Block 4

• Reserpine - depletes 5HT, NE and DA causes? 


  depression
• Antidepressants prevent stress-induced reduction in BDNF & neuronal atrophy
• What is the role MAO?

  In pre-synaptic nerve terminal MAO prevent the accumulation of neurotransmitter outside vesicles
• MAO inhibitor function?

  1. Increase amount of DA, NE and 5HT in the synaptic space
  2. Decrease metabolism of tyramine
• Amitriptyline is a TCA
• TCA ends with 


  -ptyline
• Clomipramine is a TCA
• what type of medicine is Chlorpromazine?

  typical antipsychotic
• • Typical - first generation - blocking dopamine (D2) receptor
  • Atypical - second generation -  block serotonin receptor (5HT2)
• Thioridazine - typical antipsychotics cause pigmentary retinopathy and cardiac arrhythmia
• Haloperidol - typical Antipsychotic

  • Highly potent
  • use for acute schizophrenia - control positive symptoms
• Pimozide - Typical Antipsychotic

  • use in Tourette's syndrome
  • risk for arrhythmias
• Which typical antipsychotic cause Neuroleptic malignant syndrome?

  haloperidol
• which atypical antipsychotics causes greatest risk of QT prolongation with history of cardiac arrhythmias? 


  Ziprasidone
• Quetiapine - atypical antipsychotic is use for?

  bipolar depression
• Which atypical antipsychotics is a partial D2 agonist?


  Aripiprazole
• Aripiprazole is use for?

  manic phase of bipolar disorder
• Lithium is 1st line for?

   bipolar affective disorder
• Valproate

  • Use as mood stabilizer in bipolar disorder
  • Increase DNA transcription - inhibiting histone deacetylase --> increase BDNF
• Lithium AE

  • Hand tremor – dose dependent
  • Life-threatening seizures – dose dependent
• Lithium - Before prescribing in young women - evaluate

  • thyroid & kidney function + hCG to rule out pregnancy
• Diuretics - Causes Na+ loss - promote reabsorption and increase concentration of lithium
•  pituitary apoplexy due to pituitary gland hemorrhage or infarction
• pituitary apoplexy caused by

  • preexisting adenoma - enlargement of the pituitary gland
• Sheehan syndrome caused by pituitary necrosis secondary to severe postpartum hemorrhage
• Sheehan syndrome manifestations?

  Inability to lactate and cessation of menses
• Empty sellar syndrome

  • Associated with intracranial hypertension
  • Associated with pituitary adenomas
• Gigantism

  • Caused by growth hormone excess before growth plate closure
  • Due to pituitary tumor
• Gigantism Lab

  • Elevated IGF-1
  • Failure to suppress GH with oral glucose tolerance test
• Gigantism Clinical features

  • Tall stature
  • Large hand and feet
  • Prominent jaw and forehead
  • Coarse facial features
• Acromegaly

  • Caused by somatotrope adenoma - GH excess after growth plate closure
• Acromegaly Features

  • Mandibular enlargement
  • Increase hand and foot size
  • Widened space lower incisor teeth
  • Soft tissue swelling - heel pad thickness
  • Enlargement of organs - large heart
  • Oily skin
  • Enlargement of tongue
  • Visual field defects - due to mass effect
• Acromegaly Lab

  • Elevated IGF-1
  • Failure to suppress GH with oral glucose tolerance test
• pituitary lactotrophs cells in the anterior pituitary that produces prolactin
• pituitary somatotrophs cells in the anterior pituitary that produces GH
• which drug can cause nephrogenic DI?


  lithium
• Diabetes insipidus due to

  • Central or neurogenic - loss AVP/ADH
  • Nephrogenic - insensitivity to AVP
• Diabetes insipidus Lab

  • Urine osmolarity <280 osm
  • Low urinary sodium
  • High plasma sodium and osmolarity
  • Low vasopressin - central DI
  • High/normal vasopressin - nephrogenic DI
• Diabetes insipidus

  • Treatment
  • Central DI - desmopressin
  • Nephrogenic - low sodium diets
• What type of drugs can cause SIADH ?

  Antidepressant - TCA, SSRI or oxytocin