Targets of Psychopharmacological Drug...
Transcript of Targets of Psychopharmacological Drug...
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Targets of
Psychopharmacological
Drug Action
(page 33 in syllabus)
Stephen M. Stahl, MD, PhD
Adjunct Professor, Department of Psychiatry
University of California, San Diego School of Medicine
Honorary Visiting Senior Fellow, Cambridge University, UK
Sponsored by the Neuroscience Education Institute
Additionally sponsored by the American Society for the Advancement of Pharmacotherapy
This activity is supported solely by the sponsor, Neuroscience Education Institute.
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Faculty Editor / Presenter
Stephen M. Stahl, MD, PhD, is an adjunct professor in the department of psychiatry at
the University of California, San Diego School of Medicine, and an honorary visiting
senior fellow at the University of Cambridge in the UK.
Grant/Research: AstraZeneca, BioMarin, Dainippon Sumitomo, Dey, Forest, Genomind,
Lilly, Merck, Pamlab, Pfizer, PGxHealth/Trovis, Schering-Plough, Sepracor/Sunovion,
Servier, Shire, Torrent
Consultant/Advisor: Advent, Alkermes, Arena, AstraZeneca, AVANIR, BioMarin, Biovail,
Boehringer Ingelheim, Bristol-Myers Squibb, CeNeRx, Cypress, Dainippon Sumitomo,
Dey, Forest, Genomind, Janssen, Jazz, Labopharm, Lilly, Lundbeck, Merck,
Neuronetics, Novartis, Ono, Orexigen, Otsuka, Pamlab, Pfizer, PGxHealth/Trovis,
Rexahn, Roche, Royalty, Schering-Plough, Servier, Shire, Solvay/Abbott,
Sunovion/Sepracor, Valeant, VIVUS,
Speakers Bureau: Dainippon Sumitomo, Forest, Lilly, Merck, Pamlab, Pfizer,
Sepracor/Sunovion, Servier, Wyeth
Individual Disclosure Statement
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Learning Objectives
• To explore transporters as drug targets
• To explore G protein-linked receptors as drug
targets
• To explore ligand-gated ion channels as drug
targets
• To explore voltage-sensitive ion channels as
drug targets
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Transporters and G Protein-Linked
Receptors as Targets of
Psychopharmacological
Drug Action
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4-1
Major Targets of Psychopharmacologic
Drug Action
12
12 transmembrane
region transporter
~ 30% of psychotropic drugs
7
7 transmembrane region
G protein linked
~ 30% of psychotropic drugs
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4-2
Other Targets of
Psychopharmacologic Drug Action
4 transmembrane region
ligand-gated ion channel
~ 20% of psychotropic
drugs
6 transmembrane region
voltage-gated ion channel
~ 10% of psychotropic
drugs
enzyme
~ 10% of psychotropic
drugs
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Targets of
Psychopharmacological Drug Action
• Transporters
• G protein-linked receptors
• Ligand-gated ion channels
• Voltage-sensitive ion channels
• Enzymes
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Presynaptic transporters are a primary mode of
inactivation for which of the following?
1. Monoamines
2. Amino acid neurotransmitters such as GABA and
glutamate
3. Neuropeptides
4. 1 and 2
5. 1, 2, and 3
Pretest Question 1
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Pretest Question 2
The vesicular monoamine transporter 2 (VMAT2)
is utilized by which neurotransmitter?
1. Serotonin
2. Norepinephrine
3. Dopamine
4. 2 and 3
5. 1, 2, and 3
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4-4
Monoamine Transporters
presynaptic neurons
SERT NET DAT
5HT NE DA
VMAT 2 VMAT 2 VMAT 2
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4-8A
serotonin (5HT)
vesicles
proton pump
VMAT 2
Na+
Na+
Cl-
Cl-+
K+
K+
ATPase
add fluoxetine
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4-8B
fluoxetine (Prozac)
Na+
Na+
Cl-
Cl-+
K+
K+
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4-9
Acetylcholine and Choline Transporters
presynaptic neuron
choline
transporter
VAChT
ACh
choline
ACh
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4-10
GABA Transporters
presynaptic neuron
glial cell
GAT-1
GAT-2
GAT-3
GAT-4
VIAAT
GABA
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4-11
Glutamate Transporters
presynaptic neuron
glial cell
postsynaptic neuron
EAAT
EAAT
Glu
glutamine
Glu
VGluT 1
EAAT
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Targets of
Psychopharmacological Drug Action
• Transporters
• G protein-linked receptors
• Ligand-gated ion channels
• Voltage-sensitive ion channels
• Enzymes
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Pretest Question 3
An antagonist is the opposite of an agonist.
1. True
2. False
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4-21
The Agonist Spectrum
agonist
partial agonist
antagonist
inverse agonist
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4-22
No Agonist: Constitutive Activity
3
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4-23
Full Agonist: Maximum Signal Transduction agonist
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"Silent" Antagonist: Back to Baseline,
Constitutive Activity Only, Same as No Agonist
4-24
3
antagonist
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4-25
Partial Agonist:
Partially Enhanced Signal Transduction
partial agonist
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Pretest Question 4
A partial agonist can be a net agonist when
neurotransmission is deficient but a net
antagonist when neurotransmission is
excessive.
1. True
2. False
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4-26
FULL AGONIST —
light is at its brightest PARTIAL AGONIST —
light is dimmed but still shining
NO AGONIST —
light is off
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4-27
inverse agonist
Inverse Agonist: Beyond Antagonism;
Even the Constitutive Activity Is Blocked
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4-28
Agonist Spectrum
no agonist or silent antagonist
partial agonist
agonist
inverse agonist
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Ion Channels and Enzymes
as Targets of
Psychopharmacological
Drug Action
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Targets of
Psychopharmacological Drug Action
• Transporters
• G protein-linked receptors
• Ligand-gated ion channels
• Voltage-sensitive ion channels
• Enzymes
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5-9
The Agonist Spectrum
partial agonist
antagonist
agonist
inverse agonist
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Pretest Question 5
A receptor will stop responding to an agonist:
1. When the agonist stops binding to it
2. When the receptor becomes desensitized
3. When the receptor becomes inactivated
4. 1 and 3
5. 1, 2, and 3
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5-19
Channel in
resting state
Channel
open
Channel
closed
Channel
desensitized
Channel
inactivated
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Opening, Desensitizing, and Inactivating of
Ligand-Gated Ion Channels by Agonists
Desensitized state activated by prolonged agonist
Resting state
Open state activated by acute agonist
Inactivated state not immediately reversed by removal of agonist
order of hours
order of hours
5-20
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5-23
agonist
GABA benzodiazepine
positive
allosteric
modulation
open open
further
resting
GABA A
receptors
Cl -
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Benzodiazepines: Indirect Effect on
GABA Neurotransmission
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Targets of
Psychopharmacological Drug Action
• Transporters
• G protein-linked receptors
• Ligand-gated ion channels
• Voltage-sensitive ion channels
• Enzymes
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Pretest Question 6
When voltage-sensitive sodium channels are
open and activated, the flow of sodium is:
1. Into the neuron
2. Out of the neuron
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The Pore of a Voltage-Sensitive Ion Channel
Has 6 Transmembrane Regions
outside the cell
inside the cell
1 2 3 4 5 6
5-27
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5-28
The Loop Between Regions 5 and 6 is
an Ionic Filter
1 2 3 4 5 6 1 2 3 4 5 6
Voltage-sensitive sodium channel (VSSC) Voltage-sensitive calcium channel (VSCC)
outside the cell
inside the cell Na+
Ca++
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5-29
Four Subunits Combine to Form the Alpha Pore Subunit, or Channel, for Sodium of a
VSSC (Voltage-Sensitive Sodium Channel)
outside the cell
inside the cell pore inactivation
I II III IV
=
outside the cell
inside the cell
pore inactivation
Na+
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Structure of Voltage-Sensitive Sodium
Channels (VSSCs)
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Pretest Question 7
Which of the following has evidence that it binds
the alpha subunit of voltage-sensitive sodium
channels?
1. Gabapentin
2. Pregabalin
3. Lamotrigine
4. 1 and 2
5. 1, 2, and 3
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5-32
inside the cell
outside the cell
Possible Binding Sites for Certain
Mood Stabilizers on VSSCs
lamotrigine
carbamazepine
oxcarbazepine
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Pretest Question 8
The alpha-2 delta subunit of voltage-
sensitive calcium channels is believed to
help regulate opening and closing of the
voltage-sensitive calcium channel.
1. True
2. False
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5-34
VSCCs (Voltage-Sensitive Calcium Channels) Have
Multiple Associated Regulatory Proteins
outside the cell
inside the cell
Ca++
1
2
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Opening a Presynaptic Voltage-Sensitive N or P/Q
Calcium Channel Triggers Neurotransmitter Release
5-35
glutamate
snare
vesicle
N
P,Q
2
Ca++
N
P,Q
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Structure of Voltage-Sensitive
Calcium Channels (VSCCs)
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5-37
Site of Action of Alpha-2 Delta Ligands as Selective Inhibitors of Presynaptic Voltage-Sensitive N and
P/Q Calcium Channels
N
P,Q
= alpha-2 delta
ligand
open
N
P,Q
open
N
P,Q
closed
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Molecular Action of Alpha-2 Delta Ligands
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Pretest Question 9
Which of the following are involved in regulating
neurotransmission via excitation-secretion
coupling?
1. Voltage-sensitive sodium channels
2. Voltage-sensitive calcium channels
3. Both 1 and 2
4. Neither 1 nor 2
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Nerve Impulse Propagation in Presynaptic Neuron:
Serial Opening of VSSCs (Voltage-Sensitive Sodium Channels)
reception
integration chemical encoding
electrical encoding
signal propagation
signal transduction
5-39
A
B
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Presynaptic Release of Neurotransmitter by Excitation-Secretion
Coupling: VSSCs, VSCCs, and Synaptic Vesicles
reception
integration chemical encoding
electrical encoding
signal propagation
signal transduction
5-40
A
B
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action
potential neurotransmitter
vesicle
5-41
VSSC VSCC
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5-41
Na+
VSSC VSCC
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5-41
VSSC VSCC
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5-41
VSSC VSCC
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Ca++
5-41
VSSC VSCC
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Ca++
5-41
VSSC VSCC
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Ca++
5-41
VSSC VSCC
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Synaptic Neurotransmission
With Vesicular Release
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Range of Synaptic Neurotransmission
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Summary
• The major targets of psychopharmacologic drug
action are transporters and G protein-linked
receptors
• Ion channels, both ligand gated and voltage
sensitive, are also important targets of
psychopharmacologic drug action
• Enzymes also are the targets of some important
psychopharmacological drugs