EXAM #3: CNS STIMULANTS

Question 1

What endogenous molecule are most CNS stimulants chemically similar to?

Answer 1

NE

Question 2

What will CNS stimulants increase?

Answer 2

1) Alterness
2) Productivity/ motivation
3) Arousal
4) Euphoria
5) Nervousness and anxiety

Question 3

What will CNS stimulants decrease?

Answer 3

Requirements for:

1) Sleep
2) Food intake

Question 4

What can overdose on CNS stimulants lead to?

Answer 4

• Convulsions

- Death

Question 5

What is an Analeptic?

Answer 5

Respiratory stimulants used to reverse drug-induced CNS depression (esp. post-op)

Question 6

What is the hallmark analeptic?

Answer 6

Doxapram

Question 7

What is the clinical utility of Doxapram?

Answer 7

This is a stimulant used to counteract anesthesia induced respiratory depression

Question 8

What is the MOA of doxapram?

Answer 8

Binds to carotid artery chemoreceptors/ medullary respiratory centers

Question 9

What is the common MOA of the non-doxapram analeptics?

Answer 9

GABA-A antagonists

Question 10

What is a methylxanthine?

Answer 10

Xanthine derivative CNS/ respiratory stimulant

Question 11

List the Methylxanthines.

Answer 11

Caffeine

Theophylline

Question 12

What is the primary clinical indication for caffeine?

Answer 12

Apnea of prematurity

Question 13

What is the clinical indication for Theophylline?

Answer 13

COPD/Asthma

*Drug has bronchodilator properties

Question 14

List the Sympathomimetic Amide stimulants.

Answer 14

Amphetamine analogs:

• Methamphetamine
• Dexamphetamine
• Methylphenidate

Cocaine
Modafinil
Atomoxetine

Question 15

How are the amide psychomotor stimulants metabolized?

Answer 15

1) Monamine oxidase

2) Liver p450

Question 16

What classes of drugs will have adverse drug-drug interactions with the psychomotor stimulants?

Answer 16

MAOI

SSRI

Question 17

What is the duration of action of many psychomotor stimulants? What are the clinical implications?

Answer 17

• Short duration

- Multiple dosing or extended release formulas

Question 18

What is the clinical indication for Modafinil?

Answer 18

Narcolepsy/ sleep disorders

Question 19

What drug is primarily used to treat ADHD?

Answer 19

Methylphenidate (Ritalin)

Question 20

What drug was historically used for weight loss?

Answer 20

Amphetamine

Question 21

How is the drug Orlistat used clinically?

Answer 21

Weight loss

Question 22

What is the MOA of Orlistat?

Answer 22

Lipase inhibitor that decreases GI fat absorption

Question 23

What are the three approved clinical uses for amphetamine?

Answer 23

1) Narcolepsy
2) ADHD
3) Short-term weight loss

Question 24

What risk potential does cocaine have? Why?

Answer 24

Level 5 i.e. highest b/c it stimulates VTA reward pathway

Question 25

What is the MOA of cocaine?

Answer 25

Inhibits DAT i.e. prevents DA reuptake

Question 26

What is the MOA of amphetamine?

Answer 26

1) Taken up into pre-synaptic vesicle by DAT (prevent DA reuptake) 2) Binds/ inhibits VMAT to cause DA release

Question 27

Aside from DAT, what other transporters do cocaine and amphetamine have effects on?

Answer 27

SERT | NET

Question 28

What are the common CNS related side effects of the psychomotor stimulants?

Answer 28

``` Euphoria Dysphoria Insomnia Irritability Tremor Headache Anorexia ```

Question 29

What are the cardiovascular related side effects of the psychomotor stimulants?

Answer 29

MI | CVA

Question 30

What percentage of ADHD patients are the predominant hyperactive/impulse subtype?

Answer 30

10%

Question 31

What percentage of ADHD patients are the predominant inattentive subtype?

Answer 31

30-40%

Question 32

What percentage of ADHD patients are the combined subtype?

Answer 32

50-60%

Question 33

What are the symptoms of ADHD that are common in children with the disorder?

Answer 33

1) Motor hyperactivity 2) Aggressive 3) Low frustration tolerance 4) Impulsive

Question 34

Why are psychomotor stimulants given in ADHD?

Answer 34

Dopamine Deficit Hypothesis of ADHD--esp. in the PFC

Question 35

What drugs are used to treat ADHD?

Answer 35

Methylphenidate Amphetamine salts - Addreall/ Adderall XR Dextroamphetamine

Question 36

What are the non-stimulant drugs that are given for ADHD?

Answer 36

1) Atomoxetine (NE-reuptake blockade) 2) Clonidine (alpha-2 agonist-->increase blood flow to PFC) 3) Modafinil (Activates histamine) Antidepressants - TCA - MAOI - Bupropion

Question 37

Can Modafinil be used in children? Why or why not?

Answer 37

NO--Rash?

Question 38

What are the major side effects of ADHD treatment?

Answer 38

- Decreased appetite/ weight loss | - Insomnia