Chapter 5 neuro - in this video, we will focus on various treatments for attention deficit hyperactivity disorder also known as
ADHD, and also treatment for bipolar disorder.
We'll start with the medications used for attention deficit hyperactivity disorder, or ADHD.
ADHD is developmentally inappropriate
inattention and hyperactivity
that comes from functional impairment in different settings of life.
It's thought that it's caused by deficits in an area of the brain that's associated with behavior and problem-solving.
One of the treatment modalities that we use to treat that is a sti.mulant to increase activity in the brain
These stimulants are the longest studied. They've been used the longest, and they work quickly,
so they're a pretty common choice in therapy. For our stimulants,We have dexmethylphenidate or Focalin, and
methylphenidate or Ritalin and Concerta.
New medications have been produced
that are non-stimulants which work the same way on norepinephrine and dopamine,
but they are not controlled so they don't have any abuse potential. The stimulants are controlled. Our
non-stimulant example in this video is atomoxetine or Strattera, and
the ending of the atomoxetine is not to be confused with that of fluoxetine, which is an SSRI.
Bipolar disorder is a disorder that causes shifts in mood and
activity levels,
so it can lead to extreme emotional highs and hyperactivity and they call that mania or
extreme lows, which present as depression.
Someone with bipolar disorder can have episodes of mania Or depression
or both. We treat people with bipolar disorder with mood stabilizers,
and the example today is a simple salt and it is lithium or Lithobid.
Let's work through some practice questions
Question one - 'A medication that is used for ADHD
with no abuse potential is?' and so for this video A) will be dexmethylphenidate, B) well be methylphenidate
C) will be atomoxetine, and D) will be lithium.
The correct answer is C) atomoxetine. This is the only non-stimulant medication that is approved for
ADHD. A) and B) are incorrect because those are both stimulants, and D) lithium is incorrect because,
although it is a non-stimulant, it is not used for ADHD.
Now we will go through all of these drugs again, and we will change the question to make it correct with the answers.
Question three, make A) correct - 'A stimulant that contains the d-enantiomer of another stimulant is?'
A) dexmethylphenidate.
Molecules are often made of two enantiomers.
An enantiomer is just when a molecule is a mirror image of a different molecule.
The dextro
enantiomer of methylphenidate is more pharmacologically active, and that is the only component of the dexmethylphenidate.
B) is incorrect because
methylphenidate contains the active
D enantiomer and also the less pharmacologically active L
Enantiomer. C) and D) are incorrect because those are non-stimulant medications.
Practice question four, make B) correct - 'A stimulant that is available as a capsule, tablet,
chewable tablet, suspension, solution and patch is?' B) methylphenidate.
Methylphenidate is available in all of these dosage forms, and it's also available as short, intermediate, and long
durations of action which is really helpful, especially in kiddos if they aren't able to
swallow tablets or capsules. It's nice to kind of have that paient
specificity, especially with the short, intermediate, and long acting as well.
Dexmethylphenidate is incorrect,
it's only available as a capsule and a tablet and it's also only available as short and intermediate acting.
Atomoxetineis not a stimulant, it's only available as a capsule, and lithium is incorrect because it is not a stimulant,
but it is available as a capsule, tablet and solution.
Question four, make D) correct -
'Medication use for bipolar disorder that can affect sodium levels is?' D) lithium.
Lithium was the only medication in this video that can be used for bipolar disorder and it does effective sodium.
Lithium is a pretty good mood stabilizer. It's one of the oldest we have and it's very effective in preventing suicide,
but it's use has fallen out of favor
because it has a lot of negative side effects. It can cause tremor when lithium levels are a little high, it can cause renal dysfunction, and
low thyroid levels. It's also not safe in pregnancy.
It has a small therapeutic index, and what that means is that the target dose is close to the toxic dose and
the ineffective dose so we have to have
tight control and regulation of the lithium with a lot of lab tests
to make sure that the lithium level is where it needs to be, so it's kind of falling out of favor.