ch 31 Flashcards
50:50 mix of dextroamphetamine and levoamphetamine
amphetamine
amphetamines CNS
wakefulness alertness reduce fatigue elevate mood augment self confidence and initiative
task performance that has been reduced by fatigue or boredom improves
supress appetite and perception of pain
amphetamines works on what neurotransmitter
NE - most effects are due to this
and dopamine
heart and amphetamines
increased HR and BP
dysrhythmias, angina and HTN with preexisting heart condition
tolerance and amphetamines
regular use - tolerance can develop
physical dependence amphetamines
chronic use can produce physical dependence
amphetamines and abuse -
potential for abuse due to euphoria
amphetamines is a schedule
II
adverse effect amphetamines CNS
insomnia
restlessness
adverse effects amphetamines weight
weight loss secondary to anorexia
adverse effects amphetamines psychosis
excessive use produces a state of paranoid psychosis characterized by hallucinations and paranoid delusions
looks like schitzophrenia
what med can be used for amphetamine induced psychosis -
DA receptor blocking agent - Haloperidol
after drug is withdrawn the psychosis usually resolves in a week
a disorder characterized by daytime somnolence and uncontrollable attacks of sleep
narcolepsy
what can you give in narcolepsy to promote wakefulness
amphetamines
Methylphenidate (Ritalin)
used in
works like
schedule
works similarly to amphetamines
schedule II
ADHD and narcolepsy
Dexmethylphenidate (Focalin) is used in
ADHD
Caffeine is used in
neonatal apnea
promoting wakefulness
Modafinil (Provigil) is used in
promoting wakefulness associated with
narcolepsy
shift-work sleep disorder
Obstructive sleep hypopnea syndrome
can you take Modafinil (Provigil) with food
decreases rate of absorption but not the extent
adverse effects Modafinil (Provigil)
headache nausea nervousness diarrhea rhinitis does not disrupt nighttime sleep
Modafinil (Provigil) is a schedule
IV
Modafinil (Provigil) serious reaction
SJS
erythema multiforme
toxic epidermal necrolysis
signs swelling or rash
fever
or changes in oral mucosa
Drug interactions Modafinil (Provigil)
Modafinil (Provigil) inhibits some forms of CYP and induces others
accelerates metabolism of oral contraceptives, cyclosporine, and certain other drugs thereby causing their levels to decline
what is the most common neuropsychiatric disorder of childhood
ADHD
What gender is most affected in ADHD
boys is 2-3 x the incidence of girls
what age does ADHD usually present
3-7 and often persist on into adulthood
what agent is employed most in ADHD
Methylphenidate (Ritalin)
characterized by inattention, hyperactivity and impulsivity
ADHD
what must be present to diagnose ADHD
must appear before age 7 and be present for at least 6 months
does genetics play a role in ADHD
yes, it is significant
best treatment plan for ADHD
drug therapy plus comprehensive treatment plan involving collaboration among clinicians, families and educators.
Stimulants are most effective and agents of choice
nonstimulants are less effective and second line
first line stimulant drugs for ADHD
methylphenidate (Ritalin)
dexmethylphenidate (Focalin)
Dextroamphetamine-amphetamine (Aderall)
Lisdexamfetamine (Vyvance)
Adverse effects of stimulants for ADHD
insomnia
growth suppression - take “drug holidays”
headache
abd pain
when stimulant dose is excessive
lethargy
listlessness
Nonstimulants approved for ADHD
atomoxetine
guanfacine
clonidine
what schedule is non-stimulants for ADHD
not regulated
Atomoxetine (Strattera) max response is seen in
1-3 weeks
Atomoxetine (Strattera) metabolism
about 5-10% have an atypical form of CYP2D6 which causes them to metabolize Atomoxetine (Strattera) slowly. Dosage should be reduced in these individuals
adverse effects Atomoxetine (Strattera)
GI - dyspepsia, n/v, reduced appetite dizziness somnolence mood swings trouble sleeping SI in children and adolescents but not adults
allergic reactions Atomoxetine (Strattera)
angioneurotic edema
growth and Atomoxetine (Strattera)
weight loss and growth delay secondary to anorexia
we don’t know if adult height will be affected
we don’t know if drug holidays will help
Atomoxetine (Strattera) severe risk
small chance of severe liver injury -can progress to liver failure
signs of liver injury
jaundice
dark urine
abd tenderness
unexplained flu like symptoms
Atomoxetine (Strattera) cardiac
may raise or lower blood pressure
hypotension
syncope
drug interactions for Atomoxetine (Strattera)
inhibitors of CYP2D6 can increase level of Atomoxetine (Strattera) (paxil, prozac and quinidine)
what ADHD nonstimulant may cause SI in children and adolescence
Atomoxetine
stimulants and breastfeeding
yes
no data on non-stimulants
