CNS Stimulants Flashcards
What are some stimulants for ADHD?
- Amphetamine, Dextroamphetamine
- Lisdexamfetamine
- Methylphenidate, dexmethylphenidate
What are some non-stimulants for ADHD?
- Atomoxetine
- Guanfacine
- Clonidine
What do stimulants do?
- Enhance neurotransmitter transmission by serving as direct and indirect non-catecholamine sympathomimetics
What is the MOA of stimulants?
- Block presynaptic reuptake
- Interference with vesicular monoamine transporter (VMAT)
- Increase in neurotransmitter release (NE, then DA, then 5-HT each at increasing doses)
Which isomers of AMP/MPH are more CNS active?
- D-isomers over mixed or L-isomers
What is the main activity of methyphenidate?
- Inhibition of DA reuptake and inhibition of neurotransmitter presynaptic reuptake
Does MPH stimulate neurotransmitter release?
- MPH
What are some side effects of stimulants?
- Dyspepsia/GI distress (N/V)/ Abdominal pain
- Headache
- Decreased appetite (weight loss and reduced growth progression)
- Insomnia
- Anxiety/Jitteriness
- Irritability/Aggression/Agitation
- Elevated BP/HR
What are some rare side effects of stimulants?
- Priapism
- Seizures
- Sudden cardiac death
- Stroke and MI
- Chemical leukoderma
What are some formulation abbreviations?
- Immediate release (IR)
- Extended release (ER & XR)
- Long acting (LA)
- Controlled delivery (CD)
- Oral disintegrating tablet (ODT)
What are some cautions when using stimulants?
- Marked anxiety and agitation
- Symptomatic CV disease
- Moderate-to-severe HTN
- Glaucoma
- Motor tics or family history/diagnosis of Tourette’s syndrome
- Ineffectively treated Bipolar/psychoses
- Poorly controlled seizures
- History of drug abuse
When is the onset of stimulants?
- Usually 24 hours
What are some adverse effects of - Dextroamphetamine/AMP/Adderall, Dextroamphetamine sulfate/ProCentra, Amphetamine sulfate/Evekeo, and Dextroamphetamine/Zenzedi ?
- Headache
- Insomnia
- Circulation problems
- Decreased appetite
- Slowing of growth
- New psychotic problems
- Nervousness
- Dizziness
- Diarrhea
- Constipation
- Increased tics
- Stroke and MI
- Increased BP/HR
- Mood changes
- New or worse bipolar illness
- Aggressive behavior
- Runny nose
- Dry mouth
- High potential for misuse and abuse
What is the form and duration of dextroamphetamine/AMP/Adderall?
- Tab
- 4-6 hours
What is the form and duration of dextroamphetamine sulfate/ProCentra?
- Liquid
- 4-6 hours
What is the form and duration of amphetamine sulfate/Evekeo?
- Cap
- 4-6 hours
What is the form and duration of dextroamphetamine/Zenzedi?
- Tab
- 4-6 hours
What are some immediate release forms of amphetamine-based stimulants?
- Dextroamphetamine/AMP/Adderall
- Dextroamphetamine sulfate/ProCentra
- Amphetamine sulfate/Evekeo
- Dextroamphetamine/Zenzedi
What are some extended release forms of amphetamine-based stimulants?
- Dextroamphetamine/Adderall XR
- Dextroamphetamine/Dexedrine
- Amphetamine/Dyanavel XR
- Lisdexamfetamine/Vyvanse
- Amphetamine/Mydayis
What is the form and duration of Dextroamphetamine/Adderall XR?
- CAP
- 8-12 hours
What is the form and duration of Dextroamphetamine/Dexedrine?
- Cap
- 8-10 hours
What is the form and duration of Amphetamine/Dyanavel XR?
- Liq
- 13 hours
What is the form and duration of Lisdexamfetamine/Vyvanse?
- Cap
- 10-12 hours
What is the form and duration of Amphetamine/Mydayis?
- Cap
- 16 hours
What is a non-IR form of amphetamine?
- Adzenys XR-ODT
- 3:1 ration of d-amphetamine and l-amphetamine isomers
- QD dosing
What is the form and duration of dexmethylphenidate/Focalin?
- Tab
- 4-6 hours
What is the form and duration of Methylphenidate/Methylin oral solution?
- Liq
- 3-4 hours
What is the form and duration of methylphenidate/Ritalin?
- Tab
- 3-4 hours
What are some immediate release methylphenidate based stimulants?
- Dexmethylphenidate/Focalin
- Methylphenidate/Methylin oral solution
- Methylphenidate/Ritalin
What are some sustained release methylphenidate based stimulants?
- Methylphenidate/Ritalin-SR
- Methamphetamine/Desoxyn
What is the form and duration of Methylphenidate/Ritalin- SR?
- Tab
- 4-8 hours
What is the form and duration of Methamphetamine/Desoxyn?
- 4-8 hours
What are some extended release methylphenidate based stimulants?
- Methylphenidate/Aptensio XR
- Methylphenidate HCl/Concerta
- Methylphenidate ER/ Cotempla XR-ODT
- Methylphenidate transdermal/Daytrana
- Dexmethylphenidate HCL/Focalin XR
- Methylphenidate HCl/Metadate CD
- Methylphenidate HCL ER/Ritalin LA
- Methylphenidate HCl/Quillichew
- Methylphenidate/ Quillivant XR
What is the form and duration of Methylphenidate/Aptensio XR?
- Cap
- 12 hours
What is the form and duration of Methylphenidate HCL/Concerta?
- Tab
- 10-12 hours
What is the form and duration of Methylphenidate ER/Cotempla XR-ODT?
- Tab
- 12 hours
What is the form and duration of Methylphenidate transdermal/Daytrana?
- Transdermal patch
- 10-12 hours
What is the form and duration of Dexmethylphenidate HCl/Focalin XR?
- CAP
- 6-10 hours
What is the form and duration of Methylphenidate HCl/Metadate CD?
- Cap
- 8-10 hours
What is the form and duration of Methylphenidate HCl ER/Ritalin LA?
- Cap
- 8-10 hours
What is the form and duration of Methylphenidate HCl/Quillichew?
- Chewable tablet
- 8 hours
What is the form and duration of Methylphenidate/Quillivant XR?
- Liq
- 8, 10, 12 hours
What is the main effect of non-stimulants for ADHD?
- Enhance neurotransmitter transmission via inhibition of NE presynaptic reuptake or agonists of CNS alpha2a adrenergic receptors
What do the agonists of the alpha2a adrenergic receptors do?
- Modulate noradrenergic tone in PFC by enhanced noradrenergic input from locus coeruleus
- Direct postsynaptic stimulation of alpha2a receptors located on dendritic spines of cortical pyramidal cells, thereby directly promoting functional connectivity of PFC networks
What is the onset of non-stimulants?
- 1-4+ weeks
Who is most likely to receive non-stimulants?
- Patients intolerant of stimulant effects or parents/patients resistant to using stimulant class
What is the form and duration of atomoxetine/Strattera?
- Cap
- 24 hours
What are some adverse effects of atomoxetine/Strattera?
- Nervousness
- Sleep problems
- Fatigue
- Upset stomach
- Dizziness
- Dry mouth
Why should you not open atomoxetine capsules?
- It is an ocular irritant
What is the form and duration of clonidine/Kapvay ER?
- Tab
- 12-24 hours
What is the form and duration of guanfacine/Intuniv ER?
- Tab
- 12-24 hours
What are some examples of antihypertensives?
- Clonidine
- Guanfacine
What are some adverse effects of clonidine and guanfacine?
- Fatigue
- Drowsiness
- Dizziness
- Dry mouth
- Decreased appetite
- Constipation
- Irritability
- Low BP
