This document contains the study questions and answers for the course Psychopharmacology (), University Utrecht. The answers are based on the lectures, Kenemans, Psychopharmacology 2th edition (ISBN: 2128) & Lawrence, Labbate et al. Handbook of Psychiatric Drug Therapy (ISBN 978-07-8177-486-4).
Quelques exemples de cette série de questions pratiques
1.
Concept: How does a substance move through the body
Réponse: Pharmacokinetics
2.
Concept: What does the substance do to the body?
Réponse: Pharmacodynamics
3.
Statement (true/false): The question to what receptor a substance binds can be answered through Pharmacokinetics.
Réponse: False, this answer can be answered through pharmacodynamics
4.
When can a new substance be prescribed?
Réponse: New compounds must be admitted by a regulatory board for example: FDA, CBG, EMA. Registration for medication based on research into efficacy and safety.
5.
Which phase or research is commited on animals?
Réponse: 1) Preclinical phases
6.
Concept: Relation between the toxic dose and the effective dose = TD50 / ED50
Réponse: Therapeutic index
7.
What is in the safety registration?
Réponse: Therapeutic index, drug interactions and toxicity
8.
Which Ion enters the cell when depolarization happens?
Réponse: Na+
9.
Which part of the nerve cell is covered in myeline?
Réponse: Axon
10.
Fill in: When the ...... name is expired it is sold cheaper under the ... name
Réponse: Brandname, Generic name
Aperçu du contenu
Study questions
psychopharmacology
Week 1
- Which two overarching classes of psychoactive substances can be discerned based on their
use?
Recreational: To have fun or as reward
Medicinal: To reduce, change or otherwise control problematic behavior
- What are the different names that are given to medications once they become available for
prescription, and what is the difference between these names?
Chemical name/formula
Codename (with manufacturer)
Generic name, easier to communicated
Brandname when the patent expires it’s sold cheaper on the generic name
- What is pharmacokinetics and pharmacodynamics? Describe these terms and understand their
difference.
Pharmacokinetics: ‘How does a substance move through the body?’
Pharmacodynamics: ‘What does the substance do to the body?’
To what receptors does the substance bind?
What effect does the substance have on the receptor
In Psychopharmacology this means: interactions with neurotransmitters
- Medications have a certain indication, meaning the illness, symptoms or disorder for which
they are prescribed. In general, within which area do the indications for psychoactive
substances fall?
Psychoactive substances are made to activate the mind. This can be used for ADHD.
- Describe the most common mechanisms of modulation of neurotransmission along which
psychoactive substances exert their influence on the brain.
Agonism: Psychoactive substances can act as agonists, meaning they bind to and activate specific
receptors in the brain. By mimicking the effects of endogenous neurotransmitters, these substances
enhance or prolong neurotransmission. For example, opioids act as agonists at mu-opioid receptors,
leading to pain relief and feelings of euphoria.
Antagonism: Substances acting as antagonists bind to receptors without activating them, thereby
blocking the effects of endogenous neurotransmitters. This inhibition can disrupt normal
neurotransmission processes. For instance, antipsychotic drugs often act as antagonists at dopamine
receptors, reducing the activity of dopamine and alleviating psychotic symptoms.
Reuptake inhibition: Neurotransmitters are typically reabsorbed by the presynaptic neuron after being
released into the synapse. Psychoactive substances can inhibit the reuptake process, increasing the
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,concentration of neurotransmitters in the synapse and prolonging their effects. Selective serotonin
reuptake inhibitors (SSRIs), commonly used as antidepressants, inhibit the reuptake of serotonin,
leading to increased serotonin levels in the brain.
Enzyme inhibition: Some substances can inhibit the enzymes responsible for breaking down
neurotransmitters in the synapse. By inhibiting these enzymes, the substances increase the
availability and duration of neurotransmitter activity. Monoamine oxidase inhibitors (MAOIs) are an
example of substances that inhibit the enzyme monoamine oxidase, leading to increased levels of
neurotransmitters such as dopamine, norepinephrine, and serotonin.
GABAergic modulation: The neurotransmitter gamma-aminobutyric acid (GABA) is an inhibitory
neurotransmitter that helps regulate neuronal activity in the brain. Psychoactive substances can
modulate GABA receptors, either by enhancing GABAergic inhibitory effects or by blocking them. This
modulation can result in sedation, relaxation, or anxiolytic effects. Benzodiazepines, for instance,
enhance the effects of GABA at GABA-A receptors, leading to sedative and anxiolytic effects.
Glutamatergic modulation: Glutamate is the primary excitatory neurotransmitter in the brain,
involved in various cognitive functions. Psychoactive substances can modulate glutamate receptors,
affecting excitatory signaling. NMDA receptor antagonists, such as ketamine, modulate glutamate
transmission and can induce dissociative and anesthetic effects.
- Many of the currently used psychoactive substances have been discovered by serendipity, but
once every so often new medications are developed on purpose through hypothesis-driven
research lines. Describe in broad terms the (pre)clinical development phases which a new
medicine has to pass before it can be made available to patients.
1) Preclinical phases (animals) on efficacy, safety and administration
2) Clinical research
Phase 1: A small group of healthy volunteers to see the tolerable doses (Titration)
Phase 2: Research the therapeutic effect in people with the condition (double blind, placebo)
Phase 3: Large group of double-blind, placebo-controlled studies (at least two)
Does it work, and is it better than existing drugs?
Phase 4: Research about the side effects
Long-term effects, optimal dose (lowest working and highest without side effects)
- In the development of new medicines, there are many bottle necks. What are the most
important conceptual bottle necks (think for example of brain mechanisms that cause the
disorder)? And what are the most important practical hindrances (for example, think of
pharmacokinetic properties)? And what are financial hindrances?
An important conceptual bottle neck is that some disorders have an abnormal brain structure causing
the disorder. With medication we can’t change the brain but only control or/and reduce behavior, so
the source isn’t targeted.
The most important practical hinderances is if the medication will go through the blood-brain barrier.
Making medicine is incredibly expensive. So that needs to be financed, but when it’s financed by the
company self it is a possibility that companies do research in a way there medicine looks better, so
they can make more money.
- There are various reasons why most psychoactive substances not only exert their main
(intended) effect, but also unwanted side-effects. Describe the two most important reasons.
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, 1) Medicine are made for a specific disorder while most people have other parameters that are
of influence.
2) A higher doses leads to more toxicity
- Describe the golden standard in executing (psycho)pharmacological research: placebo –
controlled and double-blind. Why are these aspects of importance?
To control for spontaneously effect a placebo (a pill without working effects) is giving to patients who
think they (might) have working medication. This is done double blind because the person who gives
it or receives can give influence on the effects of the drug that has been given. Also randomized.
- Which result will allow the conclusion that a placebo (fake pill) medicine may be useful in
treatment?
The changes from base-line and effects of medicine. You compare the differences between groups.
This is to control for the possible positive changes might happen spontaneously.
- What is an active placebo?
This is a pill with similar effects but not the same therapeutic effect. This is used so people don’t
notice they are on a placebo pill.
- What is meant with ‘Evidence-based medicine’? Why is this important?
Evidence-based medicine are drugs that have gone to research for effectiveness. This is important so
they can predict if it will work for patients with similar conditions.
- What do the conflicting interests of patients, treating physicians, pharmaceutical industry and
policy-makers mean for the credibility of the different sources of information that you can find,
for example on the internet?
There are a lot of sources of information on the internet. Everyone can access it and post information.
Physicians and patients have their own experiences with medications while the pharmaceutical want
to make money. Policy-makers might inflict the change to make that money for the pharmaceutical
company. The experiences, safety, policy and making money are all conflicting. This makes that it’s
hard to see which of these parties are the most credible.
Week 2
- Give a definition of psychopharmacology.
focuses on effects of substances on behavior, cognition and affect (incl. their mechanisms in the
brain)
- (See also Kenemans, paragraph 1.2) What is a dose-response-curve (DRC)?
Dose-response curve (DRC): The effect of certain dose what the effect is
- Effects depend on dose
- Response as function of dose
- Depends on which response you look at
- See Kenemans Fig. 5.2: Does the DRC for one particular substance always look the same?
What does it depend on? How about differences between individuals?
It does not look the same because the DRC is an average and can differ from person to person.
Personal factors like age, sex and tolerance play a role in that.
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