Stimulants and Cognitive Medications

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Information for psych pharm quiz #3 and the final exam.
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Dextroamphetamine (Dexedrine) Stimulant *indicated for ages 3-16 *duration: 4-6 hours *schedule: 2-3 times/day
Methylphenidate (Ritalin, Concerta) Stimulant *indicated in ages 6-12 *duration: 3-5 hours *schedule: 2-3 times/day
Mixture of salts and L-amphetamine (Adderall) Stimulant *indicated for ages 6 and older *duration: 4-6 hours *schedule: 2 times/day
Lisdexamfetamine dimesylate (Vyvanse) Stimulant *indicated for ages 6-12 *duration: 10-12 hours *schedule: once/day
Dexmethylphenidate (Focalin) Stimulant *indicated in ages 6 and older *duration: 4-5 hours *schedule: 2 times/day
Important note about the stimulants - can quickly increase attention and task-directed behavior; reduces impulsivity, restlessness, and distractibility -treat w/ minimum effective dose and increase (as needed) - do NOT administer later than 1600 - SE: insomnia, appetite suppression, headache, abdominal pain, lethargy -may take 6 wks. for therapeutic response *RISK FOR ABUSE POTENTIAL
Atomoxetine (Strattera) Non-stimulant *indicated for ages 6-65 *duration: 24 hrs. *schedule: once/day
Important note about non-stimulants -therapeutic response may develop slowly (~6 wks.) -SE: GI disturbances, reduced appetite, weight loss, urinary retention, dizziness, fatigue, insomnia *Risk for liver injury, increase in blood pressure and heart rate --> ongoing monitoring of VS and liver fxning needed *USE W/ CAUTION: increased risk of suicidal ideation
Tacrine (Cognex) Cholinesterase inhibitor **No longer used, due to hepatotoxicity
Donepezil (Aricept) Cholinesterase inhibitor -dosage: once daily **Better tolerated than others (preferred)
Rivastigmine (Exelon) Cholinesterase inhibitor -available as once-daily patch -most common SE: N/V, weight loss, decreased appetite **ALWAYS TAKE W/ FOOD TO DECREASE GI EFFECTS
Galantamine (Razadyne) Cholinesterase inhibitor -prescribed in first and second stages of AD
Mechanism of action ~ cholinesterase inhibitors ACTION: prevents the breakdown of acetylcholamine and thereby increases its availability at cholinergic synapses
Indications for cholinesterase inhibitors Modestly improves cognition, behavior, and function; slows progression of dementia *Use w/ caution when pts. are taking NSAIDs
Side effects of cholinesterase inhibitors N/V, diarrhea, insomnia, fatigue, muscle cramps, incontinence, bradycardia, and syncope
Memantine (Namenda) N-methyl D-aspartate (NDMA) inhibitor
Mechanism of action ~ NMDA inhibitors Normalizes levels of GLUTAMATE, which in excessive quantities contributes to neurodegeneration *Used during moderate to severe stages of AD
Indications for NDMA inhibitors Treatment of moderate to severe Alzheimer's disease (h/e, no evidence that it modifies the underlying disease)
Side effects of NMDA inhibitors Dizziness, agitation, headache, confusion, and constipation **Clearance is reduced w/ renal impairment (use w/ caution in mild to moderate renal impairment; do not use w/ severe)
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