Dementia, ADHD, Narcolepsy, Neuromuscular Disorders

Question 1

Cognitive enhancers

Answer 1

enhance cognition in persons suffering from dementia

symptomatic treatment only

Question 2

cognitive impairment results from

Answer 2

loss of cholinergic neurons and other neurodegeneration

Question 3

cholinesterase inhibitors

Answer 3

cognitive nehancer
may also release ACh

tacrine (no longer available due to hepatotoxicity)
donepezil (causes muscle cramps)
rivastigmine
galantamine

Question 4

side effects of cholinesterase inh

Answer 4

GI symptoms
depression
headache
anxiety
anorexia
donepezil- muscle cramps

Question 5

Memantine

Answer 5

cognitive enhancer
noncompetitive NMDA antagonist

usually coprescribed with AchE inhibitor
dissociative anesthetic at higher dose (like ketamine)

Question 6

side ffects of memantine

Answer 6

agitation
urinary incontinence
insomnia
diarrhea

Question 7

adhd

Answer 7

involves deficits in executivce fxn resulting from dysregulation of cns dopamine and/or noradrenergic systems projecting to frontosubcortical brain regions

Question 8

narcolepsy

Answer 8

excessive sleepiness and frequent daytime sleepiness
may include dream like hallucinations, sleep paralysis, cataplexy

decreased orexin (hypocretin) expression in brain

Question 9

methylphenidate

Answer 9

stimulant used for adhd

Question 10

dexmethylphenidate

Answer 10

more active, d-isomer of methylphenidate

ADHD stimulant

Question 11

d-amphetamine

Answer 11

ADHD and narcolepsy

Question 12

lisdexamfetamine

Answer 12

adhd

-pro drug of d-amphetamine

Question 13

stimulants for adhd/narcolepsy

Answer 13

releases and/or blocks reuptake of norepinephrine and dopamine

causes insomnia, anorexia, weight loss

Question 14

modafinil

Answer 14

narcolepsy
specific for
(armodafinil- active R isomer)

reuptake inhibitors of norepinephrine and dopamine
inc glutametergic activity, decreases GABAergic activity

similar side effect to other stimulants- insomnia, anorexia, weight loss

Question 15

atomoxetine

Answer 15

non stimulant for adhd
NE reuptake inhibitor
suicidal ideation in children and adolescents

Question 16

guanfacine

Answer 16

adhd non stimulants
a2 agonist- binds receptors in prefrontal cortex

side effects: sleepiness, lethargy, GI symptoms, hypotension, impotence

Question 17

spasticity

Answer 17

violent, painful, muscle contractions resulting from dysfunction of descending motor input

caused by trauma, inflammation, MS, cerebral palsy

Question 18

Diazepam

Answer 18

anti spastic drugs
spinal and supraspinal site of action
muscle relaxation through central mechanism- enhances GABAergic transmission

causes sedation and ataxia

Question 19

Baclofen

Answer 19

works at spinal cord
GABAb agonist- metabotropic receptors- G protein
decreases reflexes

causes drowsiness which can be decreased with intrathecal administration

used for spinal cord injury and MS

Question 20

Tizanidine

Answer 20

spinal cord
a2 agonist- reinforces pre and post synaptic inhibition in spinal cord
inhibits nociception

used for when relief of spasticity is most important due to short DOA

side effect drowsiness

Question 21

dantrolene

Answer 21

muscle is site of action
reduces muscle contraction by decreasing Ca release from sarcoplasmic reticulum

causes generalized muscle weakness, hepatotoxicity

antispastic for paralysis, cerebral palsy, MS

Question 22

botulinum toxin

Answer 22

works at muscle
inhibits Ach release from vesicles
injected into muscle
used for local muscle spasm or more general spastic disorders such as cerebral palsy

Question 23

muscle spasm

Answer 23

acute muscle spasm caused by trauma or strain
sedative and/or at level of brain stem or spinal cord
cyclobenzaprine
carisoprodol
orphenadrine

Question 24

cyclobenzaprine

Answer 24

used for muscle spasms
related to TCAs
not for spasm due to cerebral palsy or spinal cord injury

Question 25

carisoprodol

Answer 25

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