Psychopharmacology for Psychiatry

Question 1

What are the 4 main treatments in medicine?

Answer 1

• chemical
• electrical stimulation
• structural rearrangement
• talking therapies

Question 2

What is the advantage of classifying psychiatric drugs based on their chemical structure?

Answer 2

each drug has a unique structure, easy to allocate data.

Question 3

What is the disadvantage of classifying psychiatric drugs based on their chemical structure?

Answer 3

no use in clinical decision making

Question 4

What is the advantage of classifying psychiatric drugs based on the disease that they treat?

Answer 4

easy for doctors to choose drugs as they make diagnosises

Question 5

What is the disadvantages of classifying psychiatric drugs based on the disease that they treat?

Answer 5

• many psychiatric drugs are used in several disorders

- most disorders have multiple symptoms and may not all be treated with one drug

Question 6

What is classifying psychiatric drugs based on their pharmacology?

Answer 6

neuroscience based nomenclature

Question 7

What are the 4 different systems that drugs target?

Answer 7

• receptors
• neurotransmitter reuptake sites
• ion channels
• enzymes

Question 8

What are some examples of drugs that block enzyme activity?

Answer 8

• monoamine oxidase inhibitors
• acetylcholinesterase inhibitors
• lithium

Question 9

What does lithium block?

Answer 9

glycogen synthase kinase - for mood stability

Question 10

What are some examples of drugs that block receptors (antagonists)?

Answer 10

• dopamine receptors
• serotonin receptors
• histamine receptors

Question 11

What are monoamine oxidase inhibitors used to treat?

Answer 11

• anxiety

- depression

Question 12

What are acetylcholinesterase inhibitors used to treat?

Answer 12

• dementia

Question 13

What are dopamine receptor blockers used to treat?

Answer 13

schizophrenia

Question 14

What are serotonin receptor subtype antagonists used to treat?

Answer 14

depression

Question 15

What are histamine receptor antagonists used to treat?

Answer 15

sleep

Question 16

What are some examples of drug agonists?

Answer 16

• benzodiazepines

- guanfacine

Question 17

What do benzodiazepines do?

Answer 17

• enhance GABA

- help with sleep

Question 18

What does guanfacine do?

Answer 18

• enhance noradrenaline

- helps with ADHD

Question 19

What do reuptake site blockers do?

Answer 19

• block reuptake sites
• increase neurotransmitter concentration in the synapse
• enhance post-synaptic receptor activity

Question 20

What are some examples of reuptake blockers?

Answer 20

• citalopram
• desipramine
• methylphenidate

Question 21

What does citalopram do?

Answer 21

• enhances serotonin
• serotonin reuptake inhibitor (SRI)
• treats depression and anxiety

Question 22

What does desipramine do?

Answer 22

• noradrenaline reuptake inhibitor (NRI)
• enhances noradrenaline
• treats depression

Question 23

What does methylphenidate do?

Answer 23

• dopamine reuptake inhibitor (DRI)
• enhances dopamine
• treats ADHD

Question 24

Which drugs swap reuptake site direction to enhance release?

Answer 24

• amfetamine (for ADHD)

Question 25

What do drugs that target Ion Channels do?

Answer 25

block channels to reduce neuronal excitability

Question 26

What are some examples of drugs that block sodium channels?

Answer 26

- sodium valproate | - carbamazepine

Question 27

What do sodium valproate and carbamazepine treat?

Answer 27

epilepsy and mood stabilisation

Question 28

What are some examples of calcium channel blockers?

Answer 28

- gabapentin | - pregabalin

Question 29

What do gabapentin and pregabalin treat?

Answer 29

epilepsy anxiety

Question 30

How would you describe fast acting neurotransmitters?

Answer 30

on-off switch

Question 31

What is an example of an excitatory fast acting neurotransmitters?

Answer 31

Glutamate 80% of all neurons pyramidal cells

Question 32

What is an example of an inhibitory fast acting neurotransmitters?

Answer 32

GABA | 15% of interneurons

Question 33

What do fast-acting neurons tend to be involved in?

Answer 33

content: - memory - movement - vision

Question 34

How would you describe slow acting neurons?

Answer 34

modulators

Question 35

How common are slow-acting neurons?

Answer 35

5%

Question 36

What are some examples of slow acting neurotransmitters?

Answer 36

- dopamine - serotonin - noradrenaline - acetylcholine - endorphins

Question 37

What do fast-acting neurotransmitters tend to be involved in?

Answer 37

- emotions - drive - valence of memory

Question 38

What is epilepsy caused by?

Answer 38

excess glutamate

Question 39

What drug can be used to treat excess glutamate in epilepsy?

Answer 39

perampanel | glutamate blocker

Question 40

What is alcoholism caused by?

Answer 40

excess glutamate

Question 41

What drugs can be used to treat excess glutamate in alcoholism?

Answer 41

- acamprosate - ketamine (glutamate blockers)

Question 42

What is thought to cause anxiety?

Answer 42

GABA deficiency

Question 43

What drug can be used to treat a GABA deficiency?

Answer 43

benzodiazapine | GABA enhancer

Question 44

What is thought to be caused by a 5-HT deficiency?

Answer 44

depression | anxiety

Question 45

What can be used to treat a 5-HT deficiency?

Answer 45

SRIs MAOIs (serotonin enhancers)

Question 46

What is thought to be caused by excess dopamine?

Answer 46

psychosis

Question 47

What can be used to treat excess dopamine?

Answer 47

dopamine receptor blockers

Question 48

What can be caused by excess noradrenaline?

Answer 48

nightmares

Question 49

What can be used to treat excessive noradrenaline?

Answer 49

prazosin | blocker

Question 50

What is caused by a acetylcholine deficiency?

Answer 50

impaired memory/deficiency

Question 51

What is the treatment caused by a deficiency in acetylcholine?

Answer 51

acetylcholine esterase enzyme blockers

Question 52

What do most drugs for depression act on?

Answer 52

the 5-HT systems

Question 53

What is the difference between partial and full agonists?

Answer 53

partial agonists have a lower maximum efficiency than full agonists

Question 54

What are the advantages of using a partial agonist over a full agonist?

Answer 54

- improved safety (especially in overdose) | - in states of [high neurotransmitter] or excess agonist medicine can act as an antagonist

Question 55

What are inverse agonists?

Answer 55

drugs that have the the opposite effects to agonists.

Question 56

What is an orthosteric site?

Answer 56

the site that the desired substrate binds to

Question 57

What is an allosteric site?

Answer 57

a different binding site to teh substance, but on the same protein complex

Question 58

What happens when GABA binds to the GABA receptor?

Answer 58

- enhances Cl ion conductance - inhibits neurons - calms the brain

Question 59

What happens when benzodiazepines, barbituates, alcohol and neurosteroids bind to the allosteric point on the GABA receptor?

Answer 59

- enhances the action of GABA - sedation - sleep, reduced anxiety, anti-epilepsy

Question 60

What is the selectivity of haloperidol?

Answer 60

- highly selective for the dopamine receptor | - adverse effects are due to dopamine receptor block

Question 61

What is the selectivity of clozapine?

Answer 61

- non-selective - lots of adverse effects due to off-target effects (eg; sedation, weight gain, metabolic syndrome)

Question 62

What is the selectivity of amitriptyline?

Answer 62

low, also binds to histamine and acetylcholine receptors causing adverse effects

Question 63

What is the selectivity of citalopram?

Answer 63

- selective SSRI | - adverse effects are solely due to increased serotonin