Psychopharmacology Flashcards
types of treatments in medicine with psychiatric examples
Chemical – drugs e.g. drugs for psychosis/depression
Electrical stimulation e.g. ECT for depression, neurostimulation for pain syndromes
Structural rearrangement - surgery & orthopaedics e.g. psychosurgery/deep brain stimulation for severe depression
Talking therapies e.g CBT, exposure for phobias
list 3 ways to classify drug treatments
chemical structure
the disease they treat
pharmacology
pro of classifying drug by chemical structure
each drug has unique structure, easy to allocate data
con of classifying drug by chemical structure
no use in clinical decision making
what is the 1st drug for schizophrenia?
chloropromazine
what is the 2nd drug for schizophrenia?
haloperidol
pro of classifying drug based on illness they treat
easy for Drs to choose a drug as docs make diagnosis
cons of classifying drug based on illness they treat
many psychiatric medicines work in several disorders e.g. antidepressants also treat anxiety and OCD
most psychiatric disorders have multiple symptoms and a single medicine might not treat them all
what is neuroscience based nomenclature?
instead of antipsychotic > say dopamine blocker
instead of antidepressant > say serotonin enhancer
instead of hypnotic > say GABA enhancer
list drug targets types of psychiatric medications
receptors
neurotransmitter reuptake sites
ion channels
enzymes
in general, psychiatric medicine that targets enzymes have what effect?
blocks enzyme activity
list examples of psychiatric medication that target enzymes
monoamine oxidase inhibitors > anxiety and depression
acetylcholinesterase inhibitors > dementias
lithium blocks glycogen synthase kinase > mood stability
list examples of psychiatric medication that are receptor antagonists
dopamine receptor blockers > schizophrenia
serotonin receptor subtype antagonists > depression
histamine receptor antagonists > sleep
list examples of psychiatric medication that are receptor agonists
benzodiazepines enhance GABA > sleep
guanfacine enhance noradrenaline > ADHD
list examples of psychiatric medication that block neurotransmitter reuptake
citalopram > serotonin > depression and anxiety
desipramine > noradrenaline > depression
methylphenidate > dopamine > ADHD
list examples of psychiatric medication that enhance neurotransmitter release
amfetamine > ADHD
list examples of psychiatric medication that block sodium channels
sodium valproate- epilepsy and mood stabilisation
carbamazepine - epilepsy and mood stabilisation
list examples of psychiatric medication that block calcium channels
gabapentin & pregabalin – epilepsy + anxiety
fast acting (on/off switch) excitatory neurotransmitter
glutamate
fast acting (on/off switch) inhibitory neurotransmitter
GABA
slow acting (modulators) neurotransmitters
dopamine serotonin noradrenaline acetylcholine endorphins
why are partial agonists helpful?
improved safety, especially in overdose
in what conditions can partial agonists act as antagonists?
high neurotransmitter
excess agonist medicine
list examples of partial agonists
buprenorphine < heroin
aripiprazole < haloperidol
varenicline < nicotine
(partial agonist < agonist)
inverse agonists
Opposite effects to agonists
GABA – pro-cognitive - ? dementias
Histamine – increased attention – ADHD
examples of drugs that work at allosteric sites
benzodiazepines
barbiturates
alcohol
neurosteroids
compare selectivity (and adverse effects) of haloperidol and clozapine
haloperidol: very selective for dopamine receptor > adverse effects due to dopamine receptor block
clozapine: non-selective > lots of adverse effects due to off-target effects
e. g. sedation, weight gain, metabolic syndrome
compare selectivity (and adverse effects) of amitriptyline and citalopram
amitriptyline: “tricyclic” structure> adverse effects from histamine and acetylcholine receptor blockade
citalopram: SSRI > adverse effects driven solely by increased serotonin
