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Pharm Block 3 > Neuropsychopharm > Flashcards

Neuropsychopharm Flashcards

1
Q

What neurons contain norepinephrine and where do they project to?

A

locus coeruleus

nearly every part of the CNS

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2
Q

What neurons contain serotonin and where do they project to?

A

two groups of raphae nuclei

most of the brain

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3
Q

What neurons contain dopamine and where do they project to?

A

substantia nigra, which project to the striatum

ventral segmental area of the midbrain, which project to the prefrontal cortex and parts of the limbic system

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4
Q

Dopamine pathways in the brain include

A

Nigrostriatal
Tubero-infundibular
Mesolimbic*
Mesocortical*

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5
Q

GABA Localization

A

– Substantia Nigra, Globus Pallidus, Hippocampus Libmic structure – Amygdala, Hypothalamus, Spinal Cord (?!?)

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6
Q

What are the types of Affective Disorders?

A

Major Depressive Disorder* (Unipolar, Bipolar)
Dysthymic Disorder
Mania

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7
Q

What are the two biochemical basis of affective disorders?

A
  1. Classical Biogenic Amine Theory – Depressoin is due to a deficiency of NE and/or 5-HT
  2. Current Status of Theory – Affective disorders are due to an imbalance in biogenic amine neurotransmitter systems
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8
Q

Mechanisms of action of antidepressants

A

almost all antidepressants affect the functioning of the brain biogenic amine (NE, DA, 5-HT) systems , but some show selectivity toward a particular amine

  1. Tricyclic Antidepressants*
    - Blockade of transmitter uptake - NE, 5-HT
    - Receptors and second messengers
  2. SSRI
  3. SNRI
  4. Atypical antidepressants
  5. Monoamine Oxidase Inhibitors
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9
Q

What is the most commonly used anti-depressants

A

SSRI*

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10
Q

Pharmacokinetics and metabolism of SSRI*

A
  • long and short half-life available

- Fluoxtine has a long half-life active metabolite

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11
Q

Common side effects of SSRI*

A
  • nausea and vommiting
  • insomnia
  • nervousness
  • sexual dysfunction
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12
Q

Which has the lowest acute toxicity? TCA, MAO inhibitors, or SSRI?

A

SSRI

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13
Q

SSRI discontinuation syndrome?

A
  • occurs within 1 to 7 days after stopping SSRI
  • more common with shorter acting drugs (sertaline, fluvoxamine)
  • dizziness, light-headedness, vertigo, anxiety, fatigue, headache, tremor, visual disturbances
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14
Q

Major clinical uses of SSRI*

A 
Major depressive disorder
OCD
Panic disorder
Social Phobia
PTSD
Generalized anxiety disorder
PMS
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15
Q

Available SSRI*

A

Fluoxetine*
- active metabolite with long half-life
Sertraline*
- Similar in action to fluoxetine with less effects on drug metabolism; shorter half-life

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16
Q

Mechanism of action for SNRI

A

block uptake of both serotonin and norepinephrine

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17
Q

Examples of SNRI

A

Duloxetine*

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18
Q

Which conditions are allowed with Duloxetine*

A

fibromyaliga, diabetic neuropathy, back pain, osteroarthritis pain

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19
Q

Which conditions should you be careful with Duloxtine*

A

Liver disease

20
Q

Half-life of Duloxetine

A

12-18 hours

21
Q

Examples of atypical antidepressants

A

Buproprion*

Mitrazapine*

22
Q

What is Buproprion* also approved for?

A

Nicotine withdrawal, seasonal disorder

23
Q

How does Buproprion* work?

A

blocking NE and DA uptake

24
Q

How does Mitrazapine* work

A

blocks presynatpic alpha2 receptors in brain

increases appetite

25
Q

Why are atypical antidepressants ““atypical?”

A

They don’t have the typical tricyclic structure or SSRI action
May or may not block catecholamine uptake

26
Q

Facts of Tricyclic antidepressants

A

Rapidly absorbed after parenteral or oral administration
Long plasma half-life: 8 to 100 hours
amitriptyline* is an example

27
Q

How are amitriptyline*

A

Used as a drug that is demethylated to active metabolites

28
Q

Side effects of tricyclic antidepressants (amitriptyline*)

A
  • elevation of mood in depressed patients after about 2 to 3 weeks
  • Decreases REM and in creases stage 4 sleep
  • Prominent anticholinergic effects
  • Sedation
  • Cardiac abnormalities
29
Q

Overdose of tricyclic antidepressants (amitriptyline*)

A

acute toxicity – hyperpyrexia, hyper or hypotnsion, seizure, coma, cardiac defects

30
Q

Drug interactions of tricyclic antidepressants (amitriptyline*)

A
  • Guanethidine - blocks guanethidine uptake
  • Sympathomimetic drugs - esp. indirect acting ones
  • Effects on adsorption and metabolism and other drugs
31
Q

Therapeutic uses of tricyclic antidepressants (amitriptyline*)

A
  • major depression (replaced by SSRI as primary treatment)
  • Enuresis in childhood
  • Chronic pain (by amitriptyline*)
  • OCD (by clomipramine*)
32
Q

Mechanism of action of monoamine oxidase inhibitors

A
  • Block the oxidative deamination of naturally occurring biogenic amines (NE, DA, 5-HT, and ingested amines)
33
Q

Where are monoamine oxidase found

A
  • mitochondrial fraction of neurons, liver, lung, and other organs
34
Q

What types of MAO are there?

A

MAO-A and MAO-B

35
Q

Which type of MAO does MAO inhibitors act on?

A

A

36
Q

What is an irreversible inhibitor of MAO?

A

Phenelzine*

37
Q

What are the pharmacological properties of MAO inhibitors?

A
  • antidepressant action takes about 2 weeks

- produces mood elevation in depressed patients; may progress to hypomania, especially in bipolar disease

38
Q

Symptoms of acute toxicity from MAO inhibitors

A

agitation, hallucination, hyperpyrexia, convulsions, changes in bp

39
Q

Therapeutic use of MAO inhibitors

A

Antidepressants, but not first choice

40
Q

What are some other treatments for depression?

A

Electroconvulsive shock therapy (ECT), Transcranial magnetic stimulation (TMS), Cortical and sub-cortical electrical stimulation

41
Q

What is Psychosis*

A

general term for major mental disorders characterized by derangement of the personality and loss of contact with reality as evidenced by delusions and hallucinations

42
Q

What are the potential causes of Psychosis*

A

Scizophrenia* (prototype), organic brain disorders, and drug-induced states

43
Q

What are the causes of schizophrenia*

A

Unknown. There is Dopamine hypothesis

44
Q

Mechanism of action for Antipsychotics*

A

all interact with dopamine systems

45
Q

What are the types of dopamine receptors?

A 
D1 Type (D1, D5) -- active adenylyl cyclase
D2 Type (D2, D3, D4) -- inhibit adenylyl cyclase
Autoreceptors

Pharm Block 3 (10 decks)

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