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Case 10 > Psychopharmacology 2 > Flashcards

Psychopharmacology 2 Flashcards

1
Q

What is chlorpromazine and what are its side effects?

A
  • Anti-psychotic
  • Parkinsonism - loss of dopaminergic neurons in substantia nigra
  • Bind to D1, D2
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2
Q

What are the indirect measures of dopamine?

A
  • Homovanillic acid = breakdown product of dopamine

- Dopamine receptor binding

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3
Q

What does 18F fluorodopa uptake represent and what is it metabolised by?

A
  • Uptake represents dopamine synthesis - increased 20% in schizophrenia
  • Metabolised by DOPA decarboxylase
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4
Q

What does excess dopamine in the mesolimbic pathway lead to?

A

Positive symptoms (delusions, hallucinations)

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5
Q

What does hypo-activity (under-active dopamine) in the mesocortical pathway lead to?

A
  • Positive/cognitive symptoms

- Alogia, anhedonia, apathy, amotivation, social withdrawal

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6
Q

What the MOA of LSD?

A
  • Serotonin agonist
  • Psychosis
  • Lower expression serotonin receptors
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7
Q

What do NMDA (glutamate) receptor antagonists produce?

A

Psychosis

e.g. Ketamine

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8
Q

What happens to levels of glutamate in schizophrenia?

A
  • Reduced levels in CSF

- Mainly in hippocampus/PFC

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9
Q

What is inhibitory interneuron dysfunction?

A
  • GABA release inhibits excitatory neurons
  • Excitatory neurons inhibit inhibitory neurons with glutamate
  • Balance in health
  • Loss of inhibition in schizophrenia
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10
Q

What is the MOA of most antipsychotics?

A

Dopamine antagonists

Clinical effect on mesolimbic pathway

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11
Q

What effect does dopamine have in the basal ganglia?

A
  • Dopamine promotes movement
  • ACh inhibits movement
  • Dopamine blockade = parkinsonism
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12
Q

What does procyclidine do?

A

Balances cholinergic + dopaminergic activity in basal ganglia

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13
Q

What does dopamine blockade in anterior pituitary lead do?

A
  • Disinhibition of prolactin release

- Side effects = gynaecomastia, galactorrhoea, sexual dysfunction

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14
Q

What affect do antipsychotics have on the myocardium?

A
  • Block repolarisation of K+ channel
  • Prolong QT interval
  • Increased risk sudden cardiac death
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15
Q

What affect do antipsychotics have on PSNS?

A

Tachycardia, dry mouth, urinary retention, constipation, disrupt cognitive function, balance, delirium

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16
Q

What affect do antipsychotics have on M3 receptors?

A
  • Weight gain

- Metabolic syndrome

17
Q

What is neuroleptic malignant syndrome (NMS)?

A
  • Muscle rigidity, decreased HCS, autonomic instability

Serotonin syndrome as above but hyperreflexia, dilated pupils, increased bowel sounds

18
Q

How is NMS treated?

A
  • Immediate withdrawal antipsychotics
  • Dantrolene (reduce muscle spasm)
  • Dopamine receptor agonist (Bromocriptine)
  • ICU
19
Q

What effects do recreational drugs have on dopamine?

A
  • Increase in dopamine in nucleus accumbens
  • High levels of D3 receptors
  • Dopamine release in amygdala (part of memory system) during significant events
  • Mediates + reinforcement
20
Q

What are the psychopharmacological effects of alcohol?

A
  • Positive modulator @ GABA receptors

- Use of BD2 in withdrawal

21
Q

What are the psychopharmacological effects of opioids?

A
  • Mu receptor agonists - analgesia, euphoria, resp depression
  • Inhibits noradrenaline
  • Compensatory upregulation revealed on withdrawal - insomnia, restlessness, diarrhoea
22
Q

What are the psychopharmacological effects of cocaine?

A
  • Inhibits dopamine reuptake - Na channel blocker
  • Fast uptake
  • Reduce dopaminergic function on chronic use
23
Q

What are the psychopharmacological effects amphetamines?

A

Inhibits dopamine reuptake + stimulated dopamine release

24
Q

What are the psychopharmacological effects of cannabis?

A
  • Partial agonist on cannabinoid CB1 receptors (brain
  • Excitatory effects (increase cortical blood flow)
  • Depression of mesolimbic dopaminergic neurons
25
Q

What are the psychopharmacological effects of nicotine?

A
  • Increase mesolimbic dopamine levels

- Reduce MAO

Case 10 (8 decks)

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