Dementia, ADHD, Narcolepsy, Neuromuscular Disorders

Question 1

• used to enhance cognition in persons suffering from dementia
• cognitive impairment results from loss of cholinergic neurons and other neurodegeneration
• symptomatic treatment only, do not affect course of disease

Answer 1

cognitive enhancers

Question 2

tacrine, donepezil, rivastigmine, galantamine

Answer 2

cholinesterase inhibitors, may also release Ach

Question 3

hepatotoxic cholinesterase inhibitor, not available in US

Answer 3

tacrine

Question 4

cholinesterase inhibitor that causes muscle cramps

Answer 4

donepezil

Question 5

• non competitive NMDA antagonist
• typically co prescribed with AchE inhibitor
• dissociative anesthetic at higher doses
• side effects: agitation, urinary incontinence, insomnia, diarrhea

Answer 5

memantine

Question 6

• inattentiveness, overactivity, impulsivity, or a combination
• affects 3-5% of school aged children
• symptoms persist into adulthood in 30-50% of patients
• deficits in executive function resulting from dysregulation of CNS dopamine and/or noradrenergic systems projecting to frontosubcortical brain regions

Answer 6

ADHD

Question 7

• sleep disorder that causes excessive sleepiness and frequent daytime sleepiness
• dream like hallucinations, sleep paralysis, cataplexy
• assoc’d with decreased orexin (hypocretin) expression in the brain
• pathogenesis may be autoimmune

Answer 7

narcolepsy

Question 8

• methylphenidate
• dexmethylphenidate
• d-amphetamine (narcolepsy)
• lisdexamfetamine

Answer 8

stimulants used to enhance attention/wakefulness in ADHD and narcolepsy

Question 9

• release and block reuptake of norepi and dopamine
• cause insomnia, anorexia, weight loss
• can cause leukocytosis, hallucinations, mania, paranoia, cardiac arrhytmia

Answer 9

ADHD/narcolepsy drugs, stimulants

Question 10

• norepi and dopamine reuptake inhibitors, for narcolepsy/ADHD
• increase glutamatergic activity
• decrease GABAergic activity

Answer 10

modafinil, armodafinil

Question 11

• norepinephrine reuptake inhibitor, non stimulant

- black box warning for suicidal ideation in children and adolescents

Answer 11

atomoxetine

Question 12

• extended release for ADHD, non stimulant
• alpha2 agonist, binds in prefrontal cortex and has been theorized to improve delay related firing and prefrontal cortex neurons
• sleepiness, lethargy, GI, hypotension, impotence

Answer 12

guanfacine

Question 13

• violent, painful, involuntary muscle contractions resulting from dysfunction of descending motor input
• caused by trauma, inflammation, or diseases such as MS and cerebral palsy
• sites for treatment: brain, spinal cord, muscle

Answer 13

spasticity

Question 14

• site of action spinal and supraspinal
• enhances GABAergic transmission at GABAa receptors
• side effects sedation and ataxia
• use for all types of spasticity assoc’d with spinal cord lesions, cerebral palsy
• oral or IM administation, duration of action >24 hrs due to active metabolites

Answer 14

diazepam

Question 15

• soa: spinal
• GABAb agonist
• inhibits release of excitatory NTs and increases threshold for excitation, decreasing mono and polysynaptic spinal reflexes
• side effects: drowsiness, insomnia, weakness, dizziness, ataxia, confusion (decreased w/ thecal admin)
• used for spinal cord injuries, MS
• rapidly absorbed after oral dmin, plasma half life 3-4 hours, excreted unchanged in urine

Answer 15

baclofen

Question 16

• soa: spinal cord
• alpha 2 adrenergic agonist
• reinforces pre and post synaptic inhibition in spinal cord, inhibits nociception
• use in time when relief of spasticity is most important
• drowsiness, dry mouth, asthenia, hypotension, hepatotoxicity, visual hallucinations
• route of admin oral
• duration of action 3-6 hours, metabolized by CYP1A2
• concomitant used with CYP1A2 inhibitors contraindicated

Answer 16

tizanidine

Question 17

• soa muscle
• reduces muscle contraction by decreasing calcium release from sarcoplasmic reticulum
• generalized muscle weakness, hepatotoxicity
• for paralysis and hemiparalysis, cerebral palsy, MS
• oral, undergoes hepatic metabolism
• other uses: malignant hyperthermia

Answer 17

dantrolene

Question 18

• soa: muscle
• inhibits Ach release from vesicles
• use for local muscle spasm, cerebral palsy
• injected into muscle
• effects last weeks to several months

Answer 18

botulinum toxin

Question 19

cyclobenzaprine, carisoprodol, orphenadrine

Answer 19

used for muscle spasm caused by trauma or strain

Question 20

structurally related to TCA, no effective for spasm due to cerebral palsy or spinal cord injury

Answer 20

cyclobenzaprine

Question 21

-metabolized into meprobamate, a barbiturate like sedative hypnotic with abuse potential

Answer 21

carisoprodol