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Neuro Block 5 > Cognitive Enhancers > Flashcards

Cognitive Enhancers Flashcards

0
Q

What are common misdiagnosis of ADHD?

A

Learning disabilities or mood problems

Difficult children who are just diagnosised are treated

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1
Q

What is ADHD?

A

A development disorder

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2
Q

What are the brain pathways of NE and DA?

A

Norepinephrine:

  1. Locus Coeruleus –> prefrontal cortex (thinking)
  2. LC –> limbic system (emotions)

Dopamine:

  1. Tegmentum –> prefrontal cortex
  2. Tegmentum –> limbic system
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3
Q

What are the two pathways for maintaining and focusing attention?

A

Prefrontal (NE)

Mesocortical (DA)

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4
Q

What happens if you have an altered pathway of NE and DA?

A

Primary and many secondary symptoms of ADHD

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5
Q

What are treatments of ADHD?

A

Psycostimulants - methylphenidate, amphetamines

Atomoxetine

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6
Q

How are amphetamines released?

A

Immediate - Dexedrine

Sustained - Dexedrine spansules, adderall XR

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7
Q

How is methylphenidate released?

A

Immediate - Ritalin

Sustained - concerta and metadate CD

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8
Q

What psycostim also enhances NE release?

A

d,l - amphetamine

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9
Q

Why do stimulants calm the patient?

A

Because in ADHD patients the inhibitory pathways are not working

A stimulant at low doses stimulates only the inhibitory pathway

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10
Q

Why does alcohol work the way it does?

A

It is a depressant but it takes out the inhibitory pathways

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11
Q

What is reverse tolerance?

A

Become sensitive enough they can lower the dose

Can become psychotic with chronic use

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12
Q

What is Atomixetine?

A

Highly selective NE reuptake inhibitor

Also elevates DA in prefrontal cortex but NOT in the nucleus accumbens or the striatum (euphoria)

No abuse potential, not really controlled
Only approved drug to treat adult ADHD

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13
Q

What are some side effects of Atomixetine?

A
  • Difficulties in working memory

- Cholinergic neurons also effected

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14
Q

What is the prevalence of Alzheimer disease?

A

60-90 years of age

1%-40%

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15
Q

What are symptoms of AD from?

A

Destructions of several areas

  1. Nucleus basalis of Meynert (NBM)
    - brain center where many Cholinergic neuron cell bodies originate
    - earliest site of damage
16
Q

What are the two microscopic pathologies?

A

Neurofibrillary tangles

Beta-Amyloid plagues

17
Q

What are neurofibrillary tangles?

A

Structurally incompetent tau protein

Surrounds microtubules and stops movement
Interferes with transport

18
Q

What are beta amyloid peptides?

A

NBM
Overproduced and accumulate in the synapse

Interferes with normal Cholinergic transmission
- memory loss

Damage goes further and then to neocortex

19
Q

What is the treatment of AD?

A

Cannot cure
Cholinesterases inhibitors slow down but only 1yr in 20% of patient

Leads to adverse affects because you are raising ACh everywhere instead of just the places where degeneration has occurred

20
Q

What is Rivastigmine (Exelon)?

A

Inhibits both AChE and BuChE

Twice daily

More GI problems and muscle weakness than others

21
Q

What is Tactine (Cognex)?

A

AChE inhibitor

Short half life –> needs multiple intake –> poor compliance

Many drug interactions (NSAIDs)
May cause liver damag
Second-line treatment

22
Q

What is Galantamine (Razadyne)?

A

Inhibits AChE
Stim nicotinic Cholinergic neurons to release more ACh

Watch out for other drugs (especially NSAIDs)

23
Q

What is Memantine (Namenda)?

A

Moderate to severe AD

Antagonist at NMDA subtype of glutamate receptor

Better in late stages

24
Q

What two drugs have no real evidence in AD?

A

Estrogen
Selegiline
Vitamin E

25
Q

What is Ginko Biloba?

A

Modest benefit for AD

Serious side effects

26
Q

What are Nootropics?

A

“Smart drugs”

Wakeful enhances”

Modafinil and Armodafinil

Increased release of NE and DA
Elevates levels of hypothalamic histamine

Lower abuse potential

27
Q

What are Nootpics (Eureroics) approved for?

A

Treatment of:
Narcolepsy
Shift work sleep disorder
Excessive day time sleepiness associated with obstructive sleep apnea

Neuro Block 5 (20 decks)

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