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psychiatry > medicines in psychiatry > Flashcards

medicines in psychiatry Flashcards

1
Q

examples of use of (chemical/ actual) drugs- meds in psychiatry

A

drugs for depression, psychosis

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2
Q

example of electrical stimlation use in psychiatry

A

ECT electroconvulsive therapy for depression, neurostimulation for pain syndromes (parkinsons)

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3
Q

is there any case of structural rearrangement use in psychotherapy ?(surgery/ orthopaedics)

A

psychosurgery= deep brain stimlation for severe depression

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4
Q

ex. of talking psychotherapies

A

CBT, exposure for phobias- exposure of someone with a phobia to this phobia

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5
Q

what is the structure of gaba a and gaba b receptors?

A

differ in STRUCTURE
gaba-a: ligand gated ion channel
gaba -b: classic g- protein linked receptor

same function: both receptors for gaba which is inhibitory neurotransmitter

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6
Q

what different drugs act on gaba a vs gaba b?

A

gaba a: alchohol, benzodiazepines, and
gaba b: GHB (GAMMA HYDROHYBUTYRATE) and balcofen

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7
Q

What is a PAM and where do pams bind on gaba receptors?

A

positive allosteric modulator, means that on gaba receptors they wont bind where gaba binds, theyll bind on allosteric site and enhance the effects of the natural transmitter

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8
Q

examaple of GABA -A PAM

A

alprazolam (sleep promoting, muscle relaxing, muscle convulsant, anxiolytic)

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9
Q

where on receptors do agonists bind? for ex where on gaba rec.)

A

on the site of the natural agonist so where gaba would bind

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10
Q

example of gaba b agonist

A

baclofen- acts on site of gaba (decreases alchohol craving in alchohol dependant patients)

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11
Q

does balcofen have any indications in psych or other system?

A

this is more to appreciate the NbN (neuroscience based nomenclature) and that it basically presents indications across all systems if they are present ex bacofen indication of spasticity: neurological

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12
Q

what are the 4 targets of psych drugs

A

enzymes,
ion channels
neurotransmitter reuptake SITES
receptors

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13
Q

what is an issue with lenzyme target drugs?

A

theres lots of enzymes in liver and these drugs may also have effects on liver

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14
Q

what part of the neuron do most psych drugs work in?

A

synapse

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15
Q

what are autoreceptors?

A

receptors on pre synaptic neuron where neurotransmitters bind and limmit the release of further neurotransmitter

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16
Q

what happens to neurotransmitter in the synapse? how is it removed?

A

most of it reuptaken some of it broken down by enzymes in synapse

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17
Q

what is the breakdown enzyme inhibited for depression and anxiety and what neurotransmitters does it breakdown?

A

monoamine oxidase
MAOIs (inhibitors)
enzyme breaks down stuff like dopamine, serotonin, noradrenaline

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18
Q

what is the only proven therapy for dementia?

A

acetylcholinesterase inhibitors,
inhibit enzyme acetylcholinesterase which breaks down acetylcholine (substance needed to stay awake and remember things )

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19
Q

what is an enzyme inhibitor used for mood stability

A

lithium blocks glycogen synthase kinase (neurotransmitter that maintains neuronal functional stability)

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20
Q

which of the four drug target types are the most common?

A

receptro targeting medicines and specifically receptor antagonists

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21
Q

what receptor blocker is used for schizophrenia

A

dopamine receptor blocker

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22
Q

what receptor antagonist for depression

A

serotonin receptor type antagonist

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23
Q

what receptors are targeted in drugs for sleep

A

histamine receptor antagonists

or

benzodiazepines = GABA agonist

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24
Q

receptor agonist for ADHD example

A

guanfacine - noradrenaline agonist

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25
Q

explain a little bit difference between the meaning of agonists and antagonists vs inhibitory and exitatory neurotransmitters

A

Thing to consider: agonist antagonist vs inhibitory excitatory neurotransmitter - all aneurotransmitter are agonists: they stimulate aRECEPTOR, inhibitory means they inhibit CELL depolarization

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26
Q

reuptake site targetting meds for depression and anxiety or only depression

A

citalopram: enhances serotonin = serotonin reuptake nihibitor

desipramine: noradrenaline reuptake inhibitor enhances noradrenaline (only dp)

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27
Q

reuptake inhibitor for adhd

A

methylphenidate: dopamine reuptake inhibitor (DRI) - enhances dopamine

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28
Q

what is a drug that still increases the action of a neurotransmitter by increasing its conc in synapse but not by decr its reuptake by incr its release adn what is it used for?

A

adhd amfetamine

29
Q

what is 5HT

A

serotonin

30
Q

where do 5-HT neurons originate and then synapse

A

they originate in brainstem

they synapse in cortex, hypocampus or wherever…

31
Q

what structure is the target of SSRIs and what does SSRI stand for

A

selective serotonin reuptake inhibitor

target is serotonin transporter

32
Q

how many genes control serotonin post synaptic receptors and what does this mean for their variety

A

12 genes
very variable

33
Q

are most post synaptic serotonin receptors inhibitory or excitatory

A

most are excitatory

34
Q

is 5-HT 1A and 5-HT 2A inhibitory or excitatory

A

1A inhibitory and 2A excitatory

35
Q

what is basically the function of ion channel blockers?

A

block neuronal excitability

36
Q

what are 2 examples of sodium channel blockers

A

sodium valporate and carbamazepine both used for epilepsy and mood stabilisation

37
Q

what is an example of calcium channel blockers and use

A

gabapeptin and pregabalin used for epilepsy and anxiety (but even sleep and pain)

38
Q

what are the two major types of neurotransmitters and which are the main / most important in brain

A

fast acting - are the on off switch : memory movement vision

and

slow acting 5% of all neurons - add “colour, meaning” to brain functions:
emotions, drives, valence of memory

39
Q

which are the fast acting neurotransmitters and their proportions in brain

A

excitatory: glutamate : 80%
inhibitory : gaba: 15%

40
Q

what kind of neurons use glumamergic neurotransmission?

A

pyramidal cells

41
Q

what kind of neurons use gabaergic neurotransmission?

A

interneurons

42
Q

which are the slow acting neurotransmitters?

A

dopamine, serotonin, noradrenaline, acetylcholine
also endorphins and other peptides

43
Q

in what conditions do you see glutamate excess and what drugs treat it

A

alchoholism and epilepsy

treat with blockers
acamprosate and kematine
and
perampanel

44
Q

condition associated with decr in gaba and drug

A

anxiety- gaba enhancer- benzodiazepines

45
Q

disorders with decr in 5-ht and drugs

A

depression and anxiety - SRIs and MAOIs - serotonin enhancers

46
Q

disorders with excess dopamine

A

psychosis,
dopamine receptor blockers

47
Q

excess noradrenaline impact and drug

A

nightmares - prazosin - blocker

48
Q

acetylcholine deficiency disorder adn drug

A

impaired memory/ dementia, acetylcholine esterase enzyme blockers

49
Q

what system do most depression targeting drugs act on?

A

5HT systems (meaning, somehting serotonin related) - some do so exclusively and others include serotonin target along with other targets

50
Q

what is an examample of a drug with 2 neurotransmitter target systems

A

SNRIs serotonin noradrenaline reuptake inhibitors

51
Q

2 depression drugs that dont target 5-HT SYSTEM

A

NRI noradrenaline reuptake inhib
DRI dopamine reuptake inhib

52
Q

is melatonin agonist 5HT system related or not?

A

IT IS

53
Q

name 2 multimodal drugs (not drug types, DRUGS)

A

Vilazodone - USA- SSRI- 5-HT 1A agonist

vortioxetine -SSRI and multiple other 5- 5ht receptor effects

54
Q

what is the partial agonist version of heroin (ex of medicine opiod: methadone) ?

A

buprenophine

55
Q

partial agonist version of haloperidol

A

aripiprazole

56
Q

partial agonist version of nictoine and its use

A

varenicline (use for smokinf cessation)

57
Q

what is the difference(S) between partial agonists and full agonists

A

1) partial agonists have a lower maximum efficacy than full agonists

2) in states of really high nt concentration parital agonists can work as antagonists

58
Q

knowing the properties of partial agonists what is an advantage?

A

imporved safety especially in preventing overdose

59
Q

what are inverse agonists? what do they do compared to agonist and antagonist?

A

inverse agonists bind on receptors have the opposite effect to what the agonist would have had.

think of agonist: an effect
antagonist: blocks agonist form binding
reverse agonist: binds and stimulates receptor into a different action to that of agonist

60
Q

examples of inverse agonists

A

GABA a5IA : one of the action of a drug: allosteric smth gaba

is pro cognitive and used for dementias
: on some receptors has a positive effect (acts as gaba agonist) - increases attentiona nd memory

on other gaba receptors it actually has negative effects so it reverses gaba action (reverse agonist)- sobers you up bc it reverses the stimulating effect of alchohol on gaba

61
Q

how many proteins make up a gaba receptor and what does this mean for variety

A

5 dif proteins, there is hige variety Think about fact that even though some subtyoe receptors seem to be very small on pie chart, even they are stll more than dopamine receptors in brain

62
Q

what is the main site and the other sites of e receptor called? (one where natural agonist binds?)

A

orthosteric site and allosteric sites

63
Q

what is the action that leads to neuron inhibition uppon gaba binding to a receptor?

A

cl- conductance leading to neuron inhibition

64
Q

what type of receptor is gaba a and gaba ab

A

gaba a is ion channel linked gaba b is g protin linked

65
Q

what site do gaba benzodiazepines, alchohol, neurosteroids bind?

A

gaba: beta: orthosteric

allosteric:
benzo on gamma subunit
ethanol (alc) alpha subunit

66
Q

what type of drugs are haloperidol and clozapine and what are they used for?

A

dopamine receptor blockers for schitzophrenia

67
Q

compare haloperidol and clozapine

A

haloperidol is very selective, binds only on d2 receptor and only on eextra: alpha 1 receptor

vs
clozapine binds on so many receptors so has side effects such as weight gain, sedation, metabolic syndrome

68
Q

what are amitriptyline and citalopram used for? what type are they

A

56-HT reuptake blockers

69
Q

amitriptyline and citalopram

A

amitriptiline is tricyclic so has many binding sites both receptors and transporters so has many side effects especially from histamine and acetylcholine receptor blockage

citalopram is SELECTIVE serotonin reuptake inhibitor, means its selective ONLY FOR THAT, does not bind to NAYTHING else so has no side effects linked to other bindings, only related to too increased serotonin

psychiatry (6 decks)

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