Stimulants

Question 1

Cocaine

Answer 1

Indirect D Agonist (+NE/5HT) -> inc BP, HR, performance w/ euphoria + addiction + chronic stereotype move/paranoia/psychosis
MI: O2, ASA, NO, BNZ (no BBlock)
Aorta Dissect: BBlock (no ASA)
Chronic: atherosclerosis, dilated cardiomyopathy
Resp: nasal perf, hypersens
CNS: seizure, hemorrhage, addict, sens, tolerance (withdrawal)
Tx Dep: mondafinil, propranolol, baclofen (GABA-B agonist)

Question 2

Mazindol

Answer 2

Cocaine + more NE
Use: obesity
ADE: CV, allergy, D/C, Impotence, Addict
Contra: glaucoma, MOAI, Guanethidine, TCAs

Question 3

Amphetamine [Adderall]

Answer 3

Inc. Dopamine -> stimulate followed by crash
Use: ADHD
ADE: cocaine + memory/learning prob, formication, anorexia, psychosis, inc risk behavior (-> infection)
Preg: premature deliv, placental abruption
Tx OD: AlCl (acidify urine and trap)
!BBW! Abuse Potential
DDI: alk/acid urine, D block (chlorpromazine, haloperidol), dextromethorphan, Digoxin, MAOIs, 2D6 inh/ind

Question 4

Dextro/Meth-amphetamine

Answer 4

Ice/Speed
Made from Ephedrine
CNS Stim > Periph -> high risk abuse

Question 5

Methylphenidate

Answer 5

See Amphetamine
Mild CNS Stimulant
DDI: MAOIs, Alcohol, Phenytoin, Ergot, pseudoephedrine, 2D6 inh/ind

Question 6

Phentermine

Answer 6

Inh. 5HT Reuptake (not an SSRI)
Use: Obesity (short term only)
ADE: inc monoamine, hyperthyroidism, MAOI contra

Question 7

Modafenil

Answer 7

??? but no Dop effect -> low risk abuse
PK: induce microsomal enzyme -> dec OCPs, anticonvul, theophylline
ADE: headaches but NO GI/CV effect

Question 8

Atomoxetine [Strattera]

Answer 8

Inh NE Reuptake
Use: Adult ADHD
ADE: ab pain, induce mania
DDI: albuterol, epi, ergot, pseudoephedrine, 2D6 inh/ind
!BBW! inc risk suicide

Question 9

Ephedrine

Answer 9

Inc NE and D Release
Use: narcolepsy, bronchodilate, depression
ADE: CV (MI), heat stroke

Question 10

Strichnine

Answer 10

Gly Receptor Antagonist -> disinh everything -> ALL CNS Stim!!! -> convulsion
Found pesticides and contaminant street drugs
Tx OD: Diazepam

Question 11

Caffeine

Answer 11

Adenosine Receptor Antagonist + Inc cGMP/cAMP (same messengers as D and NE)
Use: Apnea of Prematurity, Migraine

Question 12

Clonidine/Guanfacine

Answer 12

Alpha2-Agonist (w/ heteroreceptor at PFC) -> improve prefrontal cortical function
Use: Tourette/Tics w/ ADHD
DDI: cyclosporine (C), bupropion (G)
NO Cyp Issues!
ADE: non-specific, paradoxical HTN then HypoTN

Question 13

Haloperidol

Answer 13

1st Gen Antipsychotic, D2 Antagonism
Use: for Tourette/Tics w/o ADHD
PK: need glucuronidation, 2D6, 3A4
DDI: anything interfere with metabolism –> QT prolong