Pharmacology of CNS Stimulants- Iszard Flashcards
ADHD medications can be divided into what 2 categories?
Stimulants (amphetamine derivatives), Non-Stimulants
what are the stimulant drugs?
Amphetamine, Dextroamphetamine, Lisdexameftamine (pro-drug), Methylphenidate
what are the non stimulants ?
atomoxetine, guanfacine, clonidine
what enhances neurotransmitter transmission by serving as direct and indirect non-catecholamine sympathomimetics
stimulants
stimulants MOA
block presynaptic reuptake, and interferes vesicular monoamine transporter (VMAT) and while increases neurotransmitter release.
stimulants increase neurotransmitter release _ then _ then _ at each increasing dose
NE
DA
5HT
_ isomers of AMP/MPH more CNS activity than _ or _ isomers
D-isomer
L-isomer/Mixed isomers
methylphenidate main activity is to
inhibit DA (dopamine) reuptake and neurotransmitter presynaptic reuptake
MPH does or does not stimulate release of neurotransmitters
does not
side effects of stimulants
dyspepsia, GI distress, decreased appetite (W/L) insomnia, anxiety, irritability, elevated BP/HR
what are the rare side effects of stimulants
Priapism (painful and prolonged errection of the penis)
lowering of the convulsion threshold leading to increased susceptibility to seizures
sudden cardiac death
stroke, MI
chemical leukoderma with daytrana patch
always assess for cardiac structural abnormalities in someone taking _ drugs for ADHD
stimulants
what is chemical leukoderma w/ daytrana patch?
hypopigmentation of the skin associated with the daytrana patch ( stimulant in patch form)
formulation abbreviation for immediate release
IR
formulation abbreviation for extended release
ER and XR
formulation abbreviation for long acting
LA
formulation abbreviation for controlled delivery
CD
formulation abbreviation for oral disintegrating tablet
ODT
in what situations should caution you in using stimulants
anxiety, agitation, symptomatic CV disease, moderate to severe HTN, glaucoma, motor tics, poorly-controlled seizures, abuse disorder
stimulant onset of activity is usually in _ minutes in most patients
20
stimulants are _ substances, MO does allow future dating
controlled
guidelines for the use of ADHD drugs
over the age of 6 is considered reasonable for medication to be a first line treatment- stimulants
dextrotoamphetamine/AMP/Adderall is given in _ form (IR)
TAB
dextroamphetamine sulfate/procentra is given in _ form (IR)
LIQ
amphetamine sulfate is given in _ form (IR)
CAP
dextroamphetamine/zenzidi is given in _ form (IR)
TAB
immediate release stimulants on average have a duration of?
4-6 hours
dextroamphetamin/adderall is given in _ form (ER)
CAP
dextroamphetimine/dexedrine is give in _ form (ER)
CAP
amphetamine/dyanaval is given in _ form (ER/XR)
Liquid
Lisedexamfetamine/vyvanse is given in _ form (ER)
CAP
amphetamine (mixed salts)/mydayis is given in _ form
CAP
dextroamphetamine/adderrall side effects
headache, insomnia, decreased appetite, new psychotic problems
dextroamphetamine sulfate side effects
nervousness, dizziness, constipation, increased TICS, stroke, MI
amphetime sulfate side effects
new or worse bipolar illness, aggressive behavior
dextroamphetamine/zenzidi side effects
runny nose, dry mouth
MOA of atomoxetine
inhibition of NE pre-synaptic reuptake
Guanfacine and clonidine MOA
agonists of CNS a2 adrenergic receptors
modulates NE tone in the PFC
stimulation of adrenergic receptors in the PFC networks
onset of activity for non stimulants
1-4 weeks
when would we use non stimulants in ADHD
if patients are intolerant of stimulant effects or resistant to stimulant class
non-scheduled!
Atomoxetine
duration:
form:
adverse effects:
duration: 24 hrs
form: CAP
AE: suicidal thoughts
clonidine and guanifacine
duration:
form:
AE:
duration: 12-24 hrs
form: TAB
SE: anxiety, irritability, decreased appetites, fatigue/drowsiness
atomoxitine; do not open capsules do to _ irritant
metabolized by?
ocular irritant
CYP2D6
discontinued use of guandacine and clonidine has a risk of?
rebound hypertension
both are anti-hypertensives
