ch 31

Question 1

50:50 mix of dextroamphetamine and levoamphetamine

Answer 1

amphetamine

Question 2

amphetamines CNS

Answer 2

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

Question 3

amphetamines works on what neurotransmitter

Answer 3

NE - most effects are due to this

and dopamine

Question 4

heart and amphetamines

Answer 4

increased HR and BP

dysrhythmias, angina and HTN with preexisting heart condition

Question 5

tolerance and amphetamines

Answer 5

regular use - tolerance can develop

Question 6

physical dependence amphetamines

Answer 6

chronic use can produce physical dependence

Question 7

amphetamines and abuse -

Answer 7

potential for abuse due to euphoria

Question 8

amphetamines is a schedule

Answer 8

II

Question 9

adverse effect amphetamines CNS

Answer 9

insomnia

restlessness

Question 10

adverse effects amphetamines weight

Answer 10

weight loss secondary to anorexia

Question 11

adverse effects amphetamines psychosis

Answer 11

excessive use produces a state of paranoid psychosis characterized by hallucinations and paranoid delusions

looks like schitzophrenia

Question 12

what med can be used for amphetamine induced psychosis -

Answer 12

DA receptor blocking agent - Haloperidol

after drug is withdrawn the psychosis usually resolves in a week

Question 13

a disorder characterized by daytime somnolence and uncontrollable attacks of sleep

Answer 13

narcolepsy

Question 14

what can you give in narcolepsy to promote wakefulness

Answer 14

amphetamines

Question 15

Methylphenidate (Ritalin)
used in
works like
schedule

Answer 15

works similarly to amphetamines
schedule II
ADHD and narcolepsy

Question 16

Dexmethylphenidate (Focalin) is used in

Answer 16

ADHD

Question 17

Caffeine is used in

Answer 17

neonatal apnea

promoting wakefulness

Question 18

Modafinil (Provigil) is used in

Answer 18

promoting wakefulness associated with

narcolepsy
shift-work sleep disorder
Obstructive sleep hypopnea syndrome

Question 19

can you take Modafinil (Provigil) with food

Answer 19

decreases rate of absorption but not the extent

Question 20

adverse effects Modafinil (Provigil)

Answer 20

headache
nausea
nervousness
diarrhea
rhinitis
does not disrupt nighttime sleep

Question 21

Modafinil (Provigil) is a schedule

Answer 21

IV

Question 22

Modafinil (Provigil) serious reaction

Answer 22

SJS
erythema multiforme
toxic epidermal necrolysis

signs swelling or rash
fever
or changes in oral mucosa

Question 23

Drug interactions Modafinil (Provigil)

Answer 23

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

Question 24

what is the most common neuropsychiatric disorder of childhood

Answer 24

ADHD

Question 25

What gender is most affected in ADHD

Answer 25

boys is 2-3 x the incidence of girls

Question 26

what age does ADHD usually present

Answer 26

3-7 and often persist on into adulthood

Question 27

what agent is employed most in ADHD

Answer 27

Methylphenidate (Ritalin)

Question 28

characterized by inattention, hyperactivity and impulsivity

Answer 28

ADHD

Question 29

what must be present to diagnose ADHD

Answer 29

must appear before age 7 and be present for at least 6 months

Question 30

does genetics play a role in ADHD

Answer 30

yes, it is significant

Question 31

best treatment plan for ADHD

Answer 31

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

Question 32

first line stimulant drugs for ADHD

Answer 32

methylphenidate (Ritalin) dexmethylphenidate (Focalin) Dextroamphetamine-amphetamine (Aderall) Lisdexamfetamine (Vyvance)

Question 33

Adverse effects of stimulants for ADHD

Answer 33

insomnia growth suppression - take "drug holidays" headache abd pain

Question 34

when stimulant dose is excessive

Answer 34

lethargy | listlessness

Question 35

Nonstimulants approved for ADHD

Answer 35

atomoxetine guanfacine clonidine

Question 36

what schedule is non-stimulants for ADHD

Answer 36

not regulated

Question 37

Atomoxetine (Strattera) max response is seen in

Answer 37

1-3 weeks

Question 38

Atomoxetine (Strattera) metabolism

Answer 38

about 5-10% have an atypical form of CYP2D6 which causes them to metabolize Atomoxetine (Strattera) slowly. Dosage should be reduced in these individuals

Question 39

adverse effects Atomoxetine (Strattera)

Answer 39

``` GI - dyspepsia, n/v, reduced appetite dizziness somnolence mood swings trouble sleeping SI in children and adolescents but not adults ```

Question 40

allergic reactions Atomoxetine (Strattera)

Answer 40

angioneurotic edema

Question 41

growth and Atomoxetine (Strattera)

Answer 41

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

Question 42

Atomoxetine (Strattera) severe risk

Answer 42

small chance of severe liver injury -can progress to liver failure

Question 43

signs of liver injury

Answer 43

jaundice dark urine abd tenderness unexplained flu like symptoms

Question 44

Atomoxetine (Strattera) cardiac

Answer 44

may raise or lower blood pressure hypotension syncope

Question 45

drug interactions for Atomoxetine (Strattera)

Answer 45

inhibitors of CYP2D6 can increase level of Atomoxetine (Strattera) (paxil, prozac and quinidine)

Question 46

what ADHD nonstimulant may cause SI in children and adolescence

Answer 46

Atomoxetine

Question 47

stimulants and breastfeeding

Answer 47

yes no data on non-stimulants