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13 Cards in this Set
- Front
- Back
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Main clinical use of stimulants (amphetamines)
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To treat ADHD.
They treat the core symptoms--impulsivity, inattention and motor restlessness. |
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How can a stimulant improve the symptoms of ADHD?
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D-amphetamine reduces activity, inattention and impulsivity in normal adults and children to an extent that is similar to the effects seen in children with ADHD.
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Some drugs for ADHD
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Trade Name
Generic Name Approved Age Adderall dextroamphetamine /amphetamine 3 and older Concerta methylphenidate (long acting) 6 and older Cylert* pemoline 6 and older Dexedrine dextroamphetamine 3 and older Dextrostat dextroamphetamine 3 and older Focalin dexmethylphenidate Metadate ER methylphenidate (extended release) 6 and older Metadate CD methylphenidate (extended release) 6 and older Ritalin methylphenidate 6 and older Ritalin SR methylphenidate (extended release) 6 and older Ritalin LA methylphenidate (long acting) 6 and older *Because of its potential for serious side effects affecting the liver, Cylert should not ordinarily be considered as first-line drug therapy for ADHD. |
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Non stimulant drugs for ADHD
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Atomoxetine (Strattera), a NE reuptake inhibitor.
Extended release alpha2 adrenergic agonists (Guanfacine and clonidine). |
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Other uses for stimulants:
Pharmacological treatment of excessive daytime sleepiness (narcolepsy, idiopathic hypersomnia, obstructive sleep apnea, shift work sleep disorder, etc) |
--Stimulants
--Modafinil (Provigil)--DA uptake inhibitor? --Narcolepsy tx: sodium oxybate (Xyrem) (Gamma-hydroxybutyrate, GHB) |
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Other uses of stimulants
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Historically, stimulants have also been used as appetite suppressants.
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Migraine:
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Headaches that are:
1. unilateral 2. pulsatile or throbbing 3. associated with nausea or vomiting 4. of sufficient intensity to interrupt usual daily activities 5. usually lasting 4-72 hours if left untreated Presence of prodrome or aura distinguishes migraine from other types of headaches Epidemiology: Affects 18% of women and 6% of men Dietary triggers: 20% |
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Pathophysiology of migraines
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-vascular theory used to be dominant
-neurogenic inflammation seems to provide a better explanation for migraines. |
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Pharmacotherapy of migraine:
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When symptoms are not severe and there is no vomiting, NSAIDs
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Treatment of severe migraine:
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-Triptans (5-HT 1B/1D agonists)--sumatriptan (Imitrex), frovatriptan (Frova--longer acting)
-Dihydroergotamine |
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Triptans
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--5-HT 1B/1D receptor agonists that inhibit neurotransmitter release
--Best in combination with a NSAID --contraindicated in persons with coronary disease --High cost-some people believe that given alone they may not be significantly better than NSAIDs. --Can be combined with antiemetics --Early intervention is very important |
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Migraine preventative therapy
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--Beta blockers--Propanolol, timolol, metoprolol
--anti-epileptic drugs--valproate (depakote), topiramate (Topamax) --Tricyclic antidepressants--amitriptiline --Behavioral therapies are effective (e.g. relaxation training, EMG biofeedback, cognitive therapy) |
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Migraine Pharmacotherapeutic future
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--CGRP antagonists
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