Neuro 2 - Carrier - Cns Stimulants

Front 1

Define ADHD

Back 1

Manifests in early childhood with symptoms of hyperactivity, impulsivity, and inattention that affect cognitive, academic, behavioral, emotional, social functioning

Front 2

What are the 1st line drugs for ADHD? 2nd 3rd?

Back 2

1st Line = Stimulants or Atomoxetine

2nd = Alpha-2 Adrenergic Agonist (used when stimulants or amoxetine ineffective) = Clonidine or Guanfacine

3rd = Anti-depressants (=used when other meds ineffective or if there are comorbid conditions) = Bupropion or Tricyclics

Front 3

What are the stimulants used to treat ADHD?

Back 3

Methylphenidate and Amphetamines

Front 4

How long does it take Methylphenidate to begin acting?

Back 4

It has multiple lengths of action

Short acting - effects within 20-60 min, lasts 2-3 hrs.

Long acting available too

Front 5

What drugs have sustained release capsules that can be opened and sprinkled on food?

Back 5

Methylphenidate and Amphetamines

1:1 immediate release : enteric coated

Front 6

Amphetamine stimulants are available in what formulations?

Back 6

Intermediate acting and longer-acting

onset = 20-60 min, lasts up to 10 hrs

Front 7

MOA Amphetamines?

Back 7

Reverse NET and VMAT

Front 8

Why are stimulants like methylphenidate and amphetamines black boxed?

Back 8

For abuse potential an drug dependence

Front 9

What are some of the SEs of Methylphenidate and Amphetamines?

Back 9

Anoreaxia, weight loss, poor growth, sleep disturbance, jitteriness, social withdrawal, development of tics

Front 10

Define Diversion

Back 10

Transfer of meds from pt for whom they were prescribed to someone else (ie looking at you all you adderall-dispensing fiends...)

Front 11

Define Misuse

Back 11

Taking higher drug than prescribed to achieve euphoria

Combining stimulants with elicit drugs and alcohol

Front 12

What are the contraindications for stimulant use?

Back 12

CV disease, HTN, Hyperthyroidism, hypersensitivity to sympathomimetic amines, motor tics or Tourette's, Glaucoma, Agitated states, Anxiety, Hx drug abuse

Front 13

What drug do we need to ask if pt has bene on before prescribing Stimulant methylphenidate or Amphetamine?

Back 13

See if pt has been on MAOI (=Phenylzine) because you can't take MAOI within two weeks of taking a stimulant

Front 14

MOA Atomoxetine?

Back 14

Blocks re-uptake of NE

Front 15

A pt has been on a stimulant amphetamine but developed substance abuse problems. What do we switch them to?

Back 15

Atomoxetine

Front 16

A pt has been on a stimulant amphetamine but developed substance abuse problems. How long do we tell the pt it will take before we see improvement on this new drug?

Back 16

Takes 1-2 weeks for initial response, up to 4 weeks for maximal response

Front 17

What are the SEs of Atomoxetine?

Back 17

weight loss, dec. appetite, Abd pain, Dyspepsia, H, Dizzy, somnolence, irritability, Tics, liver disease

Front 18

Why is Atomoxetine black boxed?

Back 18

Suicidal thinking

Front 19

What are the contraindications for Atomoxetine?

Back 19

Hypersensitivity to it, concurrent use or within 2 weeks of MAOI, Glaucoma, Pheochromocytoma (present or past), severe CV disorders that inc. BP or HR

Front 20

What drug do we need to see if pt has been on in past 2 weeks before prescribing Atomoxetine?

Back 20

MAOI

Front 21

When do we put kids on Alpha-2 Adrenergic Agonists?

Back 21

When kids respond poorly, have SE's or comorbids that mean we can't use Stimulants (CV disease, HTN, Hyperthyroidism, hypersensitivity to sympathomimetic amines, motor tics or Tourette's, Glaucoma, Agitated states, Anxiety, Hx drug abuse)


or Atomoxetine (Hypersensitivity to it, concurrent use or within 2 weeks of MAOI, Glaucoma, Pheochromocytoma (present or past), severe CV disorders that inc. BP or HR)

Front 22

SEs Alpha-2 Adrenergic Agonists?

Back 22

H, Fatigue, Abd pain, sedation

Front 23

T/F: Anti-depressants can be used to treat ADHD

Back 23

TRUE

Front 24

How does the anti-depressant Bupropion work to treat ADHD?

Back 24

Blocks Dopamine re-uptake inhibitors (blocks re-uptake of dopamine and NE)

Front 25

How do Tricyclinc anti-depressants work to treat ADHD?

Back 25

Inhibit re-uptake of NE and serotonin

Front 26

What are the INVESTIGATIONAL ADHD treatments? (ie we prob won't be asked about these)

Back 26

Donepazil, Nicotinic analogues, Modafinil can induce serious dermatologic, psychological SEs

Front 27

In the treatment of Narcolepsy, what drugs can be used to treat daytime sleepiness?

Back 27

Modafinil, Methylphenidate, Amphetamines

Front 28

In the treatment of Narcolepsy, what drugs can be used to treat cataplexy (sudden loss of muscle tone)

Back 28

REM Sleep suppressing drugs (Venlafaxine, Atomoxetine, Fluoxetine, Protriptyline, Clomipramide)
Sodium Oxybate

Front 29

Whats the order of ADHD tx choice in adults?

Back 29

Atomoxetine (try first b/c stimulants are abused)

Stimulants (methylphenidate, amphentamines)

Then: Anti-depressants

Front 30

Whats a major SE of stimulants in adults?

Back 30

sudden unexplained death/CV

Front 31

1st line for narcolepsy tx w/o cataplexy?

Back 31

Modafinil

Front 32

If you have an elderly pt, what drug do you want to choose to treat daytime sleepiness ie narcolepsy?

Back 32

Modafinil

Front 33

Whats second line after Modafenil for narcolepsy tx?

Back 33

Methylphenidate and Amphetamines

Front 34

What do you need to be careful of when using Modafenil in pts for narcolepsy?

Back 34

Be careful in pts with heart disease

Front 35

Abrupt withdrawal of REM sleep-suppressing drugs can lead to what?

Back 35

Status cataplecticus = severe nearly continuous cataplexy that can last up to several hrs

Front 36

Why is sodium oxybate, used to treat cataplexy associated with narcolepsy, black boxed?

Back 36

Potential for Abuse