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Psychiatry > Psychopharmacology > Flashcards

Psychopharmacology Flashcards

1
Q

Describe how neurotransmission works ?

A

-The presynaptic neuron synthesizes, transports and stores the neurotransmitter
-Synthesis takes place in cell body / soma which contains the essential protein synthesis machinery.
-From here axonal transport occurs, and the neurotransmitter reaches the synaptic terminal.
-Before its eventual release, the neurotransmitter is stored within the synaptic vesicle.
- The release takes place through the process of membrane fusion and exocytosis.

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2
Q

List 3 ways in which cessation of a neurotransmitter takes place.

A

1.Reuptake back to presynaptic neuron via special transporters (e.g. monoamine transporters)
2.Enzymatic breakdown at the cleft (e.g. via Catechol-O-methyltransferase/MAO-A enzyme)
3.Removed by glia or plasma circulation (e.g. glutamate shuttle)

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3
Q

What are the 2 types of glial cells and where are they found?

A

Glial cells –Schwann (CNS) and Oligondendrocytes (PNS)

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4
Q

What are the two ways of classifying neurotransmitters?

A

1.As either inhibitory and excitatory
2. As either monoamines, peptides and amino acids

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5
Q

Give 2 examples of inhibitory neurotransmitters?

A

1.Dopamine
2.GABA

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6
Q

Give 5 examples of excitatory neurotransmitters

A

1.Serotonin
2.Glutamate
3.Adrenaline
4.Noradrenaline
5.Dopamine

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7
Q

List 3 examples of amino acids?

A

-Glycine
-Glutamate
-GABA

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8
Q

List 6 examples of monoamine neurotransmitters ?

A

1.Serotonin
2.Dopamone
3.Noradrenaline
4.Adrenaline
5.Acetylcholine
6.Histamine

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9
Q

List 6 examples of peptides?

A

1.Ghrelin
2.Leptin
3.Neuropeptide Y
4.Neurotensin
5.Cholecystokinin
6.Endorphins

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10
Q

List the 4 Dopamine pathways together with their origin and destination?

A

1.Nigrostriatal pathway
Substantia Nigra to the striatum and amygdala via medial forebrain bundle.
2.Mesolimbic pathway
Ventral tegmental are to the Nucleus accumbens and hippocampus via medial forebrain bundle
3.Mesocortical Pathway
VTA - prefrontal regions and cingulate cortex via the medial forebrain bundle
4.Tuberoinfundibular pathway from hypothalamus to pituitary via portal vessels

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11
Q

What is the effect of dopamine blockade to the 4 dopamine pathways ?

A

Nigrostriatal pathway cause extrapyramidal side effects
Mesolimbic Pathway -Causes the desirable antipsychotic effect by controlling positive psychotic symptoms
Mesocortical pathway - DA blockade or low levels of dopamine will result in negative symptoms (neuroleptic induced deficit syndrome)
Tuberoinfundibular pathway- dopamine blockade will result in increase in prolactin levels.

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12
Q

List 5negative symptoms and describe them?

A

1.Alogia -reduced amount of spontaneous speech
2.Anhedonia -inability to experience pleasure from activities that were once enjoyable
3. Amotivation/Avolition-lack of motivation to engage in goal directed behavior thus making it difficult to initiate or complete tasks.
4.Asociality- lack of motivation to engage in social interactions
5.Affective flattening-reduced range of emotional expression or showing little emotion.

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13
Q

List 6 ways in which drugs increases or decrease the effect of the neurotransmitter?

A

1.Being a precursor for the neurotransmitter
2.Stopping production
3.Stopping storage
4.Increasing/reducing release
5.Mimicking/blocking at the receptor
6.Increasing/reducing reuptake or breakdown

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14
Q

What are the two types of antipsychotics?

A

1st generation-typical
2nd generation-atypical

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15
Q

What is the MOA of 1st generation antipsychotics?

A

They mainly block D2 receptors in the mesolimbic pathway
But also result in the blockade of adrenergic, histamine and muscarinic receptors.

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16
Q

Give 3 examples of 1st generation antipsychotics.

A

Haloperidol(High potency)
Fluphenazine
Chlorpromazine(Low potency)

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17
Q

List 4 extrapyramidal effects? And define them

A

1.Dystonia -sustained muscle contraction
2.Parkisonism
3.Akathisia - disorder characterized by the uncontrolled need to move./internal sense of restlessness characterized by pacing, taping
4.Tardive dyskinesia-repetitive uncontrolled movement of the lips, tongue, trunk and extremities

18
Q

What are the types of dystonia? Describe them?

A

Oculogyric crisis -involuntary upward deviation of both eyes due to spasms and increased tone in the extraocular muscles.
Torticollis -condition in which the neck muscles contract, causing the head to twist to one side.
Trismus-Locked jaw
Orthotonus- tetanic spasm characterized by rigid straightness of the body.

19
Q

What are the signs and symptoms of Parkinsonism (5) ?

A

Shuffling gait, resting tremors, dyskinesia, cogwheel rigidity, bradykinesia

20
Q

What is the treatment for each of the extrapyramidal symptoms?

A

1.Tardive Dyskinesia-Discontinue antipsychotic and +/- Clozapine
2. Parkinsonism and Dystonia -Anticholinergic
3.Akathisia- Beta blocker

21
Q

What are the antiadrenergic effects , antihistaminic effects and antimuscarinic of antipsychotics?

A

Antiadrenergic effects
Sedation
Postural hypotension
Inhibition of ejaculation

Antihistaminic effects
Sedation
Weight gain

Antimuscarinic effects
Anihidrosis
Blurry vision
Constipation
Urinary retention
Dry mouth and drowsiness

22
Q

What is the relationship between dopamine and Ach and how does this affect treatment?

A

-Dopamine and acetylcholine have a reciprocal relationship with each other in the nigrostriatal pathway

-Implication: high potency antipsychotics (haloperidol) have less anticholinergic effects but high EPSE while low potency antipsychotics (chlorpromazine) are more sedating but less EPSE

23
Q

What is the difference between 1st gen and 2nd gen antipsychotics?

A

-2nd gen antipsychotic block 5HT2A receptors thus increasing dopamine release and as a result reducing EPS
-2nd gen have a greater propensity for metabolic side effects

24
Q

What is resistant schizophrenia?

A

Trial of at least 2 different antipsychotics at their maximum effective doses for a period of at least 6 weeks of which one antipsychotic has to be a second generation antipsychotic.

25
Q

What is the treatment of choice for resistant schizophrenia and what is the drug’s side effect? What would you have to do to avoid this side effect?

A

Clozapine treatment of choice
1% develops agranulocytosis ( neutrophil count of <0.5)
Neutropenia (<1.5)
Close monitoring required

26
Q

What are the different classes of antidepressants? Which one of these is the 1st line treatment?

A

1.SSRI(1st treatment)
2.SNRI
3.Tricyclics
4.MAOI

26
Q

Give 3 examples of SSRIs and their MOA? How long do they take to see their full effect?

A

1.Citalopram, fluoxetine, sertraline.

2.Act to inhibit the re-absorption of serotonin

  1. 4-6 weeks
27
Q

What are the side effects of SSRIs? And when do they worsen.

A

-GI upset, GI bleeding, sexual dysfunction, suicidality
-Worsen in the 1st 2-3 weeks

28
Q

Give 2 examples of Serotonin and Noadrenaline reuptake inhibitors(SNRIs) and their MOAs?

A

1.Venlafaxine, duloxetine

2.Inhibit reabsorption of serotonin and nor-adrenaline

29
Q

What are the side effects of SNRIs?

A

-nausea
-GI upset
-weight gain
-sexual dysfunction
-hypertension

Require regular BP at higher doses

30
Q

Give 2 examples of TCAs and their MOA?

A
  1. Amitriptyline, Clomipramine

2.Serotonin, noradrenaline and some dopamine reuptake inhibition
Very effective – possibly better in older adults

31
Q

What are the side effects for TCAs?

A

dry mouth, blurred vision, constipation, urinary retention, weight gain, sexual function, postural hypotension, drowsiness

32
Q

What is the effect of overdosing on TCAs?

A

Prolonged QTc resulting in a high risk of arrythmias

33
Q

List one examples of a MAOI and state its MOA?

A

1.Phenelzine
2.Stops the breakdown of neurotransmitters (dopamine, noradrenaline, serotonin

34
Q

What are the side effects of MAOIs?

A

Insomnia
hepatoxicity
weight gain
postural hypotension
Hypertensive crisis risk

35
Q

Why should one avoid foods high in Tyramine? And what are these foods?

A

Because tyramine is metabolized by MAOs so their inhibition will result in increased levels of tyramine. Tyramine increases the levels of noradrenergic as it is taken up into synaptic nerve terminals where it acts as catecholamine releasing agent.
This will result in a hypertensive crisis and potentially a stroke.

Cheese, alcohol, non fresh fish/poultry, meat and yeast extracts, offal, avocado, broad bean pods…..

36
Q

In what cases are MAOIs used?

A

In very severe, treatment resistant cases.

37
Q

What are special considerations are made when prescribing antipsychotics?

A

1.HIV
Psychosis;2nd generations more tolerable than 1st generation
Depression; citalopram/ escitalopram
Mood stabilizers: avoid carbamazepine

2.Parkinson disease: hypersensitivity to antipsychotics

  1. 2nd generation: increase the risk of diabetes, hypertension
  2. aripiprazole safer option (augmentation)
38
Q

Explain the MOA of atypical antidepressants?

A
39
Q

Which antipsychotic cause hyperprolactinemia ?

A

Risperidone

Psychiatry (5 decks)

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