. blurry vision
	iii. Xerostomia (dry mouth)
	iv. constipation
	v. urinary retention
Antiadrenergic effect
	i. Orthostasis
	ii. Arrhythmias
36
Q

What are the characteristics of the second generation antipsychotics?

A 
Example: Clozapine, Risperidone, Abilify
Known as “atypicals”
Derivatives of Clozapine
MOST EFFECTIVE antipsychotic because they are BETTER TOLERATED
Has the following effects in addition to antipsychosis
	i. mood-stabilizing
	ii. antidepressant
	iii. anxiolytic effects
37
Q

What are the MOA of second generation?

A

D2 receptor AND blocking of 5-HT receptors

38
Q

What are the side effects of second generation of antipsychotic?

A
  1. Agranulocytosis (leukopenia, absence of white blood cells like neutrophils)
    1-2%
    -only in clozapine
  2. Weight gain
  3. Metabolic Syndrome (blood glucose dysregulation, lipid profiles)
    -unmask underlying symptoms?
39
Q

What is the rule of when you can stay on atypical antipsychotics?

A

If no metabolic syndrome in 6 months, then you are good

40
Q

What is metabolic syndrome?

A
  1. diabetes
  2. dyslipidemia
  3. weight gain
41
Q

What is Abilify? Significance?

A

An atypical antipsychotic
An “atypical amongst the atypicals”
Only antipsychotic that is also a partial dopamine AGONIST!

42
Q

What is clozapine (Clozaril)? Significance?

A

An atypical antipsychotic
Can lead to AGRANULOCYTOSIS
-prevents suicides

43
Q

What is the mechanism of action of antidepressants?

A

Increase monoamines such as 5-HT, NE and DA

44
Q

What is the locus of depressive symptoms?

A

5-HT1A

However, we can’t target this guy because we don’t know the serotonin profile of our patients

45
Q

If you have sexual dysfunction from one SSRI, does that mean that will happen for all SSRIs?

A

No, side effect from SSRI can be different

46
Q

What are the different classes of antidepressants?

A

A. MAOI
Example: Iproniazid, used as anti-tuberculosis medication
B. Tricyclic Antidepressants (TCA)
Example: Imipramine
C. Serotonin Reuptake Inhibitors (SRI or SSRI)
Example: Fluoxetine, prozac
D. Serotonin Norepinephrine Reuptake Inhibitors
Example:

47
Q

What is the Delineating factor for MAOI?

A

Food restrictions
Cant eat tyramine (derived from tyrosine)
Must have antihypertensive in pocket just in case

48
Q

What is the delineating factors of Tricyclic Antidepressants?

A

Fatal in overdoses
Arrhythmias, fatal cardiac events
-that’s why they are not first line

49
Q

What are delineating factors of Serotonin Reuptake Inhibitors (SRI aka SSRI)?

A

Safest and best tolerated

50
Q

What are delineating factors of Serotonin Norepinephrine Reuptake Inhibitors (SNRI)?

A

Used to treat Comorbid Pain syndrome

51
Q

Do antidepressants make patients suicidal? Significance?

A

No they are not
They just unmask already present depression
That means you need to constantly check up on patient after prescribing antidepressants REGULARLY

52
Q

What are mood stabilizers?

A

Primary treatments for bipolar affective disorder
No known MOA but it works
Example: Lithium + ANTICONVULSANTS, including Carbamazepine,valproic acid

53
Q

What is lithium known for?

A

Has both antidepressant and anti-suicidal properties

54
Q

What are two potential MOA of lithium?

A
  1. Enhance monaminergic function
  2. Inhibits the recycling of neuronal membrane phosphoinositides involved in generation of IP3 and DAG
    Inhibits recycling of IP3 and DAG
    Overall, stabilizes membrane potentials
  3. blockade of sodium channels
  4. hyperpolarization by enhancing K channel permeability
  5. may modulate VGCaChannels and GABA neurotransmission
55
Q

What are the side effects of lithium and mood stabilizers?

A
  1. Weight gain
  2. Acne
  3. Impaired cognition
  4. neural tube defects
    So it is not first line; use anti-epileptics first
56
Q

What are the two drugs to effectively reduce the rate of suicide?

A
  1. Lithium (mood stabilizer)

2. Clozapine (atypical antipsychotic)

57
Q

What are benzodiazepines?

A

Drugs used to treat symptoms of ALCOHOL withdrawal, anxiety and epilepsy
Sedates patients by binding to GABA_A chloride channel
Example: Librium
Leads to CNS depression, confusion, disinhibition
Most common sedatives used in psychiatry

58
Q

How are benzos metabolized? Significance?

A

Glucuronidation and oxidation by liver

-implications on which benzo you pick to treat alcohol withdrawal or patient with bad liver

59
Q

When you use a GABA drug, are you treating a symptom or underlying condition?

A

You are only treating the symptom

Benzodiazepines

60
Q

What is the MOA of benzo? Significance?

A

Act via the GABA_A receptor
Increase Cl- permeability
Example: Librium (Chlordiazepoxide)

61
Q

Remember this for benzodiazepines:

A

Not all benzodiazepines are created equal, some benzos pass through liver once and other twice
-benzos also have different speed of onsets and risks of abuse

62
Q

What are the three benzos that have the LEAST hepatic burden?

A

Lorazepam
Oxazepam
Temazepam

63
Q

Which benzo has the highest risk of abuse? Why?

A

Alprazolam, because of quick onset and SHORT duration

That means you’ll try to take more to get same effect

64
Q

Which benzo has lowest risk of abuse? Why?

A

Clonazepam

- long onset
- longer duration
- wont have to take as much to get same effect
65
Q

What are the 2 therapeutic strategies used to treat dementia?

A
  1. AchE inhibitors

2. NMDA receptor antagonist

B&B Week 7 Flashcards (16 decks)

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