week 8

Question 1

What are some of the different stimulants around the world?

Answer 1

Khat (Cathinone)- used in Africa and the Middle East. Stems and leaves are chewed

Methcanthinone (bath salts) - Used in Russian and US. Synthesized from Khat

Betel Nuts- used in Middle East and Asia. Similar effect of caffeine or nicotine

Question 2

Where is stimulant use a problem?

Answer 2

It is a problem throughout the world but has been particularly a problem in the US.

Question 3

What are the acute effect of stimulants?

Answer 3

Increased energy, heart rate, blood pressure, respiration, and activity. Improved concentration and alertness. Reduces appetite

Question 4

What are the long term effects/consequences of stimulant use disorder?

Answer 4

weight loss, decreased blood flow to tissues and organs, increased heart rate and blood pressure, stroke, heart attack, irritability, paranoia, psychosis, aggression/violence, insomnia, dental erosion

Question 5

What are the symptoms of stimulant withdrawal?

Answer 5

Anhedonia, anergia, depression, loss of motivation, anxiety, vivid dreams, hypersomnia, insomnia, increased appetite, psychomotor agitation, craving.

does not typically require hospitalization or medications (unless there is psychosis)

Question 6

What part of the nervous system is activated with stimulant use?

Answer 6

Sympathetic nervous system

Question 7

What neurotransmitters are involved with stimulant use?

Answer 7

Dopamine and Norepinephrine (sometimes serotonin but to a lesser extent)

Question 8

What is the mechanism of action of cocaine?

Answer 8

Increases dopamine and norepinephrine by blocking re-uptake transporters

Question 9

What are the mechanism of action of amphetamines?

Answer 9

Directly stimulates dopamine and norepinephrine release and blocks re-uptake transporters

Question 10

What are the mechanism of action of methlyphenidate (Ritalin)?

Answer 10

Inhibits the reuptake of norepinephrine and dopamine leading to increased availability of norepinephrine and dopamine at the synaptic space - same as cocaine.

Question 11

What are the causes and risks of stimulant-induced psychosis?

Answer 11

Caused by elevated dopamine. Causes hallucinations, delusions and paranoia. Typically acute and brief but can persist for months.

Question 12

What are the pharmacological effects of cocaine?

Answer 12

Half-life 30-90 min. Effects norepinephrine, dopamine, and serotonin. Blocks reuptake and primarily increases dopamine

Question 13

What are the pharmacological effects of amphetamines?

Answer 13

force the release of norepinephrine, epinephrine & dopamine, block reuptake, and inhibit metabolism of the neurotransmitters

Question 14

What are the naturally occurring stimulants ?

Answer 14

Khat, Ephedra, Betel nut

Question 15

What are most synthetic stimulants derived from?

Answer 15

Khat

Question 16

What are the 3 major symptoms of ADHD

Answer 16

Excessive Motor Activity, Inattention, and Impulsivity

Question 17

What is attention?

Answer 17

it is both the ability to maintain conscious focus AND the ability to inhibit other irrelevant information

Question 18

What part of the brain is most important in maintaining focus and attention?

Answer 18

Prefrontal Cortex

Question 19

What are the major neurotransmitters involved in attention?

Answer 19

Dopamine and Norepinephrine

Question 20

What is the most common behavioral disorder in childhood?

Answer 20

ADHD 8-12% of all children

Question 21

What percentage of children with ADHD continue to have symptoms into adulthood?

Answer 21

30-50%

Question 22

When do characteristics of ADHD usually develop?

Answer 22

Between ages 3-6

Question 23

At what age are symptoms of ADHD usually fully developed?

Answer 23

usually before age 12

Question 24

What is the gold standard for testing ADHD?

Answer 24

There is no gold standard

Question 25

How do you meausure symptoms of severity for ADHD?

Answer 25

Through rating scales

Question 26

What is one of the non-pharmacologic treatment of ADHD?

Answer 26

CBT

Question 27

How fast is the onset of efficacy for stimulants and non stimulants?

Answer 27

Stimulants - within minutes

non-stimulants- days to weeks

Question 28

What are the addiction risks for stimulants and non stimulant medication?

Answer 28

Stimulants- high risk for immediate release

Non-stimulants- low

Question 29

What are the sites of action for stimulants and non stimulants?

Answer 29

Stimulants- Primarily Dopamine and Norepinephrine(some Serotonin)
Non-stimulants- Dopamine, Norepinephrine, Serotonin

Question 30

What are the DEA schedule for stimulants and non stimulants?

Answer 30

Stimulants- schedule 2

Non-stimulant- none are scheduled

Question 31

True or false, stimulants and atomectine (straterra) are FDA approved for the treatment of ADHD

Answer 31

True

Question 32

True or false- anti depressants are FDA approved for the treatment of ADHD

Answer 32

False- but they have been found to be helpful for ADHD

Question 33

What are some ways to asses for stimulant medication misuse?

Answer 33

Relevant questions about history and diagnosis of ADHD as well as treatment history

Previous problems with accelerated dosing and running out of meds early

Taking the medication for reasons other than the primary indication

Using stimulants in the presence of an addiction

Question 34

What are some ways to reduce the risk of abuse of stimulants?

Answer 34

Establish rapport and minimize judgment

Discussion of non-pharmacological approaches to treatment

Regular follow up (weekly and then one month at a time)
Refills require in-office appointment

Get help from other staff/providers for managing difficult patients