Lippincott Chapter 16: CNS Stimulants Flashcards
16.1 A young male was brought to the emergency room by the
police due to severe agitation. Psychiatric examination
revealed that he had injected dextroamphetamine
several times in the past few days, the last time being
10 hours previously. He was given a drug that sedated
him, and he fell asleep. Which of the following drugs
was most likely used to counter this patient’s apparent
symptoms of dextroamphetamine withdrawal?
A. Phenobarbital.
B. Lorazepam.
C. Cocaine.
D. Hydroxyzine.
E. Fluoxetine.
Correct answer = B. The anxiolytic properties of benzo-
diazepines, such as lorazepam, make them the drugs of
choice in treating the anxiety and agitation of amphetamine
or cocaine abuse. Lorazepam also has hypnotic proper-
ties. Phenobarbital has hypnotic properties, but its anxio-
lytic properties are inferior to those of the benzodiazepines.
Hydroxyzine, an antihistamine, is effective as a hypnotic,
and it is sometimes used to deal with anxiety, especially if
emesis is a problem. Fluoxetine is an antidepressant with
no immediate effects on anxiety or agitation.
16.2 JM is a 10-year-old male who is sent to a pediatric
neurologist for an evaluation due to receiving poor grades
in class. JM’s parents have recently received complaints
from his teacher that he is performing poorly in school
and he is repeatedly caught not paying attention in
class. Several times a day during class, JM is noted
to be getting out of his chair and socializing with other
students. He has also been getting into fights with some
children, as he is being singled out by others and teased.
JM is given a diagnosis of ADHD with impulsivity and
irritability. Which of the following is the most appropriate
recommendation for management of the ADHD?
A. Clonidine.
B. Caffeine.
C. Dextroamphetamine.
D. Haloperidol.
E. Buspirone.
Correct answer = C. Dextroamphetamine is the only stimu-
lant medication in the list that is approved for ADHD. Certain
symptoms like fighting may improve with haloperidol and
hyperactivity may improve with clonidine, but these agents
would not improve the patient’s academic performance and
the underlying problems.
16.3 JM is a 10-year-old male with ADHD. His symptoms
are currently controlled with an oral psychostimulant.
However, he and his family wish to avoid having to
give a second dose of medication at school. They are
looking for an alternative treatment option that could
be implemented in the morning and last the entire day.
Which treatment option would be best for JM’s needs?
A. Mixed amphetamine salts in immediate-release oral
tablet formulation.
B. Methylphenidate in a transdermal delivery system.
C. Nicotine in a chewing gum formulation for buccal
absorption.
D. Methylphenidate in immediate-release pills.
Correct answer = B. Methylphenidate is also a psychostimu-
lant, and the transdermal (patch) formulation is designed
for once-per-day use to avoid middle of the day dosing.
Immediate-release formulations require dosing at least
twice daily. Nicotine is not indicated for ADHD.
16.4 Which of the following treatments for ADHD is a
controlled substance (DEA Schedule II)?
A. Clonidine.
B. Guanfacine.
C. Atomoxetine.
D. Dexmethylphenidate.
E. Desipramine.
Correct answer = D. Dexmethylphenidate is the only con-
trolled substance on the list and is DEA scheduled II. The
other agents may assist in the management of ADHD but
are not controlled substances.
16.5 Amphetamines are contraindicated in patients with all
of the following conditions except:
A. Cardiovascular disease.
B. Glaucoma.
C. Hypertension.
D. Hyperthyroidism.
E. Obesity.
Correct answer= E. The use of amphetamines in the man-
agement of obesity should be closely monitored. However,
this is an older use of these agents, and there are amphet-
amine analogs that are FDA approved for obesity. The other
conditions are contraindications when considering the use
of amphetamines, because amphetamines may exacerbate
these medical conditions.
16.6 Which of the following agents is considered a first-line
treatment for narcolepsy?
A. Donepezil.
B. Atomoxetine.
C. Clonidine.
D. Temazepam.
E. Modafinil.
Correct answer = E. Modafinil is the only drug listed that
is approved for narcolepsy. Temazepam is indicated for
insomnia, donepezil for Alzheimer’s disease, clonidine for
hypertension, and atomoxetine for ADHD.
16.7 Which of the following is a common adverse effect of
amphetamines?
A. Bradycardia.
B. Somnolence.
C. Constipation.
D. Hypertension.
E. Fatigue.
Correct answer = D. Hypertension is a possible adverse
effect that warrants caution, especially in individuals with
risk factors for increased blood pressure. Amphetamines
cause tachycardia (not bradycardia), insomnia (not som-
nolence), diarrhea (not constipation), and alertness (not
fatigue).
16.8 Which of the following CNS stimulants occurs naturally
and can be found in certain candies?
A. Amphetamine.
B. Clonidine.
C. Modafinil.
D. Caffeine.
E. Atomoxetine
Correct answer = D. Caffeine is a naturally occurring sub-
stance found in cocoa, chocolate, and many forms of tea.
Overuse of cola beverages and other caffeine-containing
products may cause adverse effects, including anxiety and
insomnia, and even increase the risk for seizures.
16.9 TT is a 35-year-old male who is interested in quitting
smoking. In previous quit attempts, he has tried
nicotine gum, the nicotine patch, and the “cold turkey”
method. He has been unsuccessful in each of these
attempts and usually resumed smoking within 4 to
6 weeks. Which of the following may be useful to assist
TT in his attempt to quit smoking?
A. Varenicline.
B. Dextroamphetamine.
C. Lorazepam.
D. Methylphenidate
Correct answer = A. Varenicline is FDA approved as an
adjunctive treatment option for the management of nico-
tine dependence. It is believed to attenuate the withdrawal
symptoms of smoking cessation, though continued obser-
vation is needed to monitor for changes in psychiatric status,
including suicidal ideation. The use of dextroamphetamine,
lorazepam, and methylphenidate will bring the risk of addic-
tion to another substance with abuse potential.
16.10 All of the following drugs are controlled substances
with a risk for drug addiction or dependence except:
A. Armodafinil.
B. Lisdexamfetamine.
C. Dexmethylphenidate.
D. Atomoxetine.
E. Methamphetamine.
Correct answer = D. Atomoxetine is the only agent listed
that is not a controlled substance. All of the other agents are
considered to have a risk for addiction and/or dependence.
