Flashcards in Wek 10 - Chapter 36 Central Nervous System Stimulants and Attention-Deficit/Hyperactivity Disorder Deck (19):
The amphetamine family consists of amphetamine, dextroamphetamine, methamphetamine, and lisdexamfetamine. All are powerful CNS stimulants. In addition to their CNS actions, amphetamines have significant peripheral actions—actions that can cause cardiac stimulation and vasoconstriction. The amphetamines have a high potential for abuse.
ADHD is the most common neuropsychiatric disorder of childhood, affecting 5% of school-age children. The incidence in boys is 2 to 3 times the incidence in girls. Symptoms begin between ages 3 and 7, usually persist into the teens, and often persist on into adulthood. The majority (60% to 70%) of children respond well to stimulant drugs.
In about 30% to 60% of cases, childhood ADHD persists into adulthood. In the United States, about 8 million adults are afflicted, although an estimated 90% are undiagnosed and untreated. Symptoms include poor concentration, stress intolerance, antisocial behavior, outbursts of anger, and inability to maintain a routine. Also, adults with ADHD experience more job loss, divorce, and driving accidents. As in childhood ADHD, therapy with a stimulant drug is the foundation of treatment. Methylphenidate is prescribed most often. About 33% of adults fail to respond to stimulants or cannot tolerate their side effects. For these patients, a trial with a nonstimulant may help. Combining behavioral therapy with drug therapy may be more effective than drug therapy alone.
methylated derivatives of xanthine, hence the family name. These compounds consist of a xanthine nucleus with one or more methyl groups attached. Caffeine, the most familiar member of the family
Amphetamine Sulfate -category
Caffeine - category
Atomoxetine - category
Norepinephrine Uptake Inhibitor
Amphetamine Sulfate - use
prominent effects on mood and arousal. At usual doses, they increase wakefulness and alertness, reduce fatigue, elevate mood, and augment self-confidence and initiative. Euphoria, talkativeness, and increased motor activity are likely. Task performance that had been reduced by fatigue or boredom improves
Amphetamine Sulfate - adverse effects
insomnia, restlessness, weight loss, increase of heart rate and blood pressure, paranoid psychosis.
Amphetamine Sulfate - mechanism of action
release of norepinephrine (NE) and dopamine (DA), and partly by inhibiting reuptake of both transmitters. These actions take place in the CNS and in peripheral nerves. Most pharmacologic effects result from release of NE.
Methylphenidate - use
ADHD and narcolepsy
Methylphenidate - adverse effects
insomnia, reduced appetite, emotional lability, abuse liability
Methylphenidate - mechanism of action
promotion of NE and DA release, and inhibition of NE and DA reuptake
caffeine - use
stimulant effects: neonatal apnea, promote wakefulness, etc
caffeine - mechanism of action
(1) reversible blockade of adenosine receptors, (2) enhancement of calcium permeability in the sarcoplasmic reticulum, and (3) inhibition of cyclic nucleotide phosphodiesterase, resulting in accumulation of cyclic adenosine monophosphate (cyclic AMP). Blockade of adenosine receptors appears responsible for most effects.
caffeine - adverse effect
potential birth defects, dysrhythmias of the heart
Atomoxetine - use
nonstimulant approved for ADHD
Atomoxetine - adverse effects
a selective inhibitor of NE reuptake, and hence causes NE to accumulate at synapses. Although the precise relationship between this neurochemical action and symptom relief is unknown, it would appear that adaptive changes that occur following uptake blockade underlie benefits. Uptake blockade occurs immediately, whereas full therapeutic effects are not seen for at least a week—suggesting that, after uptake blockade occurs, additional processes must take place before benefits can be seen.