II. CNS stimulants / psychomotor agentsdb.phm.utoronto.ca/Henderson unit 13 color 2020.pdf · 2020....
Transcript of II. CNS stimulants / psychomotor agentsdb.phm.utoronto.ca/Henderson unit 13 color 2020.pdf · 2020....
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III. Anti-depressants / mood stabilizing agents
II. CNS stimulants / psychomotor agents
Source material: Harvey and Champe "Pharmacology" 2000; Kalant and Roschlau “ Medical Pharmacology" 1998; Kandel et al. “Principles of Neural Science" 2000
Pharmacology of mood altering substances
I. Central nervous system, basic properties
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Partial agonist (LSD) presynaptic
postsynaptic
Neuron, basic properties:
information flow
Agonist:
+
Antagonist (Naloxone)
(displacement)
postsynapticpresynaptic
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axon segment
myelin sheath
Na (3)
K (2)
Na, K ATPase (antiporter – Ouabain, Digoxin)
Na
Na channel (tetrodotoxin)
Neuron, basic properties:
Ca+2Neurotransmitter
(glutamate)
depolarization
action potential
saltatory conduction
(ATP)
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Neuron, basic properties:
axonsoma terminals
dendrites
hillocks
threshold
- action potential- Na channel opening
termination
re-equilibration
(hyperpolarization)resting potential
CB
depolarization
A
-70mv
- opening of Ca channels
-inactivation of Na channels
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hyperpolarization
+
_ -90reduced probability of action potential
depolarization
excitatory+
_inhibitory
presynapticpostsynaptic
-40increased prob.of action potential
+
_ -70
NMDA
GABA
Neuron, basic properties:
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A – Ligand binding site(neurotransmitter)
B - Channel binding site(regulators, poisons, drugs)
C - Modifier / co-activator site(co-agonists, drugs)
Ca+2
+NMDA
A
B
C
(depolarize)
_
Cl -
GABA
A
B
C
(hyperpolarize)
GAD
Neuron, basic properties:
+
_
NMDA
GABA
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CNS stimulants:
Psychomotor group: - excitement and euphoria- reduction of fatigue, increased B.P.- increased motor activity - caffeine, theophylline, theobromine
- nicotine- cocaine- amphetamines
Psychotomimetic drugs (hallucinogens): - changes in thought and mood- few effects on brainstem / spinal cord
- lysergic acid diethylamide (LSD)- Phenylcyclidine (PCP)- Tetrahydrocannabinol (THC)
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Potential for dependency:
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Potential for dependency:
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Potential for dependency:
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Actions: - inhibits phosphodiesterase, leading to increased cAMP / cGMP- increased intracellular calcium, increased cardiac contractility- smooth muscle vasodilator (except cerebral vessels)- methylxanthines also block adenosine receptors- theophylline inhibits prostaglandins (smooth muscle), mild diuretics - stimulate gastric HCl secretion (contraindicated for peptic ulcers)- individual clearance rates can vary widely
(caffeine, theophylline, theobromine)(coffee 1,3,7 : tea 1,3 : coca 3,7)
Psychomotor agents, Methylxanthines:
Pharmacology: - cross CNS and placental barriers, secreted in milk- 1-200 mg (1-2 cups coffee) - reduction of fatigue, increased alertness- 1500 mg - anxiety, tremors, arrhythmia- metabolized in the liver (CYP system -3-demethylation, 8-hyroxylation)
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Psychomotor agents, Nicotine:
CNS:- reward, arousal, relaxation, enhanced attention / reaction time- sympathetic stim. < parasympathetic stim. < parasympathetic blockade- respiratory paralysis (high dose)
Pharmacology: - alkaloid, crosses CNS and placental barriers easily, secreted in milk- 1 cigarette contains 6-8 mg nicotine, 90% absorbed- acute lethal dose (~60 mg), tolerance to acute effects occurs quickly- most inactivated 2-4 hrs (lungs/liver), major metabolite - cotinine, N'-oxide
Actions: - stimulates sympathetic ganglia / adrenal medulla - increased blood pressure, heart rate, vasoconstriction- potent, fast acting poison (insecticide), pregnancy-reduced birth weight
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Actions: - CNS: stimulation of cortex and brainstem - initial exposure - intense euphoria due to cortical stimulation (limbic)- chronic intake depletes dopamine, leading to mood "cycling" / addiction- blocks presynaptic re-uptake of norepinephrine, serotonin and dopamine
axonsoma terminals
dendrites
hillocksPsychomotor agents, Cocaine:
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Psychomotor agents, Cocaine:
(dopamine transporter)
amphetamine
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Psychomotor agents, Cocaine:
CNS:- feeling of enhanced mental awareness, euphoria delusions, paranoia- chronic use depletes dopamine reserves (euphoria / depression)
PNS:- potentiation of norepinephrine ("fright or flight" actions)- associated tachycardia - arrhythmia, hypertension, pupil dilation,
vasoconstriction (necrosis of nasal septum)
Pharmacology: - similar to amphetamine, shorter duration than amphetamine - used as local anesthetic (voltage-dependent sodium channels)
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Psychomotor agents, Amphetamines:
Actions: - similar to cocaine elevated levels of catecholamines are elevated in
the synaptic cleft. However the mechanism differs. - In the case of amphetamines, NT levels are elevated through increased
release from intracellular stores. Amphetamines also inhibit MAOwhich degrades these neurotransmitters, further increasing NT levels.
- enhances alertness, reduces appetite / fatigue, insomnia (dopamine)- methamphetamine - higher ratio of CNS to peripheral (amphetamine)- medically used to combat depression, narcolepsy, appetite control
methamphetamine
asymetric carbond-form (Dexedrine)
serotonin
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Amphetamines, mode of action:Additional: - elevates blood pressure (vasoconstrictor) - produces sedation in children (basis for amphetamine-like drug Ritalin)- enhanced neural stimulation via elevated catecholamines levels excitotoxicity - hallucinations tend to be auditory and tactile in nature, strong paranoid component
COMT
MAO
COMT
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Psychotomimetics, LSD:
Actions: - exhibits serotonin agonist activity (midbrain - presynaptic receptors)- activation of sympathetic neurons - pupillary dilation, increased BP / temp.- hallucinations, mood alterations, occasional long-term psychotic changes- adverse reactions - hyperreflexia, nausea, muscular weakness- hallucinations tend to be visual in nature, potent (adult dose can be 2ug/kg)- Haloperidol and other neuroleptics used to block effects of LSD.
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Relationships among AA / NT / drugs:
Phenylalanine
(serotonin)
LSD
psilocybin
mescaline
MMDA
ephedrine
amphetamine
cocaine
MDMA (ecstasy)
Actions similar to amphetamines
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Psychotomimetics, LSD:
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Psychotomimetics, Phenylcyclidine:
CNS:- excitement / agitation rapidly alternating with euphoria / depression- individuals can exhibit schizophrenic symptoms (also animal models)- potential long-term impairment of learning / memory (NMDA receptors)- indirectly enhances dopamine and serotonin levels in the CNS
Pharmacology: - structurally related to the anesthetic ketamine and MK-801- open channel, non-competitive blocker of NMDA type glutamate receptors(non-competitive NMDA antagonist)
- highly lipid soluble, allowing persistent accumulation in the brain
Actions: - anesthetic / analgesic properties- tachycardia, hypertension, hyperthermia, increase in muscle tone- bizarre repetitive movements (stereotypy), ataxia, dysarthria
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Psychotomimetics, Phenylcyclidine:Actions: - blockade of NMDA channels by PCP (or more selective antagonists such as
MK-801) induce / exacerbate psychotic symptoms in patients- interestingly, several drugs which enhance current flow through NMDA
receptors exhibit anti-psychotic properties. Drugs which bind to dopamine D2-class receptors also exhibit anti-psychotic actions (dopamine antagonists such as clozapine)
- overall, results suggest that drugs which act directly or indirectly to affect dopamine release can have profound effects on mood / thought
(depolarize)
NMDA
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Anxiolytics and
Antidepressants
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Antidepressants and mood stabilizing agents:
Tricyclic/polycyclic antidepressants
Serotonin selective re-uptake inhibitors
Monoamine oxidase (MAO) inhibitors
Anti-depressants:
Drugs to treat mania: (lithium)
Benzodiazepines:
Barbituates: - (phenobarbital, pentobarbital, secobarbitol, thiopental)
Anxiolytics:
Non-barbituate sedatives: - (ethanol, chloral hydrate, antihistamines)
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Anxiolytics, Benzodiazepines:
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Actions: - thought to reduce anxiety by selectively inhibiting limbic circuits- no anti-psychotic activity, no effects on autonomic nervous system- some sedative properties, hypnosis at higher levels- anticonvulsant activities- muscle relaxants, reduce spasticity - presynaptic inhibition on spinal cord- used therapeutically to treat anxiety, depression, seizures, muscle spasm
Benzodiazepines: - highest density of binding sites: cerebral cortex, amygdala (limbic),
hippocampus, hypothalamus - diazepam (antagonist - flumazenil)
Anxiolytics, Benzodiazepines:
Pharmacology: - half-lives of benzodiazepines vary tremendously, this is a key component
governing their therapeutic use
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A - Ligands binding site(neurotransmitter)
B - Channel binding site(regulators, poisons, drugs)
C - Modifier / co-activator site(co-agonists, drugs)
GABA Diazepam
Cl-
A
B
C
(hyperpolarize)
Anxiolytics, Benzodiazepines:
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Anxiolytics, Benzodiazepines:
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Anxiolytics, Benzodiazepines:
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Antidepressants
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Antidepressants, Tri- poly-cyclics (TCA’s):
Adverse effects: - cholinergic: blurred vision, xerostomia, constipation, urinary retention- narrow therapeutic window (5-6) creates significant potential for overdose- cardiac over-stimulation can be life threatening- orthostatic hypotension (fainting), reflex tachycardia (elderly)- sedation (first several weeks)
Actions: - used to treat severe major depression chronic pain and panic disorders- elevates mood, improves alertness, reduced morbid preoccupation- TCA’s typically do not exhibit these effects in normal individuals- mood elevation is slow in onset (2 weeks +), however effects are persistent- tolerance to anti-cholinergic and autonomic effects usually develops- physical and psychological dependence can occur
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TCA’s, mechanisms of action:
Notes: - the events depicted only represent the initial actions of TCA’s- TCA’s also inhibit alpha-adrenergic, histamine and muscarinic receptors
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TCA’s, interactions:
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Serotonin selective re-uptake inhibitors:
Actions: - used to treat major depression, bulimia, obsessive-compulsive disorders- fewer side effects (TCA’s - cholinergic, hypotension, weight gain)
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Serotonin selective re-uptake inhibitors:Adverse effects:- sexual dysfunction, nausea, anxiety, insomnia- fluoxetine inhibits P-450 enzyme responsible for metabolizing TCA’s, neuroleptic drugs and others (some individuals lack P-450 enzyme responsible for metabolizing fluoxetine and thus eliminate it very slowly)
Non-specific:CocaineAmphetaminesLSDTCA’s
Specific:SSRI’s
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Antidepressants, MAO inhibitors:
CNS:- inhibition of MAO-A results in elevation in 5-HT, NE, and DA levels- elevation of 5-HT may indirect result of elevating NE
Adverse effects: -MAOI’s largely relegated to secondary role due to propensity to induce serious hypertensive reactions in patients ingesting foods high in tyramine (fava beans). Second/third generation anti-depressants more widely used.
- insomnia, depression of blood pressure, symptoms similar to TCA’s
Actions: - originally discovered through actions of iproniazid (derivative of anti-tubercular drug isoniazid). Used to treat “atypical depression”
- two MAO isoforms: MAO-A (mitochondrial localization - preferred substrates serotonin, norepinephrine) and MAO-B (extracellular localization – preferred substrate – phenylethylamine)
- MAO-A inhibition most important for anti-depressant effects (slow onset)
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Antidepressants, MAO inhibitors:
Amphetaminesalso inhibit MAO
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MAO inhibitors:
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Antidepressants, overview:
Serotonin
Norepinephrine
Targetneuron