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NMSP Exam 3 > Pharm: CNS Stimulants > Flashcards

Pharm: CNS Stimulants Flashcards

1
Q

Which ADHD drugs are stimulants (amphetamine derivatives)?

A

Amphetamine

Dextroamphetamine

Lisdexamfetamine (pro-drug)

Methylphenidate

Dexmethylphenidate

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2
Q

Which ADHD drugs are non-stimulants?

A

Atomexetine

Guanfacine

Clonidine

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3
Q

What is the MOA of stimulants?

What does that mean in normal words?

A

Stimulants enhance NTM transmission by serving as direct and indirect non-catecholamine sympathomimetics

They block presynaptic reuptake, interfere with VMAT, increase NTM release

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4
Q

What is the main function of methyphenidate?

A

inhibits DA reuptake and inhibits NTM pre-synaptic reuptake

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5
Q

What are the side effects of stimulants?

A

GI distress

HA

decreased appetite

Neuropsychiatric sx (insomnia, anxiety, irritability)

elevated BP/HR

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6
Q

What are rare side effects of stimulants?

A

Priapism

Sz

Sudden cardiac death-ALWAYS assess for cardiac structure abnormalities

Stroke/MI

Chemical leukoderma with Daytrana Patch

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7
Q

Patients with these conditions should use stimulants with caution

A

anxiety/agitation

CV disease, intolderant of elevated BP

HTN

Glaucoma

Tourettes

Bipolar/psychoses

Szs (poorly controlled)

Drug abuse

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8
Q

How fast are the effects of stimulants seen after first dose?

A

24hrs

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9
Q

Are stimulants controlled substances?

A

Yes

Some states allow for 3 month refills, MO allows for future dating

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10
Q

Which form does each immediate release drug come in:

Dextroamphetamine (Adderall)

Dextroamphetamine sulfate

Amphetamine Sulfate

Dextroamphetamine (Zenzidi)

A

Tab

Liq

Cap

Tab

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11
Q

Every extended-release amphetamine-based stimulant comes in cap form except for what?

A

Amphetamine/Dyanavel XR (Liq)

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12
Q

What is Adzenys XR ODT?

A

It is a 3:1 ratio of d-amphetamine and l-amphetamine isomers

XR-ODT = 50% IR and 50% ER

No water necessary and approved for ages 6 and up with QD dosing

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13
Q

Which form does each methyphenidate-based IR drug come in?

Dexmethyphnidate

Methylphenidate/Methylin

Methyphenidate/Ritalin

All the sustained release methylphenidate drugs (Methylphenidate Ritalin and Methamphetamine) are in what form?

A

Tab

Liq

Tab

Tab

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14
Q

Which methylphenidate based stimulatantes XR come in cap form?

A

Methylphenidate

Dexmethylphenidate HCl

Methylphenidate HCl

Methylphenidate HCl ER

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15
Q

Which methylphenidate-based ER stimulants coem in tab form?

A

methylphenidate HCl

Methylphenidate ER

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16
Q

Which methylphenidate based ER stimulants come in patch, chewable, and liq?

A

Patch: methylphenidate transdermal (Daytrana)

Chewable: Methylphenidate HCl

Liq: Methylphenidate

17
Q

What is the main effect of non-stimulants on ADHD?

A

Enhance NTM transmission via inhibition of the NE pre-synaptic reuptake (atomoxetine) or agonize CNS A2a adrenergic receptors (Guanfaceine/Clonidine)

18
Q

What are the two effects of Guanfacine and Clonidine?

A

modulate noradrenergic tone in the Pre-frontal cortex by enhanced noradrenergic input from locus coeruleus

direct post-synaptic stimulation of a2A receptors located on the dendritic spines of cortical pyramidal cells, thereby directly promoting functional connectivity of the prefrontal networks

19
Q

How long does it take for non-stimulants to take effect?

A

1-4 weeks

20
Q

What is the benefit of non-stimulants over stimulants?

A

useful in pt’s intolerant to stimulants

non-scheduled

21
Q

How is Atomoxetine metabolized?

A

via CYP2D6 (poor metabolizers/inhibitors)

Do NOT open capsules as it can irritate eyes

22
Q

What are the side effects of Atomoxetine?

A

nervousness, GI distress, liver injury, suicidal ideation

23
Q

What are the side effects of Clonidine and Guanfacine?

A

fatigue, drowsiness, low BP

Sudden withdrawal can lead to nervousness, anxiety, elevated BP

24
Q

What are common dosing rules with Guanfacine and Clonidine?

A

Do not crush, chew or break tablets

approved for kids 6 and up

QD dosing (HS for clonidine)

Titrate down over 1+ weeks to D/C

NMSP Exam 3 (21 decks)

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