Dopamine Pathways

Question 1

Why are dopamine pathways important for PMHNPs?

Answer 1

They explain both the therapeutic effects and side effects of antipsychotics

Question 2

How do atypical (second-generation) antipsychotics differ from typicals?

Answer 2

They antagonize 5-HT2A (serotonin) receptors in addition to D2 receptors

Question 3

What does 5-HT2A antagonism allow atypical antipsychotics to do?

Answer 3

Increase dopamine in certain pathways → fewer side effects

Question 4

Mnemonic for the four dopamine pathways

Answer 4

Many Men Never Travel
Mesolimbic
Mesocortical
Nigrostriatal
Tuberoinfundibular

Question 5

What symptoms are associated with excess dopamine in the mesolimbic pathway?

Answer 5

Positive symptoms of schizophrenia

Question 6

Examples of positive symptoms

Answer 6

Hallucinations, delusions, paranoia

Question 7

What is the effect of D2 blockade in the mesolimbic pathway?

Answer 7

Decreased positive symptoms

Question 8

Which dopamine pathway is the PRIMARY therapeutic target of antipsychotics?

Answer 8

Mesolimbic pathway

Question 9

What symptoms are associated with LOW dopamine in the mesocortical pathway?

Answer 9

Negative and depressive symptoms

Question 10

Examples of negative symptoms

Answer 10

Avolition, anhedonia, flat affect, social withdrawal

Question 11

How do serotonin-dopamine antagonists (SDAs) affect this pathway?

Answer 11

They increase dopamine → improve negative symptoms

Question 12

Why can typical antipsychotics worsen negative symptoms?

Answer 12

They further decrease dopamine in the mesocortical pathway

Question 13

What is the primary function of the nigrostriatal pathway?

Answer 13

Motor movement

Question 14

What happens when dopamine is blocked in the nigrostriatal pathway?

Answer 14

Acetylcholine (ACh) increases

Question 15

Increased acetylcholine in the nigrostriatal pathway causes what?

Answer 15

Extrapyramidal symptoms (EPS)

Question 16

Examples of EPS

Answer 16

Dystonia, parkinsonism, akathisia

Question 17

Long-term D2 blockade in the nigrostriatal pathway can cause what?

Answer 17

Tardive dyskinesia

Question 18

Why do atypical antipsychotics cause fewer EPS?

Answer 18

5-HT2A blockade increases dopamine → decreases acetylcholine

Question 19

EPS are caused by:

Answer 19

Increased acetylcholine due to dopamine blockade

Question 20

What is the normal role of dopamine in the tuberoinfundibular pathway?

Answer 20

Dopamine inhibits prolactin

Question 21

What happens when D2 receptors are blocked in the tuberfundibular pathway?

Answer 21

Prolactin levels increase

Question 22

What is the condition called when prolactin levels increase?

Answer 22

Hyperprolactinemia

Question 23

Symptoms of hyperprolactinemia

Answer 23

Amenorrhea
Galactorrhea
Sexual dysfunction
Gynecomastia
Osteoporosis

Question 24

A patient on antipsychotics develops galactorrhea and low libido. Which pathway is affected?

Answer 24

Tuberoinfundibular pathway

Question 25

Why are postmenopausal women at special risk with elevated prolactin?

Answer 25

Bone demineralization (osteoporosis)

Question 26

Which dopamine pathway explains EPS from antipsychotics?

Answer 26

Nigrostriatal

Question 27

Which dopamine pathway explains sexual dysfunction from antipsychotics?

Answer 27

Tuberoinfundibular

Question 28

Which pathway explains why atypical antipsychotics improve negative symptoms?

Answer 28

Mesocortical

Question 29

If you remember ONE thing about dopamine pathways for ANCC, what is it?

Answer 29

Same drug, four pathways — benefit in one, side effects in the others

Question 30

Why do atypical antipsychotics cause fewer EPS than typicals?

Answer 30

5HT2A blockade increases dopamine in the nigrostriatal pathway → ↓ ACh

Question 31

EPS are caused by increased levels of which neurotransmitter?

Answer 31

Acetylcholine

Question 32

Why do typical antipsychotics worsen negative symptoms?

Answer 32

They block dopamine in the mesocortical pathway

Question 33

Which dopamine pathway explains hyperprolactinemia?

Answer 33

Tuberoinfundibular pathway

Question 34

Dopamine normally does what to prolactin?

Answer 34

Inhibits prolactin release

Question 35

Galactorrhea and gynecomastia are caused by dysfunction in which pathway?

Answer 35

Tuberoinfundibular pathway

Question 36

Which pathway is responsible for the therapeutic effects of antipsychotics?

Answer 36

Mesolimbic pathway

Question 37

Mesolimbic Pathway is most associated with what and is triggered when?

Answer 37

The most commonly associated pathway for dopamine is triggered whenever the body experiences pleasurable stimuli. like food or sex. Too much dopamine in this region --> psychotic symptoms

Question 38

What is the mesocortical pathway used for?

Answer 38

Used with results including decision-making, memory and focus

Question 39

What happens in the nigrostriatal pathway?

Answer 39

Used in motor planning; around 80% of dopamine in the brain is used in this pathway

Question 40

What happens in the tuberoinfundibular pathway?

Answer 40

Dopamine in this pathway is used to inhibit prolactin release, a hormone that affects the pituitary system and can stimulate breast milk production Low dopamine --> increases prolactin