Cognitive Enhancers

Question 1

Amphetamines

Answer 1

• Pyschostimulant
• Immediate release (Dexedrine)
• Sustaine release (Adderall)
• Enhances DA release and blocks reuptake (methylphenidate and d-amphetamine)
• Enhances NE release (d,l-amphetamine i.e. Adderall XR)

Question 2

Methylphenidate

Answer 2

• Psychostimulant
• Immediate release (Ritalin)
• Sustained-release (concerts and metadate CD)
• Enhances DA release and blocks reuptake

Question 3

Atomoxetine

Answer 3

• Highly selective NE reuptake inhibitor
• Elevates DA in prefrontal cortex (but not in nucleus accumbens or striatum)
• Improves working memory by increase NE
• ONLY FIRST LINE ADHD MED WITH NO ABUSE POTENTIAL; thus only drug approved to treat adult ADHD

Question 4

Galanatamine (Razadyne)

Answer 4

• Inhibits AChE
• Stimulates nicotinic cholinergic neurons to release more stored ACh
• Can increase risk of stomach ulcers, similar to other cholinesterase inhibitors (use NSAIDS with great caution)

Question 5

Rivastigmine (Exelon)

Answer 5

• Inhibits both AChE and BuChE
• Administered twice daily
• Causes more GI problems and muscle weakness than other cholinesterase inhibitors

Question 6

Tacrine (Cognex)

Answer 6

• Anti-cholinesterase
• Short half life
• Many drug interactions
• 2nd line therapy for AD
• May cause liver damage

Question 7

Memantine

Answer 7

• Useful in patients with moderate to severe AD
• Antagonist at the NMDA subtype of glutamate
• Found to help patients in later stages of the disease to maintain additional independence
• Most common adverse effects of memantine are dizziness, headache, constipation, and confusion

Question 8

Ginko biloba

Answer 8

• May have modest benefit for AD patients
• Serious side effects (bleeding, seizures, coma) have been reported with commercial pharmaceutical grade ginkgo biloba preparations

Question 9

Modafinil (Eugeroic)

Answer 9

• Wakefulness enhancer
• Questionable mech of action. Increased release of NE and DA, elevates hypothalamic histamine levels
• Potential abuse in college students

Question 10

Armodafinl

Answer 10

• Wakefulness enhancer

- Questionable mech of action. Increased release of NE and DA, elevates hypothalamic histamine levels

Question 11

Why do stimulants work to treat ADHD?

Answer 11

• Areas of the prefrontal and limbic cortex involved with focusing and maintaining attention and prioritizing behaviors are activated by psychostimulants at low (therapeutic) doses
• Areas of the brain involved in motor activity and arousal get activated at higher (euphoric or toxic) doses