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26 Cards in this Set
- Front
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Dopamine Pathways Name pathway 1 Where does it project to / from
In untreated schizophrenia... Dopamine levels? Symptoms arising?
After addition of pure D2 antagonist... Dopamin levels? Effects? |
Dopamine Pathways Nigrostriatal Dopamine Pathway Substantia Nigra - Basil Ganglia
In untreated schizophrenia... Dopamine levels: NORMAL
After addition of pure D2 antagonist... Dopamin levels: LOW Effects: EXTRAPARAMIDAL SEs (Parkinsonism) |
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Dopamine Pathways Name pathway 2 Where does it project to / from
In untreated schizophrenia... Dopamine levels? Symptoms arising?
After addition of pure D2 antagonist... Dopamin levels? Effects? |
Dopamine Pathways Mesolimbic Dopamine Pathway VTA - Nucleus Accumbens
In untreated schizophrenia... Dopamine levels: HIGH Symptoms: POSITIVE
After addition of pure D2 antagonist... Dopamin levels: LOW Effects: REDUCES +ve SYMPTOMS and LACK OF PLEASURE / REWARD |
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Dopamine Pathways Name pathway 3 Where does it project to / from
In untreated schizophrenia... Dopamine levels? Symptoms arising?
After addition of pure D2 antagonist... Dopamin levels? Effects? |
Dopamine Pathways Mesocortical VTA - Frontal Cortex
Two branches: VTA - DLPFC - COG and NEG VTA - VMPFC - AFF and NEG
In untreated schizophrenia... Dopamine levels: LOW After addition of pure D2 antagonist... Dopamin levels: LOW |
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Dopamine Pathways Name pathway 4 Where does it project to / from
In untreated schizophrenia... Dopamine levels? Symptoms arising?
After addition of pure D2 antagonist... Dopamin levels? Effects? |
Dopamine Pathways Tuberohypophyseal Hypothal - Ant Pituitary
In untreated schizophrenia... Dopamine levels: NORMAL (Neurons active and inhibit prolactin)
After addition of pure D2 antagonist... Dopamin levels: LOW Effects: GALACTORRHEA, amenorrhea, sexual dysfunction |
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Treating schizophrenia Positive symptoms First line Second line Third line In case of emergency Non-compliance |
Treating schizophrenia Positive symptoms 1 = SDA, DPA 2 = D2, Clozapine 3 = Polypharmacy E = SDA, BZ, D2 N = Depot of SDA, D2 |
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Treating schizophrenia Negative symptoms First line Second line |
Treating schizophrenia Negative symptoms 1 = SDA, DPA 2 = Clozapine, ADM, NRI (Ruboxetine), modafinil (wake), amisulpride
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Treating schizophrenia Aggressive symptoms First line Second line In case of emergency |
Treating schizophrenia Aggressive symptoms 1 = SDA, DPA 2 = BZ, D2, Clozapine, mood stabiliser. E = SDA, BZ, D2 |
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Treating schizophrenia Cognitive symptoms First line Second line |
Treating schizophrenia Cognitive symptoms 1 = SDA, DPA 2 = a-2 agonist (adrenalin), 5HT1A, NRI, modafinil (stimulant, narcolepsy), ACh>, ACh<. |
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Treating bipolar Mania / mixed episode Severe Mild |
Severe IM = Antipsychotic or BZ Oral = Antipsychotic or Valproate
Mild Antipsychotic, Valproate, Li, Carbamazepine
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Treating bipolar What if sleep deprived in manic/mixed episode? |
Consider BZ short term |
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Treating bipolar Depressive episode Severe Moderate Mild |
Severe = consider ECT Mod = Quetiapine (SDA) or Lamotrigine (AC) + SSRI (NOT TCA!) Mild = Quetiapine (SDA) or Lamotrigine (AC)
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Treating bipolar Maintenance scheme If mania predominates - 1st line, 2nd line If depression predominates - 1st line, 2nd line |
Mania: 1 = Lithium, Aripiprazole (DPA), Quetiapine (SDA), Valproate (AC) or Olanzepine (SDA) 2 = Carmamazepine (AC)
Depression: 1 = Quetiapine (SDA), Lamotrigine (AC) 2 = Lithium |
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General Bipolar Tx First Line |
DPA (Dopamine Partial Agonist) SDA (Atypical Antipsychotic) Lithium Valproate (AC) Carbamazepine (AC) Lamotrigine (AC) Oxcarbazepine (AC) |
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General Bipolar Tx Second Line |
BZ Topiramate (AC) Zonisamide (AC) Levetiracetam (AC) Gabapentin/pregabalin (epilepsy) CCB (Calcium Channel Blocker - AH) |
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What is an SDA? |
2nd Gen Atypical Antipsychotics Both D2 and serotonin 5HT2A antagonists (affinity higher for 5HT2A) Less risk of parkinsonism and TD Effective at treating +ve and -ve, NOT cog SEs = weight gain "Pines" - clozapine, olanzapine, Quetiapine, LD Loxapine. "Dones" - Respiridone, ziprasidone, paliperidone. |
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What is a DPA? |
3rd Gen Atypical Antipsychotics Partial Agonist at D2 receptors - has affinity for receptor, but only partial efficacy e.g. Aripiprazole No typical SEs or weight gain Not very effective at treating COG dysfunction "Oles" - Aripiprazole "Ides" - Sulpride, Amisulpride |
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What is a D2 (class of drugs)? |
1st Gen Typical Antipsychotics Dopamine (D2) receptor antagonists Only effective at treating +ve symptoms Also affect other NT systems SEs = Parkinsonism, tardive dyskinesia e.g. Chlorpromazine, Haloperidol. |
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What is a TCA? |
Tricyclics and Tetracyclics - Anticholinergic - Cardio toxic - Sedative e.g. Amitriptyline |
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What is a MAOI? |
Monoamine Oxidase Inhibitors - blockage of MAO in liver - build up of tyramine - High BP - Increased risk of stroke (Need strict diet!) e.g. Tranylcypramine, Phenelzine, Moclobemide. |
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What is an SSRI? |
Selective Serotonin Reuptake Inhibitors e.g. Fluvoxamine, Sertraline, Fluoxetine, Paroxetine, Citalopram.
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What is an SNRI? |
Dual Serotonin and Norepinephrine Reuptake Inhibitor Third generation anti-depressants Venlafaxine: Acts as SSRI up to 225mg Acts as TCA above 225mg e.g. Venlafaxine, Duloxetine |
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What is a SARI? |
Serotonin-2 Antagonist and Reuptake Inhibitors e.g. Nefazodone (withdrawn), Trazodone |
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What is an NDRI? |
Noradrenaline and Dopamine reuptake Inhibitor e.g. Bupropion |
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What is a NaSSa? |
Noradrenergic and Specific Serotonergic Antagonists e.g. Mirtazepine |
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What is an NRI? |
Noradrenaline Specific Reuptake Inhibitor (NRI) e.g. Reboxetine |
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What is an SRE? |
Serotonin Reuptake Enhancer e.g. Tianepine |
