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Question 1
What are Dopaminergic Pathways?
neural pathways in the brain that use dopamine as a neurotransmitter
Question 2
What is the predominant catecholamine neurotransmitter in the CNS?
Dopamine
Question 3
dopamine synthesis
phenylaniline → tyrosine → L-dopa → dopamine → noradrenaline → adrenaline
Question 4
What are the enzymes that degrade dopamine?
Monoamine oxidase (MAO) and catechol-o-methyl transferase (COMT)
Question 5
How does dopamine cross the BBB?
L-dopa crosses the BBB and is converted to dopamine in the brain
Question 6
What are the main functions of D1-like dopamine receptors?
▪ Regulate reward system, motor activity, memory, impulse control. ▪ Regulate renal function and renin secretion.
Question 7
what are the main fucntiosn of D2 like receptors (2,3,4)
locomotion, cognition, attention and sleep
Question 8
what are the dopaminergic pathways
• nigrostriatal pathway • mesocortico/mesolimbic pathway • tuberoinfundibular pathway
Question 9
What is the function of the Nigrostriatal pathway?
For coordination of voluntary movement
Question 10
Function of the Mesocortico/mesolimbic pathway?
regulate behavior and psychosis
Question 11
function of the tuberoinfundibular pathway
dopamine inhibits prolactin secretion from the anterior pituitary
Question 12
What is the pharmacological effect of dopamine dose-dependent?
Lower doses: stimulate the dopaminergic receptors higher doses: stimulate both dopaminergic and beta1-adrenergic receptors
Question 13
What are the two types of dopamine action?
Excitatory (D1-like receptors) Inhibitory (D2-like)
Question 14
What is the pharmacological approach to treating Parkinson's disease?
Increase brain dopamine levels and antagonize acetylcholine action.
Question 15
What are the movement symptoms of Parkinson's disease?
Resting tremor, rigidity, problems initiating movement, postural instability.
Question 16
Which part of the brain is affected in Parkinson's disease?
Degeneration of dopamine-producing neurons of the substantia nigra.
Question 17
What are the classifications of anti-parkinson drugs
1. Dopamine Precursor 2. Muscarinic Agent 3. COMT inhibitors 4. MAO inhibitors
Question 18
Method of action for Dopamine precursors Levodopa-carbidopa
• Levodopa → CNS → converted to dopamine • Carbidopa: inhibits metabolism of levodopa, ↑ availability
Question 19
MOA: muscarinic antagonist benztropine
blocks CNS muscarinic receptors from Ach → improve tremors
Question 20
What is the mechanism of action of Entacapone?
inhibit COMT → reduce metabolism of Ldopa
Question 21
What is the mechanism of action of Selegiline?
MAO-B inhibitor → decrease dopamine metabolism
Question 22
What is the therapeutic goal of antipsychotic drugs in the treatment of schizophrenia?
block dopamine and/or serotonin receptors
Question 23
What is the dopamine hypothesis?
attributes schizophrenia symptoms to the hyperactivity of central dopamine pathways
Question 24
What are the two main categories of antipsychotics?
First-generation antipsychotics and Second-generation antipsychotics
Question 25
What are the typical side effects of first-generation antipsychotics?
Higher incidence of extrapyramidal symptoms (EPS)
Question 26
What are the typical side effects of second generation anti psychotics
lower incidence of EPS but higher risks of metabolic side effects
Question 27
First gen psych meds
Chlorpromazine Fluphenazine Haloperidol
Question 28
What is the mechanism of action of first-generation antipsychotics?
Competitive blocker of D2 receptors in the mesolimbic pathway
Question 29
second-generation antipsychotics?
Clozapine Risperidone
Question 30
What is the Extrapyramidal syndrome?
A group of motor symptoms including Parkinson-like movements, muscle rigidity, and spasms of the neck and facial muscles.
Question 31
What is tardive dyskinesia?
irreversible motor disorder • involuntary facial jaw movements • sticking-out the tongue • lip smacking • uncontrollable movements in the arm, leg, and torso
Question 32
What oral health issues might patients with schizophrenia face?
Poor oral hygiene and self-harming behaviors such as tongue, lip, and/or cheek biting
Question 33
What is the therapeutic goal of drugs for dementia disorders?
mostly palliative to help with decreasing symptoms or stabilizing patient condition
Question 34
Aims of drugs targeting Alzheimer's disease?
• Increasing acetylcholine availability • blocking glutamate • decreasing amyloid plaques
Question 35
Classifications of drugs targeting Alzheimer's disease?
• Acetylcholine esterase Inhibitors • NMDA receptor Agonist • Amyloid beta antibody
Question 36
Acetyl cholinesterase inhibitor drugs?
Donepezil Rivastigmine
Question 37
Acetylcholine esterase Inhibitors MOA
inhibit acetylcholinesterase (enzyme responsible for ACh hydrolysis)
Question 38
NDMA receptor agonist drug and MOA
Memantine
NMDA receptor antagonist → limit calcium influx → prevent excitotoxity
Question 39
Amyloid beta antibody drug and MOA
Aducanumab amyloid beta antibody → reduce amyloid beta plaques → delay AD progress
Question 40
What is the primary characteristic of Amyotrophic Lateral Sclerosis (ALS)?
Degeneration of motor neurons leading to the inability to control muscle movement.
Question 41
Drug and MOA for ALS treatment
Riluzole Inhibits glutamate release and inactivate sodium channels
Question 42
What is the main storage location for serotonin?
Enterochromaffin cells of the small intestine
Question 43
What enzyme degrades serotonin?
Monoamine oxidase (MAO)
Question 44
How is serotonin transported to storage vesicles?
Via vesicular monoamine transporter
Question 45
What is 5-HT1-receptor coupled with? Controls?
Gi coupled Mood regulation, anxiety, and pain perception.
Question 46
What is 5-HT2-receptor coupled with? Controls?
Gq coupled CNS and mediate hallucinogenic effects Platelet and lead to platelet aggregation
Question 47
What is 5-HT3-receptors coupled with? Controls?
sodium and potassium ion channels nausea and vomiting response and pain perception in PNS
Question 48
What is 5-HT4-receptors coupled with? Controls?
Gs coupled GI tract Increase in secretion & peristalsis
Question 49
What are the pharmacological effects of serotonin in the CNS?
mood, appetite, body temperature regulation, and sleep cycle vasoconstriction, inhibition of gastric secretion, GI motility and stimulation of smooth muscle contraction.
Question 50
What is the monoamine hypothesis of depression?
depression is caused by the lack of monoamine transmitters in the brain, particularly serotonin and norepinephrine
Question 51
What role does dopamine deficiency play in depression?
role in the lack of interest (anhedonia) symptom commonly seen in depression
Question 52
What is the time frame for the clinical response to antidepressant drugs?
Weeks
Question 53
What is the Neuroplasticity Hypothesis?
suggests lowered levels of brain-derived neurotrophic factor (BDNF) or dysfunction of its receptor, TrkB, plays a significant role in depression development
Question 54
Classifications of Antidepressants
• 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
Question 55
Tricyclic Antidepressants (TCAs) Drugs
Amitriptyline Clomipramine
Question 56
TCA MOA
Inhibit reuptake of norepinephrine & serotonin Blocks alpha-adre, hist, and musc receptors
Question 57
Monoamine Oxidase Inhibitors Drug
Phenelzine
Question 58
MAOI MOA
bind and inactivate MAO enzyme (nt. met) → increases the monoamine conc.
Question 59
What is the 'tyramine pressor response'?
A sudden increase in blood pressure and hypertensive crisis due to the accumulation of tyramine in the diet of individuals taking MAO inhibitors.
Question 60
SSRI Drugs
Fluoxetine Sertraline Citalopram Escitalopram
Question 61
What is the mechanism of action (MOA) of SSRIs?
SSRIs selectively inhibit the serotonin reuptake transporter (SERT) to increase serotonin concentration in the synaptic cleft.
Question 62
What is serotonin syndrome and what are its symptoms?
Accumulation of serotonin in the body fatal complications due to cardiovascular collapse
Question 63
What are Serotonin-Norepinephrine Reuptake Inhibitors (SNRIs)?
Venlafaxine Duloxetine
Question 64
SNRI MOA
selectively inhibit the reuptake transporters of serotonin and norepinephrine
Question 65
Rapid Acting Antidepressant Drug and MOA
Ketamine Glutamate release + block NMDA receptor → improves neuroplasticity + BDNF release
Question 66
What are serotonin receptor antagonists and what are their effects?
Trazodone block selective serotonin receptors receptors are upregulated in some depression patients
Question 67
What is a dopamine-norepinephrine reuptake inhibitor and what is an example of one?
Bupropion Increase dopamine and norepinephrine levels in the synaptic cleft
Question 68
What is the active ingredient in St. John's Wort?
Hyperforin
Question 69
How does St. John's Wort interact with CYP 450 enzymes?
It induces CYP 450 enzymes, specifically CYP3A4 and CYP2C9.
Question 70
Treatments for Bipolar disorder
Lithium Salts - Lithium carbonate Valporic acid Carbamazepine
Question 71
What is the therapeutic index of lithium salts?
Narrow therapeutic index (low safety margin)