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Premium member Presentation Transcript Chapter 36: Chapter 36 Central Nervous System Stimulants and Attention-Deficit/Hyperactivity DisorderCNS Stimulants: CNS Stimulants Increase the activity of CNS neurons Enhance the neuronal excitation; a few suppress the neuronal inhibition In sufficient doses, all can cause convulsions Limited clinical applicationsCNS Stimulants and Attention-Deficit/Hyperactivity Disorder: CNS Stimulants and Attention-Deficit/Hyperactivity Disorder Amphetamines Methyphenidate and dexmethylphenidate Methylxanthines Miscellaneous stimulants Attention-deficit/hyperactivity disorder (ADHD)Amphetamines: Amphetamines Pharmacologic effects Central nervous system Cardiovascular system Tolerance With regular use, develops to elevation of mood, suppression of appetite, and stimulation of the heart and blood vessels Physical dependence Abstinence syndrome with abrupt withdrawal Abuse High potential for abuse due to euphoriaAmphetamines: Amphetamines Adverse effects CNS stimulation Weight loss Cardiovascular effects PsychosisAmphetamines: Amphetamines Toxicity Dysrhythmias Hypertension Dizziness Confusion Hallucinations Convulsions Paranoid delusions Coma Palpitations Cerebral hemorrhageAmphetamines: Amphetamines Treatment Chlorpromazine Alpha-adrenergic blocker Diazepam Therapeutic uses ADHD Narcolepsy Obesity (not recommended due to risk for abuse)Amphetamines: Amphetamines Preparations, dosage, and administration Dextroamphetamine sulfate Short duration (Dexedrine, Dextrostat) Long duration (Dexedrine Spansules) Amphetamine/dextroamphetamine mixture Short duration (Adderall) Long duration (Adderall-XR) Methamphetamine (Desoxyn)Methylphenidate: Methylphenidate Trade names Ritalin, Metadate, Methylin, Concerta 50:50 mixture of dextro and levo isomers Preparations, dosage, and administration Short duration Ritalin, Methylin Intermediate duration Ritalin SR, Metadate ER, Methylin ER Long duration Concerta, Metadate CD, Ritalin LAMethylxanthines: Methylxanthines Derivates of xanthine Caffeine Few clinical applications Widespread ingestion for nonmedical purposes Dietary sources Chocolate Desserts Soft drinks Cola nutMethylxanthines: Methylxanthines Mechanism of action Reversible blockade of adenosine receptors Calcium permeability Accumulation of cyclic AMP Low doses Decreases drowsiness and fatigue and increases capacity for prolonged intellectual exertion Increasing doses Nervousness, insomnia, tremors Seizures with very large amountsMethylxanthines: Methylxanthines Pharmacologic effects Central nervous system Heart Blood vessels Bronchi Kidney Reproduction Pharmacokinetics Readily absorbed from the GI tract Achieves peak plasma levels within 1 hour Eliminated by hepatic metabolismMethylxanthines: Methylxanthines Therapeutic uses Neonatal apnea Promoting wakefulness Other applications Acute toxicity Stimulation of the CNS Tachycardia Respiratory stimulation Sensory phenomenaMethylxanthines: Methylxanthines Preparations, dosage, and administration For promoting wakefulness For neonatal apnea Theophylline TheobromineAttention-Deficit/Hyperactivity Disorder (ADHD) in Children: Attention-Deficit/Hyperactivity Disorder (ADHD) in Children Signs and symptoms Inattention Hyperactivity Impulsivity Fidgety Unable to concentrateADHD in Children: ADHD in Children Signs and symptoms (cont ’ d) Unable to wait his or her turn Switches excessively from one activity to another Calls out excessively in class Present prior to age 7 years Present for at least 6 monthsADHD in Children: ADHD in Children Etiology Management overview Cognitive therapy Stimulant drugs Drug therapy I: CNS stimulants Methylphenidate (Ritalin, Concerta, others) Dexmethylphenidate (Focalin) Dextroamphetamine (Dexedrine, others) Amphetamine mixture (Adderall) Pemoline (Cylert)ADHD in Children: ADHD in Children Drug therapy II: atomoxetine Description and therapeutic effects Nonstimulant No potential for abuse Administered once a dayADHD in Children: ADHD in Children Drug therapy II: atomoxetine Adverse effects GI reactions Reduced appetite Dizziness Somnolence Mood swings Trouble sleepingADHD in Children: ADHD in Children Drug therapy II: atomoxetine (cont ’ d) Drug interactions MAO inhibitors (isocarboxazid, phenelzine) CYP2D6 (paroxetine, fluoxetine, quinidine) Role in ADHD therapy Preparations, dosage, and administration Children who weigh less than 70 kg Children who weigh more than 70 kgADHD in Children: ADHD in Children Drug therapy III: antidepressants Tricycle antidepressants Decrease hyperactivity Little effect on impulsivity and inattention Second-line drugs Bupropion (Wellbutrin) Can reduce behavioral symptoms Less effective than stimulants Poses risk of seizure Second-line drugADHD in Adults: ADHD in Adults Drug therapy III: antidepressants 60% of ADHD cases persist into adulthood Symptoms Poor concentration Stress intolerance Antisocial behavior Outbursts of anger Inability to maintain a routine Drug therapy 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Narrated ADHD nelsjaym Download Post to : URL : Related Presentations : Share Add to Flag Embed Email Send to Blogs and Networks Add to Channel Uploaded from authorPOINT lite Insert YouTube videos in PowerPont slides with aS Desktop Copy embed code: (To copy code, click on the text box) Embed: URL: Thumbnail: WordPress Embed Customize Embed The presentation is successfully added In Your Favorites. Views: 41 Category: Education License: All Rights Reserved Like it (0) Dislike it (0) Added: November 23, 2011 This Presentation is Public Favorites: 0 Presentation Description Ch. 36 Comments Posting comment... Premium member Presentation Transcript Chapter 36: Chapter 36 Central Nervous System Stimulants and Attention-Deficit/Hyperactivity DisorderCNS Stimulants: CNS Stimulants Increase the activity of CNS neurons Enhance the neuronal excitation; a few suppress the neuronal inhibition In sufficient doses, all can cause convulsions Limited clinical applicationsCNS Stimulants and Attention-Deficit/Hyperactivity Disorder: CNS Stimulants and Attention-Deficit/Hyperactivity Disorder Amphetamines Methyphenidate and dexmethylphenidate Methylxanthines Miscellaneous stimulants Attention-deficit/hyperactivity disorder (ADHD)Amphetamines: Amphetamines Pharmacologic effects Central nervous system Cardiovascular system Tolerance With regular use, develops to elevation of mood, suppression of appetite, and stimulation of the heart and blood vessels Physical dependence Abstinence syndrome with abrupt withdrawal Abuse High potential for abuse due to euphoriaAmphetamines: Amphetamines Adverse effects CNS stimulation Weight loss Cardiovascular effects PsychosisAmphetamines: Amphetamines Toxicity Dysrhythmias Hypertension Dizziness Confusion Hallucinations Convulsions Paranoid delusions Coma Palpitations Cerebral hemorrhageAmphetamines: Amphetamines Treatment Chlorpromazine Alpha-adrenergic blocker Diazepam Therapeutic uses ADHD Narcolepsy Obesity (not recommended due to risk for abuse)Amphetamines: Amphetamines Preparations, dosage, and administration Dextroamphetamine sulfate Short duration (Dexedrine, Dextrostat) Long duration (Dexedrine Spansules) Amphetamine/dextroamphetamine mixture Short duration (Adderall) Long duration (Adderall-XR) Methamphetamine (Desoxyn)Methylphenidate: Methylphenidate Trade names Ritalin, Metadate, Methylin, Concerta 50:50 mixture of dextro and levo isomers Preparations, dosage, and administration Short duration Ritalin, Methylin Intermediate duration Ritalin SR, Metadate ER, Methylin ER Long duration Concerta, Metadate CD, Ritalin LAMethylxanthines: Methylxanthines Derivates of xanthine Caffeine Few clinical applications Widespread ingestion for nonmedical purposes Dietary sources Chocolate Desserts Soft drinks Cola nutMethylxanthines: Methylxanthines Mechanism of action Reversible blockade of adenosine receptors Calcium permeability Accumulation of cyclic AMP Low doses Decreases drowsiness and fatigue and increases capacity for prolonged intellectual exertion Increasing doses Nervousness, insomnia, tremors Seizures with very large amountsMethylxanthines: Methylxanthines Pharmacologic effects Central nervous system Heart Blood vessels Bronchi Kidney Reproduction Pharmacokinetics Readily absorbed from the GI tract Achieves peak plasma levels within 1 hour Eliminated by hepatic metabolismMethylxanthines: Methylxanthines Therapeutic uses Neonatal apnea Promoting wakefulness Other applications Acute toxicity Stimulation of the CNS Tachycardia Respiratory stimulation Sensory phenomenaMethylxanthines: Methylxanthines Preparations, dosage, and administration For promoting wakefulness For neonatal apnea Theophylline TheobromineAttention-Deficit/Hyperactivity Disorder (ADHD) in Children: Attention-Deficit/Hyperactivity Disorder (ADHD) in Children Signs and symptoms Inattention Hyperactivity Impulsivity Fidgety Unable to concentrateADHD in Children: ADHD in Children Signs and symptoms (cont ’ d) Unable to wait his or her turn Switches excessively from one activity to another Calls out excessively in class Present prior to age 7 years Present for at least 6 monthsADHD in Children: ADHD in Children Etiology Management overview Cognitive therapy Stimulant drugs Drug therapy I: CNS stimulants Methylphenidate (Ritalin, Concerta, others) Dexmethylphenidate (Focalin) Dextroamphetamine (Dexedrine, others) Amphetamine mixture (Adderall) Pemoline (Cylert)ADHD in Children: ADHD in Children Drug therapy II: atomoxetine Description and therapeutic effects Nonstimulant No potential for abuse Administered once a dayADHD in Children: ADHD in Children Drug therapy II: atomoxetine Adverse effects GI reactions Reduced appetite Dizziness Somnolence Mood swings Trouble sleepingADHD in Children: ADHD in Children Drug therapy II: atomoxetine (cont ’ d) Drug interactions MAO inhibitors (isocarboxazid, phenelzine) CYP2D6 (paroxetine, fluoxetine, quinidine) Role in ADHD therapy Preparations, dosage, and administration Children who weigh less than 70 kg Children who weigh more than 70 kgADHD in Children: ADHD in Children Drug therapy III: antidepressants Tricycle antidepressants Decrease hyperactivity Little effect on impulsivity and inattention Second-line drugs Bupropion (Wellbutrin) Can reduce behavioral symptoms Less effective than stimulants Poses risk of seizure Second-line drugADHD in Adults: ADHD in Adults Drug therapy III: antidepressants 60% of ADHD cases persist into adulthood Symptoms Poor concentration Stress intolerance Antisocial behavior Outbursts of anger Inability to maintain a routine Drug therapy Methylphenidate