Which stimulant is used in the treatment of attention deficit hyperactivity disorder Quizlet

C.

That Ben is experiencing the possible cardiac side-effects of Dexedrine. Dexedrine is an amphetamine and as such carries certain risks such as side effects including Tachycardia, arrhythmia, hypertension, palpitations, as well as sleeplessness, restlessness, irritability, anorexia, dry mouth, diarrhea, constipation, impotence

Which of the following are 4 physical side effects/adverse reactions associated with Amphetamines?

A.Tachycardia, arrhythmia, hypertension, palpitations
B. Hypertension, arrhythmia, palpitations, Bradycardia
C. Arrhythmia, hypotension, palpitations, Tachycardia
D.Tachycardia, idioarrhythmia, hypertension, palpitations

Stew is a 28-year old office worker who has just recently been placed on Ritalin, what medication types does the nurse know will have their effectiveness decreased by the Ritalin and therefore should be screened for during her assessment?

A. Insulin, Barbituates, Anti hyperintensives, Antihistamines, decongestants.
B. Anti coagulants, barbituates, decongestants, insulin
C. Anti hyperintensives, barbituates, decongestants, insulin
D. decongestants, barbituates, opiates, insulin

C.

Inform him that everyone is different and although many of the side effects of ADHD are shared with Ritalin, with Ritalin he may get tremors, nervousness, dizziness, and Thrombocytopenia.

Other side effects of Methylphenidate (Ritalin) include:Tachycardia, dizziness, hypertension, palpitations, as well as sleeplessness, restlessness, nervousness, irritability, anorexia, dry mouth, vomiting, diarrhea, and weight loss.

1) Restlessness, tremors, excitability, insomnia, fever, euphoria etc. (stimulation)
2) Similar to increase in NOREPINEPHRINE so hypertension, headache, flushing
3) Dry mouth, anorexia, nausea, vomiting, diarrhea, abdominal cramps, metallic taste
4) Leads to:
- LOSS of consciousness
- Followed by SEIZURE and HYPERTENSIVE CRISIS
- Use MIDAZOLAM and IV FLUID for seizures and HTN (may need to give ALPHA BLOCKER or VASODILATOR via IV if BP doesn't go down)
5) Haloperidol

Sets with similar terms

Terms in this set (26)

Attention-deficit hyperactivity disorder (ADHD) is a neurobehavioral developmental disorder in children. It affects about 3 -10% of children with symptoms starting before seven years of age. It is characterized by a persistent pattern of impulsiveness, inattention and hyperactivity. ADHD occurs about four-times as commonly in boys as in girls. ADHD is generally a chronic disorder with 6040% of individuals diagnosed in childhood continue to show ADHD signs in adulthood. The cause of ADHD is unknown, but it has a strong genetic component. The first-line treatment options for ADHD include behavioral therapy or pharmacotherapy with stimulant medications (methylphenidate, dexmethylphenidate, dextroamphetamine, mixed amphetamine salts) or both. Behavioral interventions alone may be sufficient for mild cases but when symptoms meet DSM-IV-TR criteria, stimulant therapy should be initiated. Methylphenidate and amphetamine salts are the first-line treatments for ADHD, while atomoxetine is an alternative, non-controlled drug. Amphetamine and related drugs act by increasing presynaptic release of dopamine and other biogenic amines in the brain. Stimulants are generally safe but are associated with adverse effects including headache, insomnia, anorexia, and weight loss. There is increased awareness about serious cardiovascular and psychiatric adverse events with ADHD drugs including concern for growth suppression in children (Patient Medication Guides are developed on risks and precautions). Stimulants (amphetamines and other drugs) and hallucinogens (LSD) are abused because of their euphoria or altered perception.

CHILDREN:
The most common symptoms of ADHD in children are:
Impulsiveness: acting before thinking of consequences, jumping from one activity to another, disorganization, tendency to interrupt other peoples' conversations.
Inattention: easily distracted, day-dreaming, not finishing work, difficulty listening.
Hyperactivity: restlessness, often characterized by an inability to sit still, fidgeting, squirminess, climbing on things, restless sleep.
The DSM-IV categorizes the symptoms of ADHD into three clusters, referred to as subtypes:
(1) Inattentive;
(2) Hyperactive-impulsive; and
(3) Combined.
ADHD may accompany other disorders such as anxiety, depression, and Tourette's syndrome. ADHD
exists alone in only about 1/3 of the children diagnosed with it.
Hyperactivity is common among children with ADHD but tends to disappear during adulthood.
However, it has long been observed that many children seem to "outgrow" ADHD. However, >50% children with ADHD continue to have some symptoms of inattention throughout their lives.
ADULTS:
Individuals diagnosed in childhood continue to show ADHD signs in adulthood. However, they typically do not display obvious motor overactivity.
As the demand for life planning increases with age, adolescents and adults display more procrastination, overreactions to frustration, poor motivation, difficulty with time management, and occupational and interpersonal relationship problems.
In adults, "mood swings, irritability, insecurity, boredom, and loss of temper are common. Other problems include unsafe driving, poor financial decisions, and tumultuous love relationships.
It is also known that many adolescents and adults develop coping skills as they mature, offsetting impairments.

The pathophysiology of ADHD is unclear. Although brain studies show no definitive pathologic marker for ADHD, the prefrontal cortex (which regulates attention), basal ganglia, and the caudate nucleus (which regulates movements and impulsivity) consistently are reported as abnormal—typically smaller.
There are, however, a number of factors that may contribute to ADHD including genetics and environment factors.
(i) Genetic factors
Studies indicate that genetics are a factor in about 75% of ADHD cases. Individuals with ADHD are twice as likely to display a defective 7-repeat allele of the dopamine-4 receptor gene.
Polymorphisms in dopamine and norepinephrine presynaptic transport proteins exist in persons with ADHD, causing dysregulation of dopaminergic and noradrenergic control of attention, hyperactivity, and impulsivity.
However, large majority of ADHD cases may arise from a combination of various genes, many of which affect dopamine transporters. Candidate genes include dopamine transporter, dopamine receptor D4, dopamine beta-hydroxylase, monoamine oxidase A, catecholamine-methyl transferase, serotonin transporter promoter (SLC6A4), 5-HT2A, 5-HT1B receptor, the 10-repeat allele of the DAT1 gene, the 7-repeat allele of the DRD4 gene, and the dopamine beta hydroxylase gene.
These broad targets indicate that ADHD does not follow the traditional model of a "genetic disease" and should therefore be viewed as a "complex interaction" among genetic and environmental factors.
(ii) Environmental factors
Twin studies to date have also suggested that approximately 920% of the variance in ADHD symptoms can be attributed to environmental (nongenetic) factors.
Environmental factors implicated include alcohol and tobacco smoke exposure during pregnancy and exposure to lead in very early life. Complications during pregnancy and birth might also play a role.

There is no objective test for diagnosis of ADHD. It thus remains a clinical diagnosis.
In the United States, the DSM-IV criteria are often the basis for a diagnosis (see Table 1). Many of the symptoms of ADHD occur from time to time in everyone; in patients with ADHD, the frequency of these symptoms is greater and significantly impairs their life. This impairment must occur in multiple settings to be classified as ADHD.
As with many other psychiatric and medical disorders, the formal diagnosis is made by a qualified professional in the field based on a set number of criteria.
In the US, these criteria are laid down by the American Psychiatric Association in their Diagnostic & Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM-IV-TR).
Based on the DSM-IV criteria listed below (Table 2), three types of ADHD are classified:
(1) ADHD, Predominantly Inattentive Type: if criterion 1A is met but criterion 1B is not met for the past 6 months
(2) ADHD, Predominantly Hyperactive-Impulsive Type: if Criterion 1B is met but Criterion 1A is not met for the past 6 months.
(3) ADHD, Combined Type: if both criteria 1A and 1B are met for the past 6 months
Adults with ADHD are diagnosed under the same criteria, including the stipulation that their symptoms must have been present prior to the age of seven.

(ii) Pharmacotherapy
Amphetamine and related stimulant drugs are the most effective agents for treating ADHD. About 70% of children improve after being treated with stimulants. Medications, however, are not recommended for pre-school children with ADHD
During the past 10 years, prescriptions for medications to treat ADHD have increased significantly in all age groups. Considering all age groups, children and adolescents receive the most prescriptions for medications to treat ADHD. During the last 5 years, there was 40% rise in ADHD prescriptions (USA Today, 4/13/09). In 2008, 39.5 million prescriptions were dispensed for adults, children and adolescents in the USA.
Methylphenidate is the most prescribed product (47%); amphetamine products, including mixed amphetamine salts, are second (33%); and atomoxetine was the third (16%) most prescribed drug.
Stimulants, in the short term, have been found to be safe in the appropriately selected patient and appear well tolerated over 5 years of treatment. Long term safety, however, has not been determined. The American Heart Association and the American Academy of Pediatrics suggest to carefully assessing children for heart conditions before treating them with stimulant medications.
The FDA has added black-box warnings to some ADHD medications. Amphetamines have warnings about potential for abuse, drug dependence, and sudden death. Most ADHD drugs are not FDA-approved for children less than 6 years old.

I. Either A or B:
A. Six or more of the following symptoms of inattention have been present for at least 6 months to a point that is disruptive and inappropriate for developmental level:
Inattention:
1. Often does not give close attention to details or makes careless mistakes in schoolwork, work, or other activities.
2. Often has trouble keeping attention on tasks or play activities.
3. Often does not seem to listen when spoken to directly.
4. Often does not follow instructions and fails to finish schoolwork, chores, or duties in the workplace.
5. Often has trouble organizing activities.
6. Often avoids, dislikes, or doesn't want to do things that take a lot of mental effort for a long period of time (such as schoolwork or homework).
7. Often loses things needed for tasks and activities (e.g. toys, school assignments, pencils, books, or tools).
8. Is often easily distracted.
9. Often forgetful in daily activities.
B. Six or more of the following symptoms of hyperactivity-impulsivity have been present for at least 6 months to an extent that is disruptive and inappropriate for developmental level:
Hyperactivity:
1. Often fidgets with hands or feet or squirms in seat.
2. Often gets up from seat when remaining in seat is expected.
3. Often runs about or climbs when and where it is not appropriate (adolescents or adults may feel very restless).
4. Often has trouble playing or enjoying leisure activities quietly.
5. Is often "on the go" or often acts as if "driven by a motor".
6. Often talks excessively.
Impulsiveness:
1. Often blurts out answers before questions have been finished.
2. Often has trouble waiting one's turn.
3. Often interrupts or intrudes on others (e.g., butts into conversations or games).
II. Some symptoms that cause impairment were present before age 7 years.
III. Some impairment from the symptoms is present in two or more settings (e.g. at school/work and at home).
IV. There must be clear evidence of significant impairment in social, school, or work functioning.
V. The symptoms do not happen only during the course of a Pervasive Developmental Disorder, Schizophrenia, or other Psychotic Disorder. The symptoms are not better accounted for by another mental disorder (e.g. Mood Disorder, Anxiety Disorder, Dissociative Disorder, or a Personality Disorder).

Amphetamines have powerful CNS stimulant actions in addition to peripheral adrenergic actions common to indirect sympathomimetic drugs.
Amphetamine is one of the most potent sympathomimetic amines in stimulating the CNS. Subjective effects similar to those of cocaine are produced by amphetamine and methamphetamine. Both are structurally similar to dopamine (see Fig.1).
All amphetamines:
stimulate medullary centers, thus increasing respiration
increase motor activity
elevate mood
produce insomnia
inhibit appetite
They are orally-active, and the effect lasts for several hours. Amphetamine enters the brain quickly due to its lipophilic characteristics.
Stimulant medications elicit a biphasic action: low doses reduce locomotor activity (and distractibility), while high doses cause sleeplessness and other symptoms of excessive stimulation.
In the CNS, the potency ranks: methamphetamine > d-amphetamine > methylphenidate, lamphetamine.
In the periphery, the potency ranks: l-amphetamine>d-amphetamine; methamphetamine is essentially without peripheral effects.
The primary mechanism of action of amphetamines is to increase dopamine, and possibly other biogenic amines (norepinephrine and serotonin), by stimulating presynaptic release rather than by blockade of reuptake (as is the case with cocaine) (see Fig.2).!!
Methamphetamine is often produced in small, clandestine labs starting with ephedrine, a widely available nonprescription stimulant.
Methamphetamine produces neurotoxic effects in dopamine and serotonin neurons.

Toxicity:
Acute toxic CNS effects include restlessness, dizziness, tremor, hypertensive reflexes, talkativeness, tenseness, irritability, weakness, insomnia, fever and euphoria.
Cardiovascular effects include headache, chilliness, flushing, palpitation, cardiac arrhythmias, hypertension, and circulatory collapse. Excessive sweating occurs.
Gastrointestinal symptoms include dry mouth, metallic taste, anorexia, nausea, vomiting, diarrhea, and abdominal cramps.
Massive overdoses lead to loss of consciousness following seizures and a hypertensive crisis.
The drug of choice for treating amphetamine toxicity is haloperidol.
With chronic amphetamine use, a loss of biogenic amine neurons has been reported.
Use of MDA and MDMA can selectively destroy serotonergic neurons.

Preparations & Dosage (see Table 2)
Methylphenidate is available in short-acting, intermediate-acting, and long-acting once-daily preparations (see Table 2). Short-acting preparations are the least-expensive effective option when dosed 2 or 3 times a day. Intermediate-acting agents are used infrequently because of their unpredictable absorption and variable duration of action. Once-daily preparations—including modified-release MPH (Metadate CD), once-daily extended release MPH (Ritalin LA), and osmotically released oral system (OROS) methylphenidate (Concerta)—have gained popularity because they avoid frequent dosing and provide all-day symptom coverage. OROS Methylphenidate has an advantage of less abuse potential, because it cannot be crushed and snorted.
All extended-release, once-daily preparations have the potential for increased insomnia, compared with conventional preparations, given that drug levels persist into the late-afternoon and evening hours. It is unknown whether the cardiovascular adverse effects are more problematic with extended-release preparations because of persistent blood drug levels over 8 to 12 hours.
Methylphenidate transdermal patch is available. The patch produces comparable drug levels with those of regular preparation given 3 times a day. The patch is a useful option for children who are unable to swallow pills, and wearing the patch for 9 hours provides a full day of symptom coverage.
Dosage:
Children: 5 mg, bid; Max 60 mg/day
Tabs (Methylin, Ritalin): 5 10, 20 mg
Tabs (Sustained Release): 20 mg
Methylin ER: 10, 20 mg
Ritalin-SR: 20 mg Tab
Osmotic Controlled Release (Concerta): 18, 36, 54 mg
Patch (Daytrana): 10, 15, 20, 30 mg

Adverse Effects:
Nervousness, insomnia, headache, anorexia, GI upset, weight loss, slow growth, psychiatric effects
Major Potential Risks:
(i) Cardiovascularsudden death in susceptible patients, stroke and heart attacks, hypertension.
(ii) Psychiatric exacerbate psychotic symptoms, bipolar illness; manic symptoms, aggression
(iii) Growth suppression
Drug Interactions:
Tolerance to these effects develops with continued use.
Contraindications:
Symptomatic cardiovascular disease, moderate to severe hypertension, hyperthyroidism or glaucoma;
Psychiatric conditions of anxiety, tension and agitation
Use during or within 14 days following MAO inhibitors
Abuse potential: It is listed as a schedule II controlled substance (C-II, Warning: abuse potential).
Dexmethylphenidate is the d-isomer of dl-methylphenidate that has demonstrated comparable therapeutic effects. An average titrated dose of 18.25 mg of dexmethylphenidate is comparable with an average titrated dose of 32.14 mg/day of dl-methylphenidate. Dexmethylphenidate is twice as potent as dl-methylphenidate (5 mg dl-methylphenidate = 2.5 mg dexmethylphenidate). No clinical advantage has been demonstrated for dexmethylphenidate over dl-methylphenidate.
Indications and adverse effects: Similar to methylphenidate.
Abuse potential: Listed as a C-II substance.

Central CNS Stimulants
Mixed amphetamine salts (d-amphetamine, 75% & l-amphetamine, 25%) and dextroamphetamine are comparable in efficacy with methylphenidate but are twice as potent, so dosing should begin with half the initial dose of methylphenidate (2.5 mg instead of 5 mg). There is no evidence that mixed amphetamine salts are superior to dextroamphetamine; however, some clinicians prefer them. The duration of effect with the immediate-release amphetamine products is longer than that with immediaterelease methylphenidate. Yet, multiple daily doses are required for many patients. Mixed amphetamine salts are available in an extended-release capsule that provides 12 hours of symptom control.
Clinical Indications:
Treatment of ADHD; narcolepsy; exogenous obesity
Preparations & Dosage (see Table 3)
2.5 mg - 40 mg/day
Tab: 5, 7.5, 10, 12.5, 15, 20, 30 mg
Cap (XL): 10, 20, 30 mg
Adverse Effects:
Headache, insomnia, anorexia, dry mouth, GI upset, weight loss
Drug Interactions:
MAO Inhibitors; TCA's, furazolidone
Contraindications:
Hardening of the arteries, heart disease, hypertension, hyperactive thyroid, glaucoma
Abuse potential:
It is listed as a schedule II controlled substance (C-II) in the USA.

Selective Norepinephrine Reuptake Inhibitor; Atypical antidepressant
Atomoxetine, a selective norepinephrine reuptake inhibitor (SNRI), is the first non-stimulant approved by the FDA for the treatment of ADHD. In contrast to stimulants, it has no abuse potential, and it is not a controlled substance. Several placebo-controlled clinical trials demonstrated its effectiveness for ADHD. However, atomoxetine is less efficacious than amphetamine or methylphenidate. Atomoxetine has a longer onset of therapeutic benefit (2-4 weeks), compared with stimulants (within an hour of an effective dose). Possible adverse effects are similar to those with stimulants, except for a greater risk of sedation and other side effects.
Clinical Indications:
Treatment of ADHD; depression
Alternative for children who do not tolerate/respond to stimulants.
Dosage:
Children & adolescents: Initial: 0.5 mg/kg/d titrate to max dose 1.4 mg/kg or 100 mg
Adult: Initial 40 mg/d titrate to max dose 80 mg/day
Cap: 10, 18, 25, 40, 60 mg
Common side effects:
Children: upset stomach, decreased appetite, nausea or vomiting, dizziness, tiredness, mood swings.
Adults: insomnia, constipation, dry mouth (xerostomia) nausea, decreased appetite, dizziness, sexual side effects; problems urinating; menstrual cramps.
Drug Interactions:
Substrate of CYP2D6
Contraindications:
Elderly or narrow angle glaucoma; adjustments needed in hepatic & renal impairment
Major potential risks:
The following are the major potential risks and side effects:
Suicidal thoughts or actions (may increase thoughts of suicide or suicide attempts).
Hepatotoxicity (can cause liver damage in rare cases).
Weight loss/slowed growth (may lose weight while being treated with drug).
Impaired motor skills
FDA has issued boxed warnings and additional warnings regarding hepatotoxicity and suicidal ideation.
Medication Guide, distributed with each prescription, provides information about these risks.
FDA ALERT [09/2005]: Suicidal Thinking in Children and Teens
Atomoxetine may increase thoughts of suicide or suicide attempts in children and teens. Call your child's healthcare professional right away if your child or teen has:
• new or increased thoughts of suicide
• changes in mood or behavior including becoming irritable or anxious

Drug efficacy and safety
1. The first-line treatment options for ADHD include behavioral therapy or stimulant medications (methylphenidate, dexmethylphenidate, dextroamphetamine, mixed amphetamine salts) or both.
2. Behavioral interventions alone may be sufficient for mild cases (with fewer and less-severe symptoms).
3. When symptoms meet DSM-IV-TR criteria (moderate-to-severe) and cause functional impairment in more than one setting, stimulant therapy should be initiated following a thorough baseline symptom assessment and a medical workup to ensure the safety of the medication.
4. Stimulants are comparable in efficacy, but there is some variation in response. For example, if methylphenidate is ineffective, dextroamphetamine or mixed amphetamine salts may be effective, and vice versa.
5. Atomoxetine may be considered first-line for those with an active substance abuse disorder, because it has no abuse potential and is not a controlled substance. However, it is less effective than stimulants.
6. Stimulants medications have been used safely and effectively to treat ADHD in children since the 1950s. Only in the past 10 to 15 years, however, have medications been prescribed routinely into adolescence and adulthood. The substantial increase in the number of people taking stimulants for longer periods of time is bound to increase reports of psychiatric adverse events and cardiovascular toxicity.
7. The FDA (2006) has concluded that the rate of sudden unexplained death does not appear to be greater in patients with ADHD medication than in the general population. Because amphetamines are known to increase blood pressure and pulse, careful baseline screening and monitoring are needed.
8. The FDA (2005) directed the manufacturers of all drug products approved for ADHD to develop Patient Medication Guides to alert patients about possible cardiovascular risks and adverse psychiatric symptoms associated with these medications and to advise them of precautions to be taken.

Amphetamines are very effective for ADHD therapy. However, amphetamines also carry significant risks, including the possibility of misuse, abuse and addiction.
Drug abuse refers to the use of an illicit drug or the excessive or nonmedical use of an approved drug. Drugs are abused because they cause strong feelings of euphoria or alter perception. With chronic exposure to addictive drugs, the brain shows signs of widespread adaptation. These adaptive changes become fully apparent once drug exposure is terminated. This state is called withdrawal and is observed following chronic exposure to most drugs of abuse. Consequently, the person may develop signs and symptoms of psychological or physiological dependence on drugs, and may exhibit abstinence syndrome.
Generally, addictive drugs activate the mesolimbic dopamine system ("dopamine hypothesis of addiction"). Major stimulants (amphetamines, MDMA, MDA, nicotine, caffeine) and hallucinogens (LSD, mescaline & psilocybin) are discussed briefly.

Amphetamines
Amphetamines cause a feeling of euphoria and self-confidence that contributes to the rapid development of psychological dependence. Drugs in this class include dextroamphetamine and methamphetamine ("speed"), a crystal form of which ("ice") can be smoked.
Larges doses of amphetamines induce euphoria (sense of stimulation, joy, and well-being), improve both self-confidence and the ability to concentrate. These rewarding effects are mediated through mesolimbic and mesocortical dopamine systems. The subject is oriented in time and space and is aware of the surroundings and able to respond to them.
At high doses, the disturbances of perception (visual hallucinations) and overt psychotic behavior may be due to release of serotonin from tryptaminergic neurons and of dopamine in the mesolimbic system. Because schizophrenia may result, in part from excessive dopamine neurotransmission, amphetamine-induced psychosis may mimic the natural disease more closely than LSD or other related agents.
With high doses, especially with continued use over hours/days, repetitive stereotypic behavior and paranoia may develop. After the stimulatory phase of amphetamine action dissipates, the user often feels a deep depression (a 'crash') and fatigue. This secondary depression may lead to readministration of the drug to get 'up' again.
Chronic high-dose abuse leads to a psychotic state with delusions and paranoia that is difficult to differentiate from schizophrenia. Symptoms of overdose include agitation, restlessness, tachycardia, hyperthermia, hyperreflexia, and possibly seizures.
Marked tolerance develops to amphetamine, mostly a functional tolerance. Although a limited physical dependence is associated with amphetamine, psychological dependence can be linked to chronic amphetamine use. Cross-tolerance develops with other amphetamine analogs.
Abstinence syndrome is characterized by increase appetite, sleepiness, exhaustion, and mental depression.

MDMA: Methylenedioxy-methamphetamine ('ADAM', 'Ecstasy', 'XTC') is a "club drug" with stimulant as well as psychedelic effects (psychotomimetic). MDMA became popular during the 1980s on college campuses because of testimonials that it enhances insight and self-knowledge, although no evidence exists to support this contention. Acute effects are dose-dependent and include feelings of energy, altered sense of time, and pleasant sensory experiences with enhanced perception. Negative effects include tachycardia, dry mouth, jaw clenching, and muscle aches. At higher doses, visual hallucinations, agitation, hyperthermia, and panic attacks have been reported. A typical oral dose is one or two 100-mg tablets and lasts 3 to 6 hours. Seizures are the most common reason for ER admission. MDMA produce degeneration of serotonergic nerve cells and axons in rats. There is possibility that it may cause neurotoxicity in humans.
MDA: Methylenedioxy-amphetamine is often the street form of MDMA. MDA produces empathy, serenity, joy, insight, and self-awareness. MDA does not produce perceptual changes or loss of control but seems to eliminate anxiety and defensiveness. It can leave a person very tired and sluggish. Physiological effects include involuntary teeth grinding, elevated heart rate, nystagmus, and at high doses, anxiety, high BP, and panic. Toxicity includes profuse sweating, skin reactions, and confusion.
Caffeine
Caffeine (in beverages) is the world's most widely consumed psychoactive substance. It is a CNS stimulant. The FDA lists caffeine as a "multiple purpose generally recognized as safe food substance". Caffeine is as an antagonist of adenosine receptors. The caffeine molecule is structurally similar to adenosine, and binds to adenosine receptors without activating them (competitive inhibitor).
Acute toxicity from overdosing of caffeine includes excessive CNS stimulation with tremor, insomnia, and nervousness. Sleep disorder and anxiety disorder can result from long-term excessive caffeine intake. Psychological dependence on caffeine has been recognized for some time. Abstinence signs and symptoms develop following abrupt discontinuation of exposure to caffeine. Withdrawal from caffeine is accompanied by lethargy, irritability, and headache.

Nicotine
Nicotine (in tobacco products) is legal in most countries despite its potential for adverse health effects.
In the U.S., cigarette smoking is a major preventable cause of death; tobacco use is associated with a high incidence of cardiovascular, respiratory, and neoplastic disease. Psychological dependence develops to nicotine. Abstinence signs and symptoms develop following abrupt discontinuation of exposure to this agent. Acute toxicity from overdosing of nicotine includes excessive CNS stimulation with tremor, insomnia, and nervousness. Nicotine withdrawal is associated with irritability and sleeplessness, and relapse after attempted cessation is very common. The anxiety and mental discomfort experienced from discontinuing nicotine are major impediments to quitting the habit.
Nicotine is a selective agonist of the nicotinic ACh receptors, which are involved in important brain functions. The rewarding effect of nicotine requires involvement of the VTA, where nAChRs are expressed on dopamine neurons. When nicotine excites projection neurons, dopamine is released in the nucleus accumbens and the prefrontal cortex.
Several strategies are available for smoking cessation. They include:
Quitting "cold turkey" (abrupt cessation of all nicotine use).
Smoking-cessation support and counseling.
Nicotine replacement therapy for withdrawal symptoms, cravings, and urges (e.g., transdermal nicotine patches, gum, lozenges, and sprays).
Nicotinic receptor agonist varenicline (Chantix) - which is a partial agonist selective for 42 nicotinic receptor subtypes. The efficacy of varenicline in smoking cessation is thought to be due to its partial agonistic activity at nicotine receptors that can prevent nicotine binding. The FDA has approved (2006) its use for twelve weeks for smoking cessation therapy. Caution: It may cause seizures, so prescribe with caution.

LSD, Mescaline & Psilocybin
Several drugs with hallucinogenic effects have been classified as having abuse liability, including lysergic acid diethylamide (LSD), mescaline, and psilocybin. These three drugs are commonly called hallucinogens because of their ability to alter consciousness such that the individual senses things that are not present. They induce, often in an unpredictable way, perceptual symptoms, including shape and color distortion. Phencyclidine (PCP, "angel dust") is probably the most dangerous of the currently popular hallucinogenic agents. Psychosis-like manifestations (depersonalization, hallucinations, distorted time perception) have led some to classify these drugs as psychotomimetics. The perceptual and psychological effects of such drugs are usually accompanied by marked somatic effects, particularly nausea, weakness, and paresthesias. Panic reactions ("bad trips") may also occur. Hallucinogens differ from most other drugs of abuse in that they induce neither dependence nor addiction. These drugs fail to stimulate dopamine release (drugs that activate the mesolimbic dopamine system are potent addictive agents). Hallucinogens increase glutamate release in the cortex, presumably by enhancing excitatory afferent input from the thalamus.

Sets with similar terms

Which stimulant is used in the treatment of attention deficit hyperactivity disorder?

Which of the following is a drug that can be used to treat attention deficit hyperactivity disorder ADHD )? Psychology?

What is the name of the stimulant drug that is the first line therapy to treat attention deficit hyperactivity disorder ADHD and narcolepsy?

What are the two most common treatments for attention deficit hyperactivity disorder?