CNS Stimulants

Question 1

What are the three mechanisms of actions of CNS stimulants?

Answer 1

1. Indirect action (release of endogenous monoamines, or inhibition of monoamine uptake
2. Direct action (agonist activation or receptors, antagonists inhibition of modulatory receptors)
3. Enhancement of second messenger signaling pathways

Question 2

What is ADHD

Answer 2

Difficulty sustaining attention, excessive activity and or difficulty controlling age inappropriate behavior

Question 3

What is Binge eating disorder or Obesity

Answer 3

BMI >30

Is characterized by frequent episodes of uncontrolled eating associated with negative physical, psychological, and social effects

Question 4

What is infantile apnea?

Answer 4

Suspension of breathing for longer than 20 seconds or suspension of at least 10 seconds accompanied by bradycardia and oxygen desat

Question 5

What are the 3 types of CNS stimulants?

Answer 5

Monoamine uptake inhibitors
Monoamine releasers
Methylxanthines

Question 6

Of the 3 CNS stimulates, which have the potential for abuse?

Answer 6

Monoamine uptake inhibitors
Monoamine releasers

Question 7

ADHD red flags in ages:

Answer 7

Preschoolers: does not responde to normal praise and punishment
School age children: poor impulse control, poor socialization
Adolescents: impulse control problems and substance abuse
Adults: inability to complete tasks, low stress tolerance

Question 8

What are the two meds for ADHD?

Answer 8

Methylphenidate (Ritalin)
D-Amphetamine (Dexadrine)

Question 9

What is paradoxical about ADHD drugs?

Answer 9

These drugs are amphetamines- stimulants, that cause:
increased vigilance and persistence
Increased attentiveness and concentration
Decreased excessive motor activity

Question 10

What is the mechanism of action for methylphenidate and d-amphetamine?

Answer 10

Indirect agonists (DA, NE, 5-HT)
-Block monoamine uptake into the terminal
-Release monoamines from neuronal stores, and act at trace amine receptors TAAR

Question 11

Which of the two typical ADHD meds has less peripheral effects and more prominent CNS effects? It’s also called psychomotor stimulant

Answer 11

Methyphenidate

Question 12

What is the second line medication for kids who do not responde to drug therapy?

Answer 12

Atomoxetine TCA

Question 13

What are adverse effects of monoamine uptake inhibitors and releasers?

Answer 13

-decreased appetite
-insomnia
-cardiovascular complications
-nervousness and anxiety
-Bruxism
-hyperthermia
-psychosis

** ADDICTION **

Question 14

What are the different formulations of methylphenidate CNS stimulants for ADHD?

Answer 14

Ritalin (immediate release) - half life of 2-3 hours
Daytrana (transdermal) - gives steady state
Concerta (Extended release)
Focalin XR

Question 15

What are the formulations of amphetamines ADHD?

Answer 15

-Aderall and Aderall XR
-Dexedrine and Dexedrine XR
-Vyvanse

The extended release are for ages 6 and older because chewing the tablets could lead to overdose

Question 16

Methylphenidate and D-amphetamine are what schedule of drugs?

Answer 16

Schedule II

Question 17

What are the strategies for different formulations of CNS stimulants?

Answer 17

1. Increase duration of therapeutic effect after single dose - extended release, beads, capsules
2. Decrease risk of overdose and toxicity
3. Decrease risk of diversion
4. Increase market share

Question 18

What are alternative CNS stimulants for ADHD?

Answer 18

Atomoxetine (Strattera)
-SNRI: selective norepinephrine reuptake inhibitor

Guanfacine Extended release
-alpha adrenergic receptor agonist

Question 19

What is the black box warning label for alternative CNS stimulants atomoxetine for ADHD?

Answer 19

Warning label for increased risk of suicidal thoughts among children and adolescents.

Question 20

What are the serious adverse effects of guanfacine extended release?

Answer 20

Bradycardia, hypotension

Question 21

What are the terms for the treatment of obesity of CNS stimulants?

Answer 21

1. BMI > 30
2. Treatment must be short term
3. Only pts with increased medical risk- at risk for diabetes, cardiovascular disease