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iTx ii > Neurotransmitters and receptors > Flashcards

Neurotransmitters and receptors Flashcards

1
Q

Adrenergic: Epinephrine (adrenaline) & Norepinephrine (NE or noradrenaline)

A

Receptors: Alpha 1 and 2, beta 1, 2, &3, G-protein-coupled receptors

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2
Q

Serotonergic: Serotonin (5-HT - 5-hydroxytryptamine)

A

Receptors: G protein-coupled receptors (5-HT1, 5-HT2, 5-HT4, 5-HT7) or ligand-gated ion channels (5-HT3)

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3
Q

Dopaminergic: Dopamine (DA) receptors

A

receptors: D1 to D5; & trace amine-associated receptor (TAAR)

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4
Q

GABAergic: Gamma aminobutyric acid (GABA)

A

inhibitory: GABA-a, GABA-b, GABA-c

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5
Q

Glutamatergic: Glutamate

A

Excitatory: (NMDA: N-methyl-D-aspartate receptor, AMPA, 1 kainate, and omega receptors)

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6
Q

Histamine receptors

A

receptors: H1 to H4

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7
Q

Acetylcholine (Ach)

A

Receptors: cholinergic receptors (mAChRs-Muscarinic (M1 to M5) and nAChRs-Nicotinic (N1 and N2))

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8
Q

D2 blockade

A
  • dopamine tracts: mesolimbic: reduction in positive sxs
  • Nigrostriata - EPS
  • tuberoinfundibulnar: elevation in prolactin
  • Mesocortical tract - exacerbate negative sxs
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9
Q

H1 blockade effects

A
  • sedation, drowsiness, appetite increase, wt gain, anti-emetic effect, anxiolytic effects
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10
Q

M1 blockade

A

Help with EPS; anticholinergic side effects (dry mouth, dry eyes, blurred vision, constipation, urinary retentions), sinus tachycardia, QRS changes, confusion, worsening cognition, delirium

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11
Q

M3 blockade

A

Reduced insulin release, glucose intolerance, T2DM (beta cell failure)

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12
Q

a1 blockage

A

Postural hypotension, dizziness, reflex tachycardia, sedation

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13
Q

a2 blockade

A

presynaptic receptors enhances serotonergic and noradrenergic transmission; may improve cognitive deficits and have antidepressant activity

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14
Q

5-HT1A blockage

A

antagonism/partial agonism: hypothesized to be related to pro-cognitive, anxiolytic, and antidepressant effects

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15
Q

5-HT2A blockade

A

sedation, dopaminergic actions may stop extrapyramidal symptoms (EPS), improve negative, positive and mood symptoms

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16
Q

5-HT2C blockage

A

increased appetite and weight gain; hypothesized to be associated with pro-cognitive and antidepressant effects

17
Q

5-HT7 blockage

A

hypothesized to be associated with pro-cognitive, anxiolytic, and antidepressant effects

18
Q

Synthesis of Serotonin and Norepinephrine

A

5-HT is synthesized from amino acid tryptophan by the tryptophan hydroxylate (TPH). Aromatic L-amino acid decarboxylase converts 5-hydroxytryptophan to serotonin……
- rate limiting step enzymes are regulated by feedback inhibition via auto receptors located presynaptically (first step)

19
Q

What are the 5 areas on a synapse that can regulate serotonin and norepinephrine?

A
  1. tryptophan hydroxylase
  2. Sodium/5-HT reuptake transporter
  3. MAO degrades 5-HT to 5-hydroxyindole acetaldehyde
  4. 5-HT1b receptor (autoreceptor)
  5. VMAT
20
Q

MAO inhibitors

A
  • isocarboxazid (Marplan)
  • Phenelzine (Nardil)
  • Selegiline (Edepryl, Emsam)
  • Tranylcypromine (Parnate)
21
Q

MAOi MOA

A

block deamination of monoamines by inhibiting the functional flavin moiety of MAO; increase the 5-HT and NE available in cytoplasm of presynaptic neurons which leads to increased uptake and storage of 5-HT and NE in synaptic vesicles and leakage into the extracellular space

22
Q

drugs in MAOi class

A

-Hydraxines (Phenelzine) - irreversible MAOi
-Non-hydraxines (Tranylcypromine) - irreversible MAOi
- Isocarboxazid - reversible MAOi
- Selegiline (transdermal patch, less tyramine toxicity

23
Q

MAOi Adverse Effects

A
  • systemic tyramine toxicity from foods, wines, etc. leads to uncontrolled catecholamine release, can induce hypertensive crisis
24
Q

MAOi contraindications

A

concomitant use of: sympathomimetic drugs, other MAOis, L-DOPA, L-trypophan, phenylalanine, bupropion, excessive coffee, chocolate intake, high tyramine containing foods, heart failure, general anesthesia, local anesthesia with vasoconstrictors, liver disease

25
Q

MAOi: Dietary restrictions

A

Tyramine - cured meat, aged cheese, aged and fermented food and drink

26
Q

Tricyclic Antidepressant (TCA) MOA

A

-Desipramine - alpha1 adrenoceptors and desensitize alpha2 autoreceptors –> equilibration of NE system

27
Q

TCA moa, clinical application, AE, CI

A

MOA: inhibit reuptake of 5-HT and NE from synaptic cleft by blocking 5-HT and NE reuptake transporters, thereby enhancing postsynaptic responses
Clin. App: Depression second-line treatment
AE: heart block (abnormal heart rhythm), cardiac arrhythmia, ORTHOSTATIC HYPOTENSION
CI: concomitant use of MAOIs, cardiac conduction system defects, patients recovering from myocardial infarction

28
Q

Muscarinic Adverse Events

A
  • blurred vision
  • dry mouth
  • impaired memory
  • constipation
  • urinary retention
29
Q

Dopaminergic D2 AE

A
  • extrapyramidal movement disorders
  • prolactinemia
  • sexual dysfunction
30
Q

a1-adrenergic AE

A
  • postural hypotension
  • dizziness
  • reflex tachycardia
31
Q

Histaminergic H1 AE

A
  • sedation
  • drowsiness
  • weight gain
  • hypotension
32
Q

SSRI - Selective Serotonin Reuptake Inhibitors MOA

A

first line treatment for depression
MOA: selectively inhibit reuptake of serotonin and thereby increase synaptic serotonin levels; also cause increased 5-HT receptor activation and enhanced postsynaptic responses
– well absorbed orally; food intake may alter absorption of some SSRIs w/o affecting clinical efficacy

33
Q

SSRI drugs

A

Fluoxetine
Fluvoxamine
Paroxetine
Sertraline
Citalopram
Escitalopram

34
Q

SSRI clinical applications

A

depression, anxiety, OCD, PTSD, panic disorders, bulimia nervosa (<– Fluoxetine)

35
Q

SSRI AE, CI

A

AE: decreased effects and less toxicity in overdose compared to MAOIs and TCA; sexual dysfunction; GI distress; vasospasm; sweating; anxiety; somnolence; nausea; diarrhea; agitation
—–> Serotonin syndrome from concomitant use of MAOIs; hyperthermia, muscle rigidity, myoclonus, rapid fluctuation in mental status and vital signs. Can lead to mania in bipolar patients
CI: concomitant use of MAOI

36
Q

Serotonin-Norepinephrine Reuptake inhibitors (SNRI) drugs in class

A

Duloxetine
Venlafaxine
Desvenlafaxine
Milnacipran
Levomilnacipran (FETZIMA)-newer SNRI

37
Q

SNRI moa, clin. app., AE, CI

A

MOA: blocks 5-HT reuptake transporter and NE reuptake transporter in a concentration dependent manner
Clin. App.: depression, anxiety, panic disorder w/ or w/o agoraphobia, pain syndromes, fibromyalgia
AE: may exacerbate mania or depression in susceptible patients
CI: Concomitant use of monoamine oxidase inhibitors

38
Q

Norepinephrine and Dopamine Retake Inhibitor (NDRI) drugs

A

Buproprion - aminoketone antidepressant that is selective inhibitor of the norepinephrine and dopamine uptake

iTx ii (4 decks)

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