Stimulants and attention deficit hyperactivity disorder part 3 Flashcards
Clinical presentation of ADHD
symptoms at age 5-9
six or more symptoms must be present
significant impairment in two or more settings
symptoms documented by parents, teachers, and children
interferes with functioning and development
Symptoms of ADHA
difficulty organizing tasks/activities, does not seem to listen, easily distracted, loses things for activities
Fidgets or squirms
leaves seat, runs/climbs excessively, interrupts
medial prefrontal cortex control might not be fully functional
Methylxanthines indirect acting sympathomimetics
stimulant compounds mimic the effect of endogenous agonists of the sympathetic nervous system
Pharmacology of Methylxanthines
Antagonize adenosine receptors
Inhibit phosphodiesterases: increase cAMP
Increase activity of ryanodine receptor, increasing intracellular Ca
adenosine receptor A1
A1- Gi/o-linked, pre and post synaptic; inhibitory modulation of many neurotransmitters
Located in the cerebral cortex, hippocampus, cerebellum, thalamus, brain stem, and spinal cord
CNS activation: sedation, neuroprotection, anxiolysis, temperature reduction, anticonvulsant activity
Peripheral activation: decreased heart rate, bronchoconstriction
Adenosine receptors A2a, A2b, A3
A2a - Gslinked, vasodilation
A2b- Gs-linked mostly on glial cells
A3- gq-linked, only active in a state of excessive catabolism ex: seizures, stroke, hypoglycemia, not antagonized by methylxanthines
Cocaine
Indirect acting sympathomimetic
Inhibits monoamine transporters NE,5-HT,DA
used as local anesthetic
Pharmacology Amphetamines
Non-selective activation of monoamines (more selective for 5-HT) “psychedelic revivial”
Highly rewarding = abuse potential
Examples of amphetamines
Dextroamphetamine (dexedrine)
Lisdexamfetamines (Vyvanse)
Methylphenidate
Adderall mix of salts : long acting agents \
Use: Narcolepsy, anorexiant/weight loss, ADHD
Non-stimulants for ADHD
Atomoxetine (stratterera), norepinephrine transporter NET (reuptake) inhibitor (for adults)
Bupropion (wellbutrin)
Clonidine(catapres)/ Guafacine (tenex)
Modafinil (provigil) - approved for narcolepsy not ADHD
Nonpharm therapies for ADHD
elimination of artificial food additives, colors and/ or preservatives
EEG biofeedback
Essential fatty acid supplementation
Yoga/massage
Green outdoor spaces
Symptoms of Narcolepsy
Excess daytime sleepiness
Cataplexy/weakening of muscles
Poor quality of sleep
Sleep paralysis
Hypnogogic hallucinations
Treatment of Narcolepsy
Stimulants for sleepiness
Solriamfetol (sunosi)- NET and DAT - treatment of sleep apnea and narcolepsy excessive sleepiness (TONES)
Antidipressants
Xyrem
Pitolisant - Histamine 3 (H3) receptor antagonist
