Week 7 Clinical Pearls

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15 Terms

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Tuberomammillary nucleus (TMN)

Contains the “on” switch

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Ventrolateral preoptic nucleus (VLPO)

Contains the “off” switch

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Guanfacine mechanism of action

alpha-2 agonist

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Methylphenidate mechanism of action

Dopamine-norepinephrine multimodal; blocks DAT and NET

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Amphetamines mechanism of action

dopamine-norepinephrine reuptake inhibitor

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Wellbutrin mechanism of action

dopamine reuptake inhibitor

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Hyperactivity

Modulated by the prefrontal cortex

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Impulsivity

Modulated by the orbitofrontal cortex

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ADHD presentation

Children: present with hyperactivity

Adults: not hyperactive but do report internal restlessness and difficulty sitting still

Hyperactivity symptoms are going to decline markedly with age, becoming more subjective, less apparent, or obvious to others.

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Melatonin and melatonin receptor agonists

Effective hypnotics for sleep onset.

They DO NOT help with sleep maintenance.

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Classic ADHD onset

Presents around age 7 due to the abnormalities in the prefrontal cortex circuits.

dACC is associated with impulsivity, one of the symptoms of ADHD.

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Z drugs

Schedule IV medications.

A DEA license is required to prescribe these medications.

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Dopamine agonists

First-line treatment for insomnia related to restless leg syndrome (RLS)

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Melatonin

Secreted by pineal gland, regulates circadian rhythms

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Norepinephrine and Dopamine

Associated with the symptoms of inefficient information processing in the prefrontal circuits. Rather than a deficiency, Stahl posits that NE and DA are “out of tune”