Psychopharmacology for psychiatry

Question 1

Types of treatment

Answer 1

Chemicals - drugs/meds
electrical stimulation - ECT for depression
structural rearrangement - surgery/orthopaedics
talking (psycho) therapies - CBT

Question 2

What are three ways of classifying drugs?

Answer 2

Chemical Structure,
Illness Treated,
Pharmacology (what they do e.g. dopamine blocker)

Question 3

What is a pro and con of classifying by chemical structure?

Answer 3

Each drug can be uniquely classified // no use in clinical decision making

Question 4

What is a pro and 2 cons of classifying by illness treated?

Answer 4

Easy for doctors to choose // some medicines have multiple functions, some illnesses need multiple symptoms treated

Question 5

What are the two GABA receptors?

Answer 5

GABA A & GABA B

Question 6

What is an example of GABA-A agonist?

Answer 6

Alprazolam
treats GAD, anxiety and alcohol withdrawal
muscle relaxant, anticonvulsant, sleep promoting

Question 7

What is an example of GABA-B agonist?

Answer 7

Baclofen
treats spasticity
decreases alcohol craving

Question 8

What are the 4 target sites for psychiatry medications?

Answer 8

Receptors,
Neurotransmitter Reuptake Sites,
Ion Channels,
Enzymes

Question 9

What is the general action of enzyme targeting medications?

Answer 9

Block enzyme activities

Question 10

What are three examples of enzyme targeting medicines?

Answer 10

Monoamine Oxidase Inhibitors (anxiety)
Acetylcholinesterase inhibitors (dementia)
Lithium blocking glycogen synthase kinase (mood stability

Question 11

What are 3 examples of receptor antagonists?

Answer 11

Dopamine antagonist (schizophrenia),
serotonin antagonist (depression),
histamine antagonist (sleep)

Question 12

What are two examples of receptor agonists?

Answer 12

Benzodiazepines enhance GABA (sleep),
Guanfacine enhance Noradrenaline (ADHD)

mimic endogenous neurotransmitter to stimulate activity

Question 13

Action of reuptake site targeting medicines

Answer 13

Most block reuptake sites to increase NT conc in the synapse to enhance post-synaptic receptor action
Some switch reuptake site direction to enhance release

Question 14

What are three examples of Reuptake transporter blockers?

Answer 14

Citalopram (serotonin, depression),
Desipramine (noradrenaline, depression), Methylphenidate (dopamine, ADHD)

Question 15

What is an example of Reuptake transporter enhancer?

Answer 15

Amfetamine - ADHD

Question 16

What are 2 examples of sodium channel blockers?

Answer 16

Sodium Valproate - epilepsy // Carbamazepine - epilepsy

Question 17

What are 2 examples of calcium channel blockers?

Answer 17

Gabapentin and Pregabalin - epilepsy

Question 18

Fast acting NT - 95% of neurons

Answer 18

Excitatory - glutamate. 80% of neurons, pyramidal cells
Inhibitory - GABA. Inter-neurons

affect content e.g. memory, movement, vision

Question 19

Slow acting (modulators) - 5% of all neurons

Answer 19

dopamine/serotonin/NA/acetylcholine
endorphins and other peptides

controls emotions, drives etc

Question 20

For glutamate neurotransmitter system, is the change in neurotransmitter an excess or deficiency, and what disorder can it lead to?

Answer 20

Excess,
epilepsy, treated with Perampanel

alcoholism, treated with Acamprosate, Ketamine (blocker)

Question 21

For GABA neurotransmitter system, is the change in neurotransmitter an excess or deficiency, and what disorder can it lead to?

Answer 21

Deficiency,
anxiety, Benzodiazepines, GABA enhancer

Question 22

For 5-HT neurotransmitter system, is the change in neurotransmitter an excess or deficiency, and what disorder can it lead to?

Answer 22

Deficiency,
depression/anxiety
treated with SSRIs and NSSRIs, MAOIs, serotonin enhancers

Question 23

For dopamine neurotransmitter system, is the change in neurotransmitter an excess or deficiency, and what disorder can it lead to?

Answer 23

Excess,
psychosis, treated with Dopamine receptor blockers

Question 24

For noradrenaline neurotransmitter system, is the change in neurotransmitter an excess or deficiency, and what disorder can it lead to?

Answer 24

Excess,
nightmares, treated with Prazosin blockers

Question 25

For acetylcholine neurotransmitter system, is the change in neurotransmitter an excess or deficiency, and what disorder can it lead to?

Answer 25

Deficiency, amnesia/dementia treated with Acetylcholinesterase enzyme blockers

Question 26

How do partial agonists work?

Answer 26

Lower efficacy than full agonists, will only illicit response sometimes upon receptor binding

Question 27

What are the advantages of partial agonists?

Answer 27

Improved safety if overdose can act as antagonists in high neurotransmitter

Question 28

Which neurotransmitter system do most drugs act on?

Answer 28

5HT system

Question 29

Aripiprazole

Answer 29

Used instead of haloperidol Prevents total destruction of dopamine activity. THis prevents parkinsonian motor symptoms. dampened dopamine activity

Question 30

Inverse agonists

Answer 30

a drug that binds to the same receptor as an agonist but induces the opposite pharmacological response. Used on GABAergic neurons to create pro cognitive effects in dementia

Question 31

Receptor subtypes

Answer 31

5 proteins make up a receptor -> multiple different combinations different subtypes have different actions

Question 32

How does allosteric modulation work?

Answer 32

Drug binds to a different site of the protein to the neurotransmitter and can cause its effects - Benzodiazepines and enhancing GABA action

Question 33

GABA and allosteric modulation

Answer 33

GABA-A receptor is an ion-channel linked receptor GABA binds at the orthosteric site (target site), enhances Cl- conductance -> neuron inhibition and calm brain Benzodiazepines, alcohol, neurosteroids act on allosteric sites, enhance GABA action -> sedation, reduced anxiety etc

Question 34

Compare the selectivity and function of haloperidol and clozapine

Answer 34

Both dopamine receptor blockers for schizophrenia Haloperidol is very selective Clozapine is non-selective, causes systemic adverse effects like weight gain and sedation

Question 35

Compare the selectivity and function of amitriptyline and citalopram

Answer 35

Both 5-HT reuptake blockers for depression Citalopram is an SSRI (selective) Amitriptyline is non-selective, causes adverse effects from blocking histamine and ACh receptors