Term
| when are psychomotor stimulants used? |
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Definition
| in management of ADHD and to reduce opioid-induced sedation in CA pts |
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Term
| what are other names for ADHD? |
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Definition
| hyperkinetic syndrome, ADD, and minimal brain dysfunction w/hyperactivity |
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Term
| does hyperactivity always occur w/ADHD? |
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Definition
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Term
| what is the etiology for ADHD? |
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Definition
| unknown - may be related to deficiency in brain catecholamines |
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Term
| what characterizes drug therapy for ADHD? |
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Definition
| ~75% successful - by *increasing the ability to concentrate and perform a task, the drug can calm the pt during work projects (increases energy internally to allow parts of brain involved in tasking to be active ). |
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Term
| what are the CNS stimulants which may be used to tx ADHD? |
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Definition
| caffeine, amphetamines, methylphenidate. |
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Term
| what are the "other" agents which may be used to tx ADHD? |
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Definition
| antidepressants: TCAs (imipramine & desipramine have some efficacy but are toxic, atomoxetine may be used), MAOI (good efficacy, but toxic), barbiturates (ineffective +paradoxical excitation), clonidine (useful in limited cases), and modafinil. |
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Term
| what characterizes caffeine as a CNS stimulant? |
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Definition
| caffeine does not appear to be effective in ADHD. at doses > 500 mg/day, caffeinism may occur: anxiety, h/a, insomnia, and increased muscle tension. can also cause unacceptable hyperglycemia in DM pts. |
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Term
| what characterizes amphetamines as CNS stimulants? MOA? |
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Definition
| amphetamine, methamphetamine are powerful CNS stimulants. major MOA: indirect simulation of the CNS via promotion of catecholamine release from pre-synaptic storage sites and inhibition of their re-uptake at the pre-synaptic membrane. minor MOA: direct stimulation of post-synaptic adrenergic receptors and inhibition of MAO. (activate sympathetic system in every way possible) |
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Term
| what are amphetamines used for? |
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Definition
| wt loss (4-8 wks), narcolepsy (excessive sleepiness, sleep attacks, sleep paralysis), and ADHD |
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Term
| what ADRs are associated w/amphetamines? |
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Definition
| acute: tachycardia, elevated BP, insomnia, anorexia, tachyphylaxis, and tourettes (motor/verbal tics). chronic: decreased wt gain (inhibited growth in children), psychological dependence, development of significant tolerance and physical dependence, and toxic psychosis. |
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Term
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Definition
| an immediate release amphetamine |
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Term
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Definition
| a 1x/daily extended release single-entity amphetamine - double pulses delivery system. pts on this had significant improvement in symptoms, control, and quality of life with continuous long-term treatment. |
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Term
| what characterizes methylphenidate as a CNS stimulant? |
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Definition
| similar to amphetamine, but less CNS stimulation and less CV activation. major drug of abuse. regarded as ADHD DOC. ADRs: similar to amphetamines, but less intense, less inhibitory effect on growth, and less motor tics. |
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Term
| what are additional uses for methylphenidate? |
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Definition
| depression (geriatric pts/stroke pts) and antagonism of opioid-induced sedation in CA pts. |
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Term
| what is concerta? dexmethylphenidate? |
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Definition
| concerta: extended methylphenidate release formulation. dexmethylphenidate: d-isomer, more potent in treating ADHD (focalin, focalin xr) |
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Term
| what characterizes clonidine as a tx for ADHD? |
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Definition
| this alpha-2 adrenergic agonist at the pre-synaptic membrane causes a decreased release of catecholamines - the opposite effect which appears necessary for pharm ADD management. it can be used alone or w/methylphenidate when prominence of aggressive symptoms, fam hx of tic disorders, and presence of severe conduct disorder. ADRs: sedation, bradycardia, and hypotension. |
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Term
| what characterizes antidepressant therapy for ADHD? |
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Definition
| the TCAs imipramine & desipramine have some efficacy but are toxic. thus they are used in pts unresponsive to stimulant therapy. ADRs: anticholinergic and cardiac arrhythmias. *atomoxetine, a SNRI focuses on blocking NE uptake. |
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Term
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Definition
| mechanism unknown. may *facilitate glutamate activity and *reduce release of GABA. weak interaction with dopamine transporter, a system that seems necessary for its wake-promoting action; *blocks DA reuptake. it is approved for narcolepsy, but has been prescribed off-label for sleepiness and fatigue from other illnesses, including depression, sleep apnea, parkinson's disease, chronic-fatigue syndrome, and multiple sclerosis. it has been used to improve problems w/shift work in hospitals. limited abuse potential. |
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Term
| what characterizes cocaine? |
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Definition
| cocaine is a stimulant, similar to amphetamine/methamphetamine. it is not a narcotic, but it is one of the most addicting drugs available. it is a free base (non-ionized, highly lipid soluble) which allows extremely rapid absorption from the lungs when smoked and rapid entrance into the brain (crack). smoking crack onset: 1-2 min, snorting cocaine onset: 20-30 min, and IV injection onset 1-2 min. duration of action: 30-60 min. it is rapidly biotransformed by plasma cholinesterase. |
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Term
| how is cocaine tested for? |
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Definition
| present degree of impairment: blood/saliva. determination of previous use: urine (inactive metabolites for 5-10 days) and hair (good for checking to see if it will affect pregnancy). |
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Term
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Definition
| blocks reuptake of DA and NE at the presynaptic membrane. |
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Term
| what are the acute pharmacological effects of cocaine? |
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Definition
| euphoria (DA), tachycardia, HTN and hyperthermia (due to vasoconstriction from increased NE action), migraine-like h/a, nervousness, insomnia, anorexia, mydriasis, and constipation. |
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Term
| what characterizes acute toxicity to cocaine? |
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Definition
| CV: MI (constriction of coronaries) and cardiac arrhythmias (sinus tachy, PVCs, ventricular tachy, v-fib, rupture of ascending aorta, CVA). respiratory: rhinorrhea. CNS: assaultive behavior and seizures (death possible). |
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Term
| what characterizes chronic toxicity to cocaine? |
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Definition
| CNS: anxiety, paranoia, delirium, hallucinations, psychosis, and brain atrophy. respiratory: reduced sense of smell, rhinitis, ulceration/perforation of nasal septum, pulmonary edema, and pulmonary hemorrhage. GI: intestinal ischemia. reproductive: ED and delay in orgasm. renal: nephrotoxicity and renal failure. injection related: hepatitis, tetanus, and AIDS risk. other: TB. |
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Term
| does tolerance develop to cocaine? |
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Definition
| yes and there is clinical evidence of physical dependence. |
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Term
| what characterizes withdrawal syndrome w/cocaine? |
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Definition
| general fatigue, depression, prolonged sleep, hyperphagia (increased appetite), intense craving for cocaine (lasts ~7 days), exacerbation of pre-existing psychological disturbances (depression and possible suicide attempts). |
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Term
| what characterizes polyaddiction? |
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Definition
| CNS depressants are often taken concomitantly - so often cocaine abusers will present w/BZD physical dependence as well. |
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Term
| what is tx for acute cocaine intoxication? |
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Definition
| if not severe, may end within 24 hours; treat symptoms. dopamine agonists such as bromocriptine have been used to curb the craving. |
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Term
| what is tx for chronic cocaine intoxication? |
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Definition
| psychotherapy, lithium, antidepressants |
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Term
| how does cocaine use affect pregnancy? |
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Definition
| cocaine induced vasoconstriction probably reduces the blood flow and, consequently, oxygen delivery to the fetus. prenatally, this increases risk of spontaneous abortion/fetal death. postnatally: immediate - decreased head circumference, visual disturbances, increased muscular rigidity, abnormal sleep patterns (apnea, SIDS) and cerebral infarct. at 2 years - sensory/motor difficulties, difficulty in climbing stairs, afraid of quick movements, and difficulty initiating words. |
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Term
| how does cocaine use affect breastfeeding? |
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Definition
| this has been used topically to reduce breast soreness - but infants can ingest enough to get seizures. |
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Term
| what is the etiology of substance abuse? |
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Definition
| *1) experimentation: acute use influenced by peer pressure. *2) dependence - significant factors: low self-esteem, immaturity, inability to solve personal problems, easily frustrated, difficulty in relating to opposite sex, over-dependence on family/friends - insignificant factors: family income, personal income, area of residence, and level of intelligence. |
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Term
| what is the role of family in prevention of substance abuse? |
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Definition
| love, respect and discipline need to be provided. |
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Term
| how should adult family members serve as good role models? |
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Definition
| interaction with spouse, children and friends, proper respect for legitimate drug therapy, responsible social use of alcohol |
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Term
| what is the role of school in preventing substance abuse? |
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Definition
| strengthen values of self, family, friends, life in general. increase awareness of toxic effects of cigarettes, alcohol, and drugs. should provide limited counseling if necessary. |
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Term
| what issue is always present w/impaired healthcare professionals? |
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Definition
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Term
| what are additional issues for healthcare professionals? |
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Definition
| increased number of pts to manage, reduced control of ordering tests/selecting therapeutic procedures/prescribing medications, lowered career satisfaction, decreased income, knowledge of clinical pharmacology, accessibility to drugs, and code of silence. |
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Term
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Definition
| MDMA, rohypnol, GHB, and ketamine |
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Term
| what characterizes MDMA (3-4 methylenedioxymethamphetamine)? |
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Definition
| this is a synthetic, psychoactive drug chemically similar to the stimulant methamphetamine and the hallucinogen mescaline. at high doses, MDMA can interfere with the body’s ability to regulate temperature. this can lead to a sharp increase in body temperature (hyperthermia), resulting in liver, kidney, and cardiovascular system failure. b/c MDMA can interfere w/its own metabolism, potentially harmful levels can be reached by repeated drug use at short intervals. research in animals links MDMA exposure to long-term damage to serotonin neurons and can lead to changes in brain function, affecting cognitive tasks and memory with long term use as well as depression. |
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Term
| what characterizes GHB, ketamine and rohypnol? |
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Definition
| these are predominately CNS depressants - often colorless, tasteless, and odorless. thus they are referred to as "date rape" drugs. |
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Term
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Definition
| GHB (gamma hydroxybutyrate) is a CNS depressant which has been abused for its euphoric, sedative, and anabolic (body building) effects. coma and seizures can occur following abuse of GHB. combining use with other drugs such as alcohol can result in nausea and breathing difficulties. GHB may also produce withdrawal effects, including insomnia, anxiety, tremors, and sweating. it has been used by body builders and in poisonings, overdoses, date rapes, and deaths. |
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Term
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Definition
| ketamine is an anesthetic which can cause dream-like states and hallucinations. in high doses, ketamine can cause delirium, amnesia, impaired motor function, high blood pressure, depression, and potentially fatal respiratory problems. |
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Term
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Definition
| aka flunitrazepam, rohypnol is a BZD. when mixed with alcohol, rohypnol can incapacitate victims and prevent them from resisting sexual assault. it can produce “anterograde amnesia,” which means individuals may not remember events they experienced while under the effects of the drug. also, rohypnol may be lethal when mixed with alcohol and/or other depressants. |
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