Week 6 Clinical Pearls

First-line treatment for OCD

SSRIs

Primary action of hallucinogenic drugs (LSD, mescaline, psilocybin, MDMA)

Agonism of 5HT2A receptors

Other mechanism of hallucinogen action

May have additional actions at other serotonin receptors (5HT1A and 5HT2C) and other neurotransmitter systems.

MDMA in particular also blocks serotonin transporter (SERT)

Hypothalamus

Brain center that controls appetite by utilizing a complex set of circuits and regulators.

One formulation of how is does this is the notion that there is a major appetite-stimulating pathway whose actions are mediated by two peptides (neuropeptide Y and agouti-related protein)

Phentermine

Acts much like amphetamine, blocking both the dopamine transporter (DAT) and the norepinephrine transporter (NET) and, at high doses, the vesicular monoamine transporter (VMAT)

Buprenoprhine

Approved for persons <18 years of age

Disulfiram-alcohol reaction

Reaction may occur within 2 weeks of alcohol ingestion

Methadone

Full mu-receptor agonist with a long half-life, which can prevent withdrawal symptoms for 24 hours and provide steady control of cravings throughout the day.

In addition to its opioid receptor activity, it is also an antagonist of the NMDA receptor

Hallucinogen intoxication

Can cause what is perceived as a panic attack, often called a “bad trip”.

As intoxication escalates, one can experience an acute state of confusion (delirium) where the abuser is disoriented and agitated.

Disulfiram mechanism of action

Irreversibly inhibits aldehyde dehydrogenase, resulting in the build-up of toxic levels of acetaldehyde.

Severe side effects present almost immediately when alcohol is consumed.

Acamprosate mechanism of action

Reduces glutamate release associated with alcohol withdrawal.

May start 5-7 days after alcohol abstinence

Naltrexone mechanism of action

Blocks the enjoyment of heavy drinking through its action on reward circuitry.

It can be used while still drinking and in the first days afterward.

Sedative hypnotics mechanism of action

Act at GABA-A receptor sites in reward circuits

Impulsive disorders

Focused on reward and associated with the mesolimbic pathway