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Tuberomammillary nucleus (TMN)
Contains the “on” switch
Ventrolateral preoptic nucleus (VLPO)
Contains the “off” switch
Guanfacine mechanism of action
alpha-2 agonist
Methylphenidate mechanism of action
Dopamine-norepinephrine multimodal; blocks DAT and NET
Amphetamines mechanism of action
dopamine-norepinephrine reuptake inhibitor
Wellbutrin mechanism of action
dopamine reuptake inhibitor
Hyperactivity
Modulated by the prefrontal cortex
Impulsivity
Modulated by the orbitofrontal cortex
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.
Melatonin and melatonin receptor agonists
Effective hypnotics for sleep onset.
They DO NOT help with sleep maintenance.
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.
Z drugs
Schedule IV medications.
A DEA license is required to prescribe these medications.
Dopamine agonists
First-line treatment for insomnia related to restless leg syndrome (RLS)
Melatonin
Secreted by pineal gland, regulates circadian rhythms
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”