3. Psychomotor Stimulants Flashcards
Attention Deficit Hyperactivity Disorder (ADHD)
Other names: ____ Syndrome
Attention Deficit Disorder (ADD)
Minimal Brain Dysfunction with Hyperactivity
Signs / Symptoms
- increased ____ activity
- impaired ____
- ____ attention span
- easy ____
- ____ behavior
- learning ____
____ does not always occur in ADHD.
hyperkinetic
motor coordination short distractibility impulsive disability
hyperactivity
ADHD
Etiology
Unknown. May be related to deficiency in brain ____.
ADHD estimated to affect 5% of children & 2.5% of US adults.
Association between ADHD and earlier-onset substance abuse; ____ not proven.
catecholamines
causation
ADHD
Drug Therapy
Appears to be successful in approximately ____% of cases.
By increasing the ability to concentrate and perform a task, selected drugs seem to ____ the patient during work projects.
2011: >52 million Rxs ADHD meds / ____% inc from 2010.
75
calm
10
ADHD
CNS Stimulants
Caffeine: ____
Amphetamines = ____ > pemoline
Other:
Antidepressants:
– ____:
imipramine & desipramine have some efficacy but are toxic
– ____ Inhibitors:
efficacy = amphetamine & methylphenidate but are too toxic
Barbiturates: ____ (+ paradoxical ____)
Clonidine: useful in ____ cases
ineffective
methylphenidate
tricyclic
MAO
ineffective
excitation
limited
ADHD
1. Caffeine Does not appear to be \_\_\_\_ in ADHD. At doses > \_\_\_\_ mg / day, 'caffeinism' may occur with symptoms such as: \_\_\_\_ Headache \_\_\_\_ Increased muscle tension
Caution in pts with diabetes: may cause unacceptable ____.
effective
500
anxiety
insomnia
hyperglycemia
ADHD
- Amphetamines
Amphetamine; methamphetamine (DESOXYN).
Powerful ____ stimulants.
____ mg, p.o., will produce a significant increase in CNS activity in the non-tolerant person.
Tmax of dextroamphetamine approximately ____ hrs.
Mechanisms of action: a. Major: \_\_\_\_ stimulation of CNS via: 1) promote release of \_\_\_\_ from pre-synaptic storage sites 2) inhibit re-uptake of released \_\_\_\_ at pre-synaptic membrane
b. Minor
1) ____ stimulation of post-synaptic adrenergic receptors
2) inhibition of ____
CNS 5-10 3.5 indirect catecholamines re-uptake
direct
MAO
Amphetamines
Uses \_\_\_\_: short-term (only 4-8 weeks) \_\_\_\_ Ø excessive sleepiness Ø sleep 'attacks' Ø sleep paralysis \_\_\_\_
weight loss
narcolepsy
ADHD
Amphetamines
ADRS
Acute \_\_\_\_ Elevated blood pressure \_\_\_\_ Anorexia
____
Gilles de la Tourettes Syndrome (involuntary tics): motor: ____, body, limbs
verbal: ____, phrases (may be obscene)
appears to be related to excessive central ____ activity
Chronic
Same as acute plus:
____ weight gain: inhibits growth of children Psychological dependence
Development of significant ____ & physical dependence (addicts may use from 1-2 grams per day!)
Toxic ____
tachycardia insomnia tachyphylaxis head words DA
decreased
tolerance
psychosis
Amphetamines
ADDERALL
____ formulation. Combines neutral sulfate salts of ____ and amphetamine, with the dextro isomer of ____ and d,l-amphetamine aspartate monohydrate.
immediate release
dextroamphetamine
amphetamine saccharate
Amphetamines
ADDERALL XR
____ daily extended-release, single-entity amphetamine product [same as Adderall regular tablets].
Adderall XR capsule contains ____ types of drug-containing beads designed to give a ____-pulsed delivery of amphetamines, which prolongs release of amphetamine from Adderall XR compared to the conventional ADDERALL ® immediate-release) tablet formulation.
once
two
double
Amphetamines
ADDERALL XR
• There are adults with ADHD. Does that mean chronic therapy? ____.
• Amphetamines are not ripping apart tissues. The more that a drug acts like a ____ product,
the less ripping apart. Alcohol degenerates cardiac muscle and skeletal muscle and brain tissue.
- Amphetamines, on the other hand does not have too much ____ damage - Someone could be on these for a ____.
yes
natural
pathologic
lifetime
Lisdexamfetamine dimesylate (Vyvanse®) CII
Prodrug of ____.
Does not bind to ____ reuptake sites.
Converted to dextroamphetamine and l-lysine primarily in ____
due to the hydrolytic activity of ____. Significant hydrolysis
even at low ____ levels (33% of normal).
T1⁄2 < ____ hr
ADHD
Moderate to Severe Binge Eating Disorder (BED)
Safety and effectiveness for Tx of ____ have not been
established.
NOT indicated for ____.
Use of other sympathomimetic drugs for weight loss has been
associated with serious ____ adverse events.
Prior to treatment, assess for presence of ____ disease
Severe renal impairment: Maximum dose is ____ mg/day
End stage renal disease (ESRD):
Maximum dose is ____ mg/day
dextroamphetamine NE and DA blood RBCs hematocrit
1
obesity
weight loss
cardiac
50
30
ADHD Initial dose: \_\_\_\_ mg every morning Titration schedule: \_\_\_\_ mg weekly Recommended dose: \_\_\_\_ mg per day Maximum dose: \_\_\_\_ mg per day
30
10 or 20
30 to 70
70
BED
Initial dose: ____ mg every morning
Titration schedule: ____ mg weekly
Recommended dose: ____ mg per day
Maximum dose: ____ mg per day
30
20
50 to 70
70
Warnings/Precautions
Serious Cardiovascular Reactions: ____ in children and adolescents with serious heart problems, as well as sudden death, stroke, and myocardial infarction in adults reported. Avoid use in patients with known structural cardiac ____,
cardiomyopathy, serious heart ____, or coronary artery
disease.
BP and Heart Rate Increases: Monitor ____ and pulse.
Consider benefits and risks before use in patients for whom ____ increases may be problematic
sudden death
abnormalities
arrhythmia
blood pressure
blood pressure
