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Cassandra's Pharmacology > Module 4 Chapter 31 CNS stimulants/ADHD > Flashcards

Module 4 Chapter 31 CNS stimulants/ADHD Flashcards

1
Q

50:50 mix of dextroamphetamine and levoamphetamine

A

amphetamine

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2
Q

amphetamines CNS

A 
wakefulness
alertness
reduce fatigue
elevate mood
augment self confidence and initiative

task performance that has been reduced by fatigue or boredom improves

supress appetite and perception of pain

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3
Q

amphetamines works on what neurotransmitter

A

NE - most effects are due to this

and dopamine

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4
Q

heart and amphetamines

A

increased HR and BP

dysrhythmias, angina and HTN with preexisting heart condition

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5
Q

tolerance and amphetamines

A

regular use - tolerance can develop

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6
Q

physical dependence amphetamines

A

chronic use can produce physical dependence

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7
Q

amphetamines and abuse -

A

potential for abuse due to euphoria

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8
Q

amphetamines is a schedule

A

II

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9
Q

adverse effect amphetamines CNS

A

insomnia

restlessness

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10
Q

adverse effects amphetamines weight

A

weight loss secondary to anorexia

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11
Q

adverse effects amphetamines psychosis

A

excessive use produces a state of paranoid psychosis characterized by hallucinations and paranoid delusions

looks like schitzophrenia

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12
Q

what med can be used for amphetamine induced psychosis -

A

DA receptor blocking agent - Haloperidol

after drug is withdrawn the psychosis usually resolves in a week

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13
Q

a disorder characterized by daytime somnolence and uncontrollable attacks of sleep

A

narcolepsy

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14
Q

what can you give in narcolepsy to promote wakefulness

A

amphetamines

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15
Q

Methylphenidate (Ritalin)
used in
works like
schedule

A

works similarly to amphetamines
schedule II
ADHD and narcolepsy

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16
Q

Dexmethylphenidate (Focalin) is used in

A

ADHD

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17
Q

Caffeine is used in

A

neonatal apnea

promoting wakefulness

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18
Q

Modafinil (Provigil) is used in

A

promoting wakefulness associated with

narcolepsy
shift-work sleep disorder
Obstructive sleep hypopnea syndrome

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19
Q

can you take Modafinil (Provigil) with food

A

decreases rate of absorption but not the extent

20
Q

adverse effects Modafinil (Provigil)

A 
headache
nausea
nervousness
diarrhea
rhinitis
does not disrupt nighttime sleep
21
Q

Modafinil (Provigil) is a schedule

A

IV

22
Q

Modafinil (Provigil) serious reaction

A

SJS
erythema multiforme
toxic epidermal necrolysis

signs swelling or rash
fever
or changes in oral mucosa

23
Q

Drug interactions Modafinil (Provigil)

A

Modafinil (Provigil) inhibits some forms of CYP and induces others

accelerates metabolism of oral contraceptives, cyclosporine, and certain other drugs thereby causing their levels to decline

24
Q

what is the most common neuropsychiatric disorder of childhood

A

ADHD

25
Q

What gender is most affected in ADHD

A

boys is 2-3 x the incidence of girls

26
Q

what age does ADHD usually present

A

3-7 and often persist on into adulthood

27
Q

what agent is employed most in ADHD

A

Methylphenidate (Ritalin)

28
Q

characterized by inattention, hyperactivity and impulsivity

A

ADHD

29
Q

what must be present to diagnose ADHD

A

must appear before age 7 and be present for at least 6 months

30
Q

does genetics play a role in ADHD

A

yes, it is significant

31
Q

best treatment plan for ADHD

A

drug therapy plus comprehensive treatment plan involving collaboration among clinicians, families and educators.

Stimulants are most effective and agents of choice

nonstimulants are less effective and second line

32
Q

first line stimulant drugs for ADHD

A

methylphenidate (Ritalin)
dexmethylphenidate (Focalin)
Dextroamphetamine-amphetamine (Aderall)
Lisdexamfetamine (Vyvance)

33
Q

Adverse effects of stimulants for ADHD

A

insomnia
growth suppression - take “drug holidays”

headache
abd pain

34
Q

when stimulant dose is excessive

A

lethargy

listlessness

35
Q

Nonstimulants approved for ADHD

A

atomoxetine
guanfacine
clonidine

36
Q

what schedule is non-stimulants for ADHD

A

not regulated

37
Q

Atomoxetine (Strattera) max response is seen in

A

1-3 weeks

38
Q

Atomoxetine (Strattera) metabolism

A

about 5-10% have an atypical form of CYP2D6 which causes them to metabolize Atomoxetine (Strattera) slowly. Dosage should be reduced in these individuals

39
Q

adverse effects Atomoxetine (Strattera)

A 
GI - dyspepsia, n/v, reduced appetite
dizziness
somnolence
mood swings
trouble sleeping
SI in children and adolescents but not adults
40
Q

allergic reactions Atomoxetine (Strattera)

A

angioneurotic edema

41
Q

growth and Atomoxetine (Strattera)

A

weight loss and growth delay secondary to anorexia
we don’t know if adult height will be affected
we don’t know if drug holidays will help

42
Q

Atomoxetine (Strattera) severe risk

A

small chance of severe liver injury -can progress to liver failure

43
Q

signs of liver injury

A

jaundice
dark urine
abd tenderness
unexplained flu like symptoms

44
Q

Atomoxetine (Strattera) cardiac

A

may raise or lower blood pressure
hypotension
syncope

45
Q

drug interactions for Atomoxetine (Strattera)

A

inhibitors of CYP2D6 can increase level of Atomoxetine (Strattera) (paxil, prozac and quinidine)

46
Q

what ADHD nonstimulant may cause SI in children and adolescence

A

Atomoxetine

47
Q

stimulants and breastfeeding

A

yes

no data on non-stimulants

Cassandra's Pharmacology (14 decks)

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