Cogitive Enhancers - Lichtblau

Question 1

What are the potential uses of cognitive enhancers?

Answer 1

• Attention Deficit (Hyperactivity) Disorder
  
  • ADD
  • ADHD
• Alzheimer disease
• “Smart drug” (nootropics)

Question 2

What are the key characteristics of ADHD?

Answer 2

• Charachterized by co-existence of:
  
  • attentional problems (inattentive)
  • hyperactivity
  • impulsivity
  • each behavior occurring infrequently alone
• Symptoms onset before age 7

Question 3

How should ADHD be diagnosed?

Answer 3

• Complete developmental, mental, nutritional, physical, and psychosocial examination
• Parent & teacher questionnaires
• Psychological evaluation of the child AND family
  
  • IQ testing
  • psychological testing

Question 4

What drugs (classes) are used to treat ADHD?

Answer 4

• Psychostimulants
  
  • Methylphenidate
  • Amphetamines
• Atomoxetine (Straterra)

Question 5

What is the neurochemical action of psychostimulants?

Answer 5

• Enhances DA release and blocks reuptake
• Enhances NE release

Question 6

What are some specific examples of psychostimulant amphetamines used to treat ADHD?

Answer 6

• Dexedrine = immediate release
• Dexedrine Spansules/Adderall XR = sustained release

Question 7

What are some specific examples of psychostimulant methylphenidates used to treat ADHD?

Answer 7

• Ritalin = immediate release
• Concerta/Metadate CD = sustained release

Question 8

Why are CNS stimulants effective in treating ADHD?

Answer 8

These drugs stimulate activation of inhibitory areas that allow the patient to focus (inhibit excitatory stimuli).

-increase underactive inhibitory centers

Question 9

What areas of the brain are activated by psychostimulants at low (therapeutic) doses?

Answer 9

Areas of the prefrontal and limbic cortex involved with focusing and maintaining attention and prioritizing behaviors.

Question 10

What areas of the brain are activated by psychostimulants at higher (euphoric/toxic) doses?

Answer 10

Areas of the brain involved in motor activity and arousal

Question 11

What is the MOA of Atomoxetine (Strattera)?

Answer 11

• Highly selective NE reuptake inhibitor
• Elevates DA levels in the prefrontal cortex
  
  • NOT nucleus accumbens/striatum
• Increase ACh release from post-synaptic neurons in the frontal cortex
  
  • only when alpha1-NE & D₁-DA receptors on post-synaptic membrane are simultaneously activated by NE/DA

Question 12

What is different about ADHD treatment with Atomoxetine (Strattera) compared to psychostimulants?

Answer 12

• No abuse potential
• Not a DEA Schedule II controlled substance
• Only drug approved by the FDA to treat adult ADHD

Question 13

What are the microscopic changes in patients with Alzheimer Disease?

Answer 13

• Neurofibrillary tangles within the neuron cell body
  
  • surround neurons’ microtubules
  • interfere with cell’s ability to eliminate waste from the cell body –> axon terminal
• Beta-amyloid polypetides along axon dentrite are overproduced
  
  • accumulate in synapse and interfere with normal cholinergic neurotransmission

Question 14

What are the macroscopic changes in patients with Alzheimer Disease?

Answer 14

Brain looks like swiss cheese

• large ventricles
• shrunken cortex

Question 15

What is the basic mechanism for all drugs used to treat mild to moderate Alzheimer Disease?

Answer 15

Elevate ACh levels by inhibiting acetylcholinesterase

Question 16

What AD drug inhibits both AChE & BuChE, is administered twice daily, and causes gastrointestinal problems/muscle weakness?

Answer 16

Rivastigmine (Exelon)

Question 17

What AD drug has a short half-life so it needs to be given multiple times per day, has poor compliance because of this, may cause liver damage, also has many drug interactions (esp. NSAIDs), and is the second-line therapy for AD?

Answer 17

Tacrine (Cognex)

Question 18

What AD drug inhibits AChE only, stimulates nicotinic cholinergic neurons to release more stored ACh, should be taken cautiously due to drug interference with elimination from the body, and increases the risk of stomach ulcers so NSAID us is with great caution?

Answer 18

Galantamine (Razadyne)

Question 19

What AD drug is useful in patients with moderate to severe AD, is an antagonist at the NMDA subtype of glutamate receptor, found to help patients in the later stages of the disease maintain additional independence, and has adverse side effects that include dizziness, headache, constipation, and confusion?

Answer 19

Memantine (Namenda)

Question 20

What AD drug may have a modest benefit for patients with AD, but has serious side effects like bleeding, seizures, and coma?

Answer 20

Ginko Biloba

Question 21

What four drugs are sometimes taken for AD, but have insufficient evidence that they improve cognition or function?

Answer 21

1. Vitamin E
2. Selegiline (Eldepryl)
3. Estrogen
4. NSAIDs

Question 22

What are Nootropics?

Answer 22

“Mind Bend/Turn”

Also Known As:

• Smart drugs
• Memory enhancers
• Cognitive enhancers
• Intelligence enhancers

Question 23

What are some examples of Nootropics?

Answer 23

• Supplements
• Piracetam (Nootropil, Nootropyl, Nooracetam)
• Aniracetam (Memotropil, Memodrin, Ampamet, Draganon, Referan)
• Oxiracetam
• Choline
• Ampakines
• Nootropic Vitamins

Question 24

What are Eugeroics?

Answer 24

“Wakefulness Enhancers”

Question 25

What are two examples of Eugeroics? MOA?

Answer 25

• Modafinil (Provigil)
• Armodafinil (Nuvigil)

Increase release of NE & DA

Elevate hypothalamic histamine levels