Stimulants and ADHD

Question 1

Where do stimulants act?

Answer 1

D1 receptors in pre-frontal cortex

Question 2

Where is the abuse potential in stimulants?

Answer 2

Weight loss/appetite suppression

Question 3

ADHD Dx Components

Answer 3

Inattentiveness and hyperactivity

Question 4

Which genes/neurotransmitters are responsible in ADHD?

Answer 4

SR, DA, and NE

Maybe GABA and Ach

Question 5

Anatomical Differences in ADHD

Answer 5

Less DA receptors

Less prefrontal cortex activation and some basal ganglia

Question 6

Ritalin MOA

Answer 6

Blocks reuptake of NE and DA
Reduced distractibility
D>L
High first pass - low bioavail

Question 7

Ritalin Side Effects

Answer 7

Nervousness
Insomnia
Weight loss/loss of appetite
Headache
Tics, seizures, weird heartbeat

Question 8

First use of amphetamines

Answer 8

Decongestant

Question 9

Amphetamines

Answer 9

Dextroamphetamine
Amphetamine salts
Vyvanse - prodrug of amphetamine converted after GI tract

Question 10

Amphetamine vs Ritalin MOA

Answer 10

Amph - blocks DA uptake into vesicles/releases DA into cytoplasm - dump DA into synapse
Ritalin - Blocks DAT and reuptake

Question 11

Ritalin vs Cocaine

Answer 11

Both block DAT, but Ritalin has slower clearance and onset is longer
Normal doses - act in prefrontal cortex, not nucleus accumbens (like cocaine)

Question 12

Effects on NE

Answer 12

Suppression of NE neurons in locus coeruleus (midbrain)

Question 13

2nd line ADHD

Answer 13

NDRI - bupropion
NRI - Strattera - adult approved - 3-6w onset
TCAs
Haldol

Question 14

Alpha 2 agonists

Answer 14

More consistent firing of these neurons from locus coeruleus to prefrontal cortex may = better arousal/attention