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🏠4. Psychiatric Disorders

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Question Bank

1
What are Dopaminergic Pathways?
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neural pathways in the brain that use dopamine as a neurotransmitter

2
What is the predominant catecholamine neurotransmitter in the CNS?
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Dopamine

3
dopamine synthesis
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phenylaniline → tyrosine → L-dopa → dopamine → noradrenaline → adrenaline

4
What are the enzymes that degrade dopamine?
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Monoamine oxidase (MAO) and catechol-o-methyl transferase (COMT)

5
How does dopamine cross the BBB?
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L-dopa crosses the BBB and is converted to dopamine in the brain

6
What are the main functions of D1-like dopamine receptors?
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▪ Regulate reward system, motor activity, memory, impulse control. ▪ Regulate renal function and renin secretion.

7
what are the main fucntiosn of D2 like receptors (2,3,4)
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locomotion, cognition, attention and sleep

8
what are the dopaminergic pathways
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• nigrostriatal pathway • mesocortico/mesolimbic pathway • tuberoinfundibular pathway

9
What is the function of the Nigrostriatal pathway?
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For coordination of voluntary movement

10
Function of the Mesocortico/mesolimbic pathway?
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regulate behavior and psychosis

11
function of the tuberoinfundibular pathway
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dopamine inhibits prolactin secretion from the anterior pituitary

12
What is the pharmacological effect of dopamine dose-dependent?
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Lower doses: stimulate the dopaminergic receptors higher doses: stimulate both dopaminergic and beta1-adrenergic receptors

13
What are the two types of dopamine action?
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Excitatory (D1-like receptors) Inhibitory (D2-like)

14
What is the pharmacological approach to treating Parkinson's disease?
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Increase brain dopamine levels and antagonize acetylcholine action.

15
What are the movement symptoms of Parkinson's disease?
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Resting tremor, rigidity, problems initiating movement, postural instability.

16
Which part of the brain is affected in Parkinson's disease?
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Degeneration of dopamine-producing neurons of the substantia nigra.

17
What are the classifications of anti-parkinson drugs
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1. Dopamine Precursor 2. Muscarinic Agent 3. COMT inhibitors 4. MAO inhibitors

18
Method of action for Dopamine precursors Levodopa-carbidopa
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• Levodopa → CNS → converted to dopamine • Carbidopa: inhibits metabolism of levodopa, ↑ availability

19
MOA: muscarinic antagonist benztropine
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blocks CNS muscarinic receptors from Ach → improve tremors

20
What is the mechanism of action of Entacapone?
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inhibit COMT → reduce metabolism of Ldopa

21
What is the mechanism of action of Selegiline?
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MAO-B inhibitor → decrease dopamine metabolism

22
What is the therapeutic goal of antipsychotic drugs in the treatment of schizophrenia?
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block dopamine and/or serotonin receptors

23
What is the dopamine hypothesis?
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attributes schizophrenia symptoms to the hyperactivity of central dopamine pathways

24
What are the two main categories of antipsychotics?
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First-generation antipsychotics and Second-generation antipsychotics

25
What are the typical side effects of first-generation antipsychotics?
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Higher incidence of extrapyramidal symptoms (EPS)

26
What are the typical side effects of second generation anti psychotics
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lower incidence of EPS but higher risks of metabolic side effects

27
First gen psych meds
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Chlorpromazine Fluphenazine Haloperidol

28
What is the mechanism of action of first-generation antipsychotics?
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Competitive blocker of D2 receptors in the mesolimbic pathway

29
second-generation antipsychotics?
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Clozapine Risperidone

30
What is the Extrapyramidal syndrome?
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A group of motor symptoms including Parkinson-like movements, muscle rigidity, and spasms of the neck and facial muscles.

31
What is tardive dyskinesia?
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irreversible motor disorder • involuntary facial jaw movements • sticking-out the tongue • lip smacking • uncontrollable movements in the arm, leg, and torso

32
What oral health issues might patients with schizophrenia face?
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Poor oral hygiene and self-harming behaviors such as tongue, lip, and/or cheek biting

33
What is the therapeutic goal of drugs for dementia disorders?
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mostly palliative to help with decreasing symptoms or stabilizing patient condition

34
Aims of drugs targeting Alzheimer's disease?
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• Increasing acetylcholine availability • blocking glutamate • decreasing amyloid plaques

35
Classifications of drugs targeting Alzheimer's disease?
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• Acetylcholine esterase Inhibitors • NMDA receptor Agonist • Amyloid beta antibody

36
Acetyl cholinesterase inhibitor drugs?
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Donepezil Rivastigmine

37
Acetylcholine esterase Inhibitors MOA
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inhibit acetylcholinesterase (enzyme responsible for ACh hydrolysis)

38
NDMA receptor agonist drug and MOA
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Memantine NMDA receptor antagonist → limit calcium influx → prevent excitotoxity

39
Amyloid beta antibody drug and MOA
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Aducanumab amyloid beta antibody → reduce amyloid beta plaques → delay AD progress

40
What is the primary characteristic of Amyotrophic Lateral Sclerosis (ALS)?
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Degeneration of motor neurons leading to the inability to control muscle movement.

41
Drug and MOA for ALS treatment
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Riluzole Inhibits glutamate release and inactivate sodium channels

42
What is the main storage location for serotonin?
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Enterochromaffin cells of the small intestine

43
What enzyme degrades serotonin?
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Monoamine oxidase (MAO)

44
How is serotonin transported to storage vesicles?
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Via vesicular monoamine transporter

45
What is 5-HT1-receptor coupled with? Controls?
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Gi coupled Mood regulation, anxiety, and pain perception.

46
What is 5-HT2-receptor coupled with? Controls?
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Gq coupled CNS and mediate hallucinogenic effects Platelet and lead to platelet aggregation

47
What is 5-HT3-receptors coupled with? Controls?
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sodium and potassium ion channels nausea and vomiting response and pain perception in PNS

48
What is 5-HT4-receptors coupled with? Controls?
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Gs coupled GI tract Increase in secretion & peristalsis

49
What are the pharmacological effects of serotonin in the CNS?
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mood, appetite, body temperature regulation, and sleep cycle vasoconstriction, inhibition of gastric secretion, GI motility and stimulation of smooth muscle contraction.

50
What is the monoamine hypothesis of depression?
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depression is caused by the lack of monoamine transmitters in the brain, particularly serotonin and norepinephrine

51
What role does dopamine deficiency play in depression?
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role in the lack of interest (anhedonia) symptom commonly seen in depression

52
What is the time frame for the clinical response to antidepressant drugs?
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Weeks

53
What is the Neuroplasticity Hypothesis?
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suggests lowered levels of brain-derived neurotrophic factor (BDNF) or dysfunction of its receptor, TrkB, plays a significant role in depression development

54
Classifications of Antidepressants
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• Tricyclic Antidepressants • Monoamine Oxidase Inhibitors • Selective Serotonin Reuptake Inhibitors • Serotonin-Norepinephrine Reuptake Inhibitors • Rapid Acting Antidepressants • Serotonin receptor antagonists • Dopamine-norepinephrine reuptake inhibitor • Over The Counter

55
Tricyclic Antidepressants (TCAs) Drugs
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Amitriptyline Clomipramine

56
TCA MOA
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Inhibit reuptake of norepinephrine & serotonin Blocks alpha-adre, hist, and musc receptors

57
Monoamine Oxidase Inhibitors Drug
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Phenelzine

58
MAOI MOA
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bind and inactivate MAO enzyme (nt. met) → increases the monoamine conc.

59
What is the 'tyramine pressor response'?
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A sudden increase in blood pressure and hypertensive crisis due to the accumulation of tyramine in the diet of individuals taking MAO inhibitors.

60
SSRI Drugs
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Fluoxetine Sertraline Citalopram Escitalopram

61
What is the mechanism of action (MOA) of SSRIs?
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SSRIs selectively inhibit the serotonin reuptake transporter (SERT) to increase serotonin concentration in the synaptic cleft.

62
What is serotonin syndrome and what are its symptoms?
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Accumulation of serotonin in the body fatal complications due to cardiovascular collapse

63
What are Serotonin-Norepinephrine Reuptake Inhibitors (SNRIs)?
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Venlafaxine Duloxetine

64
SNRI MOA
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selectively inhibit the reuptake transporters of serotonin and norepinephrine

65
Rapid Acting Antidepressant Drug and MOA
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Ketamine Glutamate release + block NMDA receptor → improves neuroplasticity + BDNF release

66
What are serotonin receptor antagonists and what are their effects?
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Trazodone block selective serotonin receptors receptors are upregulated in some depression patients

67
What is a dopamine-norepinephrine reuptake inhibitor and what is an example of one?
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Bupropion Increase dopamine and norepinephrine levels in the synaptic cleft

68
What is the active ingredient in St. John's Wort?
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Hyperforin

69
How does St. John's Wort interact with CYP 450 enzymes?
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It induces CYP 450 enzymes, specifically CYP3A4 and CYP2C9.

70
Treatments for Bipolar disorder
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Lithium Salts - Lithium carbonate Valporic acid Carbamazepine

71
What is the therapeutic index of lithium salts?
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Narrow therapeutic index (low safety margin)