NR546 week 7 / NR 546
WEEK 7 test your
knowledge quiz EXAM
2024
A 27-year-old bartender was diagnosed with ADHD at age 10. She has been on and
off medication since then, first on immediate-release methylphenidate, then on the
methylphenidate patch. She experimented with illicit drugs during her late
adolescence and is still a heavy drinker. After a few years of self-medication with
alcohol and cigarettes, she is seeking medical attention again. You decide to put her
on 80 mg/day of atomoxetine, one of the non-stimulant medications effective in
ADHD.
Why does atomoxetine lack abuse potential? - ✔✔✔ANSWER-It increases
dopamine levels in the prefrontal cortex but not in the nucleus accumbens.
,Sleep Hygiene - ✔✔✔ANSWER-sleep hygiene measures should be explored prior
to prescribing medications:
-Limit screen time
-Limit caffeine
-Limit nicotine
-Dark, cool room
-Reduce noise
Sleep Medications - ✔✔✔ANSWER--Over-the-Counter Sleep Aids
• antihistamines such as diphenhydramine (Benadryl)
• Valerian root
-Melatonin Agonist Medications
-ramelteon (Rozerem)
• prescription melatonin
-Orexin Receptor Antagonists
• Suvorexant (Belsomra)
• Lemborexant (Dayvigo)
-Sedating Antidepressants
• trazodone (Desyrel)
• amitriptyline (Elavil)
• mirtazapine (Remeron)
, -Z-drugs (Sedative/hypnotic drugs) First-line agents for insomnia include:
• zolpidem (Ambien)
• zaleplon (Sonata)
• eszopiclone (Lunesta)
• PEARLS: potential for abuse/dependence, Drugs may increase suicidal ideations,
Abrupt discontinuation can result in rebound insomnia and withdrawal symptoms
-Benzodiazepines (BZOs)
• not considered a first-line treatment due to the potential for misuse
• when first-line agents fail, benzodiazepines may be used with caution for
insomnia
Sleep meds Lifespan Considerations: Older Adult - ✔✔✔ANSWER-2019
American Geriatric Society (AGS) Beers Criteria include the following
recommendations:
-Consider nonpharmacologic strategies.
-Avoid combining z-drugs with other central nervous system (CNS) medications to
prevent falls.
-Avoid using z-drugs or antihistamines in clients with dementia, cognitive
impairment, or a history of falls.
-Consider melatonin as an alternative.
Rationale: The prefrontal cortex lacks high concentrations of dopamine
transporters (DAT), so in this brain region, DA gets inactivated by norepinephrine
transporters (NET). Therefore, inhibiting NET in the prefrontal cortex increases
both DA and NE. As only a few NET exist in the nucleus accumbens, atomoxetine
does not induce an increase in DA and NE in the nucleus accumbens, the reward
center of the brain, thus atomoxetine does not have abuse potential.
WEEK 7 test your
knowledge quiz EXAM
2024
A 27-year-old bartender was diagnosed with ADHD at age 10. She has been on and
off medication since then, first on immediate-release methylphenidate, then on the
methylphenidate patch. She experimented with illicit drugs during her late
adolescence and is still a heavy drinker. After a few years of self-medication with
alcohol and cigarettes, she is seeking medical attention again. You decide to put her
on 80 mg/day of atomoxetine, one of the non-stimulant medications effective in
ADHD.
Why does atomoxetine lack abuse potential? - ✔✔✔ANSWER-It increases
dopamine levels in the prefrontal cortex but not in the nucleus accumbens.
,Sleep Hygiene - ✔✔✔ANSWER-sleep hygiene measures should be explored prior
to prescribing medications:
-Limit screen time
-Limit caffeine
-Limit nicotine
-Dark, cool room
-Reduce noise
Sleep Medications - ✔✔✔ANSWER--Over-the-Counter Sleep Aids
• antihistamines such as diphenhydramine (Benadryl)
• Valerian root
-Melatonin Agonist Medications
-ramelteon (Rozerem)
• prescription melatonin
-Orexin Receptor Antagonists
• Suvorexant (Belsomra)
• Lemborexant (Dayvigo)
-Sedating Antidepressants
• trazodone (Desyrel)
• amitriptyline (Elavil)
• mirtazapine (Remeron)
, -Z-drugs (Sedative/hypnotic drugs) First-line agents for insomnia include:
• zolpidem (Ambien)
• zaleplon (Sonata)
• eszopiclone (Lunesta)
• PEARLS: potential for abuse/dependence, Drugs may increase suicidal ideations,
Abrupt discontinuation can result in rebound insomnia and withdrawal symptoms
-Benzodiazepines (BZOs)
• not considered a first-line treatment due to the potential for misuse
• when first-line agents fail, benzodiazepines may be used with caution for
insomnia
Sleep meds Lifespan Considerations: Older Adult - ✔✔✔ANSWER-2019
American Geriatric Society (AGS) Beers Criteria include the following
recommendations:
-Consider nonpharmacologic strategies.
-Avoid combining z-drugs with other central nervous system (CNS) medications to
prevent falls.
-Avoid using z-drugs or antihistamines in clients with dementia, cognitive
impairment, or a history of falls.
-Consider melatonin as an alternative.
Rationale: The prefrontal cortex lacks high concentrations of dopamine
transporters (DAT), so in this brain region, DA gets inactivated by norepinephrine
transporters (NET). Therefore, inhibiting NET in the prefrontal cortex increases
both DA and NE. As only a few NET exist in the nucleus accumbens, atomoxetine
does not induce an increase in DA and NE in the nucleus accumbens, the reward
center of the brain, thus atomoxetine does not have abuse potential.
