Gyógyszerészet 2020. május

A pszichiátriai kórképek és ezen belül a szkizofrénia hatékony gyógyszeres kezelése több mint hatvan éve áll a gyógyszerkutatás homlokterében. Az elmúlt évtizedekben számos hatásmechanizmus-megközelítéssel próbálkoztak a fejlesztők és értek el eredményeket a kórkép tüneteinek enyhítésében. Az elmúlt húsz év hazai eredeti gyógyszerkutatásának kiemelkedő sikere a kariprazin, amely egy új atípusos antipszichotikum és amely az eddigi megközelítésektől különböző hatásmechanizmusa révén eltérő hatáskvalitást és funkcionális javulást hozott a pszichiátriai kórképben. Az új biológiai célpont a dopamin D₃-receptor altípusa. Lapunk egy korábbi száma 2016-ban (Domány Gy, Krámos B. Dopamin D₃-receptoron ható atípusos antipszichotikumok – szerkezet-hatás összefüggések. Gyógyszerészet. 2016;60(6):334-8.) foglalkozott már ennek a receptor altípusnak a szerkezet-hatás összefüggéseivel, a kariprazinról pedig 2015-ben (Laszlovszky I, Németh Gy. Kariprazin – mérföldkő a magyar gyógyszerkutatásban és egyedülálló lehetőség a negatív szimptómás skizofrén betegek kezelésére. Gyógyszerészet. 2015;59(11):643-6.) jelent meg közlemény. A most megjelenő, széleskörű összefoglaló a dopamin D₃-receptor altípusnak a farmakológiai és hatásmechanizmus rejtelmeibe kíván bepillantást adni az olvasónak. Kiss Béla és munkatársainak közleményét terjedelmi okokból két részben közöljük. Az első rész a Gyógyszerészet 2020. áprilisi számában olvasható.

IRODALOM

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Kiss B., Laszlovszky I., Krámos B.: Dopamine D₃ receptors and antipsychotics – Aspects of mechanism of action and pharmacological properties – part II.

Disturbance of brain dopaminergic system is thought to play major role in the symptoms of schizophrenia (positive, negative symptoms and cognitive deficits). Current antipsychotics display affinities to wide range of receptors but their primary target in schizophrenia therapy are thought to be dopamine D₂ receptors. Dopamine D₃ receptors which belong to the D₂-type dopamine receptor family have special distribution in the brain and play important roles in several CNS functions. Dopamine D₂– and D₃-receptors demonstrate high degree of structural and functional similarity. Most of the antipsychotics display similar in vitro affinity for dopamine D₂ as well as for dopamine D₃ receptors. Compounds (antagonists, partial agonists) with high affinity and selectivity toward D₃ receptors were developed but did not result in clinically useful antipsychotics. Current antipsychotics demonstrate dopamine D₂ occupancy in the living brain but only few of them (e.g. cariprazine and blonanserin) produced meaningful dopamine D₃ receptor occupancy. We pointed out some factors (e.g. in vitro affinity for D₃ receptors, endogenous concentration of dopamine, in vivo antagonism at dopamine D₂ receptors) which may explain the lack of D₃ occupancy of some antipsychotics. Antipsychotics with high and preferential affinity for D₃ receptors, beside their affinity for dopamine D₂ receptors (exemplified with cariprazine), may possess profile useful for the treatment of not only schizophrenia but for other psychiatric conditions, too. 

Absztrakt

Óriási, már a patikákban is tapasztalható igény jelentkezett a hivatalosan is világjárványt okozó SARS-CoV-2 azonosítására, ezért számos gyártó cég kezdett tesztgyártásba. A vírusfertőzés kimutatásának arany standardja jelenleg a légutakból vett mintákban található vírus RNS azonosítása molekuláris vizsgálatokkal (real time-PCR készülékkel). A PCR-alapú azonosítást helyettesítő, kiegészítő módszerek százai között találunk légúti mintákból nyerhető antigének, illetve szérumból nyerhető humán antitestek kimutatására irányuló teszteket is. Bár világjárványról van szó, országonként eltérő intézkedések és eljárásrendek léptek érvénybe mind a fertőzés megelőzését és kezelését, mind a kórokozó azonosítását illetően. Jelen közlemény¹ a tesztelés lehetőségeire fókuszál, és elsősorban a bizonyítékon alapuló információkat, nemzetközi és hazai szervezetek által tett ajánlásokat veszi figyelembe.

Irodalom

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Miseta, I.: Coronavirus (rapid) tests – what you should know about them as a pharmacist

IRODALOM

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Fritz Á., Tóth M.D., Susánszky É.: Pharmacists as gatekeepers in recognizing depression and preventing suicide – part II.

Hungary has one of the highest suicide rates in the European Union. Since depression is a major risk factor for suicide, the detection and treatment of this mental disorder is an effective way of preventing suicidal behavior. In daily practice, pharmacists often meet patients who are at higher risk of mental health problems. Therefore, as gatekeepers, they can play a key role in preventing depression and suicide. The first part of our article draws pharmacists’ attention to depression and suicide to enable better recognition of verbal and non-verbal signs of these disorders. In the second part, the results of a pilot study are presented. The purpose of the study was to assess the level of stigmatization among pharmacists against depression and their confidence in communication with depressed patients.