Scribd Logo
Upload

Welcome to Scribd!

  • 37 views

    CNS II Drug Notes

    Uploaded by

    Erin Young
    ADHD is more common in boys than girls and symptoms usually emerge between ages 3-7. It is characterized by inattention, hyperactivity and impulsivity. Stimulant medications like amphetamines are often used to treat ADHD as they improve focus by increasing dopamine and norepinephrine in the brain. Common side effects include insomnia, appetite suppression and growth delay. Other medications used to treat ADHD include methylphenidate, atomoxetine, tricyclic antidepressants, SSRIs and atypical antidepressants.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as DOCX, PDF, TXT or read online from Scribd

    CNS II Drug Notes

    Uploaded by

    Erin Young
    37 views4 pages
    ADHD is more common in boys than girls and symptoms usually emerge between ages 3-7. It is characterized by inattention, hyperactivity and impulsivity. Stimulant medications like amphetamines are often used to treat ADHD as they improve focus by increasing dopamine and norepinephrine in the brain. Common side effects include insomnia, appetite suppression and growth delay. Other medications used to treat ADHD include methylphenidate, atomoxetine, tricyclic antidepressants, SSRIs and atypical antidepressants.

    Copyright

    © Attribution Non-Commercial (BY-NC)

    Available Formats

    DOCX, PDF, TXT or read online from Scribd

    Did you find this document useful?

    Is this content inappropriate?

    ADHD is more common in boys than girls and symptoms usually emerge between ages 3-7. It is characterized by inattention, hyperactivity and impulsivity. Stimulant medications like amphetamines are often used to treat ADHD as they improve focus by increasing dopamine and norepinephrine in the brain. Common side effects include insomnia, appetite suppression and growth delay. Other medications used to treat ADHD include methylphenidate, atomoxetine, tricyclic antidepressants, SSRIs and atypical antidepressants.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as DOCX, PDF, TXT or read online from Scribd
    Download as docx, pdf, or txt
    37 views4 pages

    CNS II Drug Notes

    Uploaded by

    Erin Young
    ADHD is more common in boys than girls and symptoms usually emerge between ages 3-7. It is characterized by inattention, hyperactivity and impulsivity. Stimulant medications like amphetamines are often used to treat ADHD as they improve focus by increasing dopamine and norepinephrine in the brain. Common side effects include insomnia, appetite suppression and growth delay. Other medications used to treat ADHD include methylphenidate, atomoxetine, tricyclic antidepressants, SSRIs and atypical antidepressants.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as DOCX, PDF, TXT or read online from Scribd
    Download as docx, pdf, or txt
    of 4

    ADHD: more prominent in boys than girls & signs begin to show ages 3-7.

     Characterized by: Inattention, hyperactivity, impulsivity


     ADHD drugs improve hyperactivity and impulsiveness by improving concentration. (stimulants improve attention and focus)
     Principal AEs of stimulants are insomnia and growth suppression. Insomnia is from CNS stimulation & growth suppression is secondary to appetite
    suppression

    Drugs used to treat ADHD:

    Amphetamines

    Classification Amphetamine family


    Drug Names Amphetamine – 50/50 mixture of dextroamphetamine & levamphetamine (equimolar mixtures = racemic)
    Dextroamphetamine – amphetamine w/ extra methyl group; more selective for CNS stimulation, less PNS SE.

    MOA (brief) Works in CNS & periphery (vasoconstriction & cardiac stimulation) Promotes release of NE & D & partially inhibits
    reuptake of both
    Molecular Molecules are mirror images of each other (enantiomers) but have somewhat different properties
    Effects Produced 1. Increased mood & arousal
    2. Increased wakefulness & alertness
    3. Reducing fatigue
    4. Augment self confidence & initiative
    5. Euphoria & talkativeness
    6. Stimulate respiration by stimulating the medullary
    7. Dec appetite by affecting the hypothalamic feeding center
    8. Dec perception of pain
    9. Enhance the effect of morphine and other opioids (mechanism is unknown)
    Adverse Effects CV effects due to release of NE (inc HR, AV conduction, force of contraction, & vasoconstriction); tolerance; physical
    dependence; abuse; CNS stimulation; weight loss; psychosis
    When is it used? ADD/ADHD; Narcolepsy; Obesity
    Specific Agents MOA Adverse Effects Uses/Other
    Methylphenidate Structurally dissimilar from amphetamines Same as amphetamines ADHD/Narcolepsy
    Ritalin but actions are the same. Comes in SD, ID, &
    LD (short, intermediate, long durations)

    Dexmethylphenidate Same as amphetamines; nearly identical to


    Focalin methylphenidate

    Atomoxetine Prevents reuptake of NE (allows it to N/V, dec appetite, dizziness, somnolence, Used in adults and children. #1
    Strattera accumulate in synapse) mood swings, insomnia, urinary retention, non-stimulant for ADHD. Not a
    sexual dysfunction, CV (inc HR & BP), controlled substance. Initial
    suicidal thinking in children response develops slowly 1-3wk
    ADHD drugs (Continued):
    Antidepressants:

    Tricyclic
    Antidepressants
    Drug Names Amitriptyline, Clomipramine, Desipramine, Doxepin, Imipramine, Nortriptyline, Protriptyline, Trimipramine
    MOA 1. Blocks reuptake of NE and 5HT 2. Blocks α1 rec on vessels (orthostatic hypotension) 3. Blocks muscarinic
    rec (anticholinergic response) 4. Blocks histamine rec (sedation) 5. Dec vagal influence & slow conduction
    (bundle of His)
    Dosage/Route Start low go slow. No benefit w/ high aggressive doses b/c of long ½ life. Usually qd dosing. Do not use PRN.
    Individualized dosing; initial response 1-3 wk and maximal response 1-3 months.
    Therapeutic Range Lethal dose is only 8x’s normal daily dose. Death caused by anticholinergic & cardio toxic effects.
    Adverse Effects Orthostatic hypotension; sedation; anticholinergic effects; cardiac toxicity (in overdose); Yawngasm (clomipramine)
    Overdose Gastric lavage followed by activated charcoal. Physostigmine to counteract anticholinergic effects. Give propranolol,
    phenytoin or lidocaine for dysrhythmias
    Drug Interactions MAOIs w/ TCAs can cause severe HTN (b/c of inc NE); Direct acting sympathomimetics (NE); Indirect acting
    sympathomimetics (amphetamine, ephedrine) TCAs dec effect by preventing uptake of these drugs into nerve
    terminals; Anticholinergics; CNS depressants
    When is it used? Depression, insomnia, neuropathic pain, OCD, panic disorder

    SSRIs:

    Therapeutic Selective Serotonin Reuptake Inhibitors


    Classification
    Drug Names Citalopram (Celexa), Escitalopram (Lexapro), Fluoxetine (Prozac), Fluvoxamine, Paroxetine (Paxil), Sertraline (Zoloft)
    MOA Produce selective inhibition of 5HT reuptake ONLY, and thereby intensifies transmission at serotonergic synapses.
    Just as effective as TCAs w/out the sedation, anticholinergic, hypotension, and cardiotoxicity
    Dosage/Route May take a couple of weeks to a month to develop
    Adverse Effects Insomnia, nausea, wt gain, hyponatremia, withdrawal Sx & neonatal withdrawal Sx; serotonin syndrome: begins 2-
    72 hrs after initiation of Tx, s/s –AMS, risk inc w/ concurrent use of MAOI or ritonavir, deaths have occurred; sexual
    dysfunction occurs in 70% of men & women – drugs to overcome can give given (women - yohimbine, buspirone
    bupropion, nefazodone, mirtazapine. Men – sildenafil (Viagra))
    Drug Interactions MAOIs (d/c SSRIs at least 5 weeks before beginning MAOI); Warfarin (b/c Fluoxetine & warfarin are both highly
    protein bound); TCAs; lithium
    When is it used? Depression, OCD, bulimia nervosa, PMDD, & unlabeled uses
    Other Antidepressants:

    Class & Specific Agents MOA Adverse Effects Uses/Other


    5HT/NE Reuptake Inhibitors Like SSRIs, without TCA AE Same as SSRI Depression, anxiety
    Venlafaxine (Effexor)
    Duloxetine (Cymbalta)

    Monoamine Oxidase Inhibitors Monoamine (MAO)converts NE, 5HT, Inc in tyramine can cause severe More dangerous than TCAs or SSRIs
    Isocarboxazid, Phenelzine, & D (monoamine NTs)into inactive hypertensive crisis- tyramine foods: Depression, S: Parkinson’s. DI:
    Tranylcypromine (all non selective) products; MAO is enzyme in liver & yeast, cheeses, sausages; CNS Ephedrine, amphetamine, SSRI, TCA,
    Selegiline (selective for MAO-B) intestine that inactivates tyramine in stimulation, ortho hypotension. s/s S/NRI’s. Lower BP by giving IV
    food. By inhibiting MAO – NE, 5HT, & HTN crisis: HA, tachycardia, phentolamine (short-acting α
    D are increased in availability. palpitations, N/V. adrenergic agonist) or sublingual
    nifedipine

    Atypical Antidepressants
    Bupropion (Wellbutrin) Similar to amphetamines. Unclear Seizures at high doses; HA; agitation; DI: MAOIs
    MOA: blocks D uptake. Suppresses constipation; wt loss; insomnia;
    appetite, inc sexual desire. tachycardia

    Nefazodone Blockade of 5HT & NE reuptake

    Mirtazapine Inc release of 5HT & NE

    Trazodone Weak 5HT reuptake blockade

    You might also like