NR546 / NR 546 Week 7
Test Your Knowledge
Quiz
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.
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.
In the nucleus accumbens, there are only a few NE neurons and NE transporters.
Inhibiting NET in the nucleus accumbens will not lead to an increase in NE or DA.
Atomoxetine does not modulate serotonin levels. The striatum and the anterior
cingulate cortex are not brain areas involved in reward.
A common cause of insomnia is ____________ - ✔✔✔ANSWER-restless legs
syndrome (RLS)
ADHD and Comorbidities tx order: - ✔✔✔ANSWER-1.
alcohol/stimulant/substance abuse
2. mood disorders
3. anxiety disorders
4. ADHD
Children and adolescents
1. Nicotine dependence
2. ADHD
ADHD lifespan considerations - ✔✔✔ANSWER--Symptoms change with age.
, -Not only a childhood diagnosis
-Hyperactivity decreases markedly with age
-Primary Symptoms: inattention, restlessness, cognitive & emotional impulsivity,
executive functioning deficits, and self-regulation
-Adults struggling with executive functioning difficulties and disorganization may
experience occupational stress or anxiety.
ADHD Lifespan Considerations: Breastfeeding - ✔✔✔ANSWER-Stimulants are
not recommended while breastfeeding.
ADHD Lifespan Considerations: Children - ✔✔✔ANSWER--ADHD medications
are not approved for children under 6.
-Consider short-acting medications for children who have significant appetite loss
or are underweight; this may improve appetite for lunch and dinner.
ADHD Lifespan Considerations: Pregnancy - ✔✔✔ANSWER-Stimulants may
cause fetal harm including increases in low birth weight and pregnancy.
ADHD Patient Education - ✔✔✔ANSWER--Common side effects include
restlessness, irritability, anxiety, insomnia, stomachache, headaches, tics, and
worsening of aggression symptoms.
-Clients may note a worsening of symptoms, or "crash" when the medication wears
off, especially with immediate-release (IR) medications.
-Medications may cause appetite changes and subsequent weight loss.
• Take medication with breakfast to decrease anorexia.
ADHD Prescribing Pearls - ✔✔✔ANSWER--Before initiation of any stimulant,
obtain thorough health history.
Test Your Knowledge
Quiz
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.
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.
In the nucleus accumbens, there are only a few NE neurons and NE transporters.
Inhibiting NET in the nucleus accumbens will not lead to an increase in NE or DA.
Atomoxetine does not modulate serotonin levels. The striatum and the anterior
cingulate cortex are not brain areas involved in reward.
A common cause of insomnia is ____________ - ✔✔✔ANSWER-restless legs
syndrome (RLS)
ADHD and Comorbidities tx order: - ✔✔✔ANSWER-1.
alcohol/stimulant/substance abuse
2. mood disorders
3. anxiety disorders
4. ADHD
Children and adolescents
1. Nicotine dependence
2. ADHD
ADHD lifespan considerations - ✔✔✔ANSWER--Symptoms change with age.
, -Not only a childhood diagnosis
-Hyperactivity decreases markedly with age
-Primary Symptoms: inattention, restlessness, cognitive & emotional impulsivity,
executive functioning deficits, and self-regulation
-Adults struggling with executive functioning difficulties and disorganization may
experience occupational stress or anxiety.
ADHD Lifespan Considerations: Breastfeeding - ✔✔✔ANSWER-Stimulants are
not recommended while breastfeeding.
ADHD Lifespan Considerations: Children - ✔✔✔ANSWER--ADHD medications
are not approved for children under 6.
-Consider short-acting medications for children who have significant appetite loss
or are underweight; this may improve appetite for lunch and dinner.
ADHD Lifespan Considerations: Pregnancy - ✔✔✔ANSWER-Stimulants may
cause fetal harm including increases in low birth weight and pregnancy.
ADHD Patient Education - ✔✔✔ANSWER--Common side effects include
restlessness, irritability, anxiety, insomnia, stomachache, headaches, tics, and
worsening of aggression symptoms.
-Clients may note a worsening of symptoms, or "crash" when the medication wears
off, especially with immediate-release (IR) medications.
-Medications may cause appetite changes and subsequent weight loss.
• Take medication with breakfast to decrease anorexia.
ADHD Prescribing Pearls - ✔✔✔ANSWER--Before initiation of any stimulant,
obtain thorough health history.
