Psychomotor Stimulants

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Used in management of ADD and to reduce opioid induced sedation of cancer pts

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Psychomotor Stimulants

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Other names for Attention Deficit Hyperactivity Disorder (ADHD)

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- Hyperkinetic Syndrome
- ADD
- Minimal Brain Dysfunction with Hyperactivity

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______ does not always occur in ADHD

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Hyperactivity

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Drug therapy is successful in ___% of ADHD cases

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75%

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ADHD etiology is unknown --> may be related to deficiency in brain ________

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catecholamines

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Ineffective CNS stimulant in treating ADD

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Caffeine

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Drug tx of ADD MOA

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CNS stimulation incs ability to concentrate and perform a task and calm patient during work projects

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At does > 500mg/day Caffeinism may occur with these sxs (4)

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- Anxiety
- H/A
- Insomnia
- Inc muscle tension

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Caffeinism sx's may occur at _____/day

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500mg

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Use of is cautioned in pts with DM --> may cause unacceptable hyperglycemia

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Caffeine

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Amphetamines have lots of _____ so can't prescribe long term

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Tolerance

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Powerful CNS stimulant (5-10 mg po produces effect)

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Amphetamine

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MOA = activate the sympathetic NS in every way possible

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Amphetamines

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Amphetamines MOA (4)

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- Indirectly incs catecholamine release
- Indirectly inhibits re-uptake of released catecholamines at pre-syn membrane
- Directly Stimulates post-syn adrenergic R's
- Inhibits MAO

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Amphetamines major action - indirectly stimulates the CNS via (2)

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- Incs catecholamine release
- Inhibits re-uptake of catechol

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Amphetamines minor MOA

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- Directly stimulates post-syn R's
- Inhibits MAO

Front 17

Short term use of Amphetamines

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Weight loss
(from incs symp's) --> inc HR, BP, lungs, more relaxed, not thinking about eating during fight or flight

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3 uses for amphetamines

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- Weight loss (short term)
- Narcolepsy
- ADHD

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3 characteristics of narcolepsy

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- Excessive sleepiness
- Sleep attacks
- Sleep paralysis

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Amphetamines = tremendous tolerance development (truck drivers 800-1,000 mg/day - normal = 5-10mgs)

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Tachyphylaxis

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Amphetamines ADRS (5)

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- Tachycardia
- HTN
- Insomnia
- Anorexia
- Tourettes

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Psychomotor stimulant that chronically causes decreased weight gain - inhibits growth in kids

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Amphetamines

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Amphetamines ADRs (3)

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- Dec weight gain
- Psychological dependence
- Toxic Psychosis

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Amphetamine with diferent name - combo of salts of dextroamphetamine and amphetamine

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Adderall

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1/day amphetamine
- Has 2 types of drugs beads that give double pulsed delivery

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Adderall XR

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Study in 560 kids of effects of Adderall XR (2)

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- Improvement in sx's, control and quality of life
- Better test scores

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4 week trial of Adderall XR in 248 adults findings (2)

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- Sx improvement --> higher dose = more improvement
- Adult ADHD is underdx and undertx'ed

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Claimed advantages of Adderall XR (3)

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- Rapid onset with or w/o food
- Efficacious throughout day
- Eliminates stigma of in-school dosing

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Methylphenidate = aka

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Ritalin

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Similar to amphetamines but less CNS stimulation and less CV activation
- Major drug of abuse

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Methylphenidate

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Regarded as DOC for ADHD by most docs

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Methylphenidate

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- Similar actions to amphetamines but less intense
- Less growth inhibition
- Motor tics

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Methylphenidate

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Methylphenidate additional uses (2)

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- Depression in geriatrics and stroke pts
- Antagonism of opioid-induced sedation in cancer pts

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Extended release tablet of Methylphenidate

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Concerta

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d-isomer of methylphenidate
- More potent to tx ADHD

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Dexmethylphenidate

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Dexmethylphenidate XR
- For age 6+

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Focalin XR Strength

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Alpha-2 agonist that is used to tx ADHD

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Clonidine

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Clonidine MOA

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- Dec release of catecholamines
(effect is opposite that which appears necessary to tx ADHD)

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Clonidine used in combo with methylphenidate when (3)

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- Prominent aggression
- Family hx of tics
- Severe conduct disorder

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Clonidine ADRs (3)

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- Sedation
- Bradycardia
- Hypotension

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Use of these is limited to pts unresponsive to stimulant therapy for ADHD

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Antidepressants

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Antidepressants used to tx ADHD (2)

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- Imipramine
- Desipramine

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Antidepressants used to tx ADHD ADRs (2)

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- Anticholinergic
- Some potentially fatal --> prolonged QT = arrythmias

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- Selective NE reuptake inhibitor
- FDA approved for all ages (1st nonstimulant to be so)

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Atomoxetine

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Only ADHD drug that is FDA approved approved for adults

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Atomoxetine

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Drug for ADHD that is not a controlled substance - prescription can be filled over the phone

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Atomoxetine

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FDA approved for narcolepsy but estimated 80% prescribed as off label uses

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Modafinil

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Modafinil MOA (used to tx narcolepsy) (less ADRs than psychomotor stimulants)

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- Unknown --> may facilitate glutamate activity and dec release of GABA

Front 49

Study - worked to tx shift-work sleep disorder --> became FDA approved for

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Modafinil

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Used for ADHD but taken off the market b/c of liver toxicity

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Pemoline