L 21-22 Psychomotor Stimulants

Practice flashcards based on clinical pharmacology lecture notes regarding psychomotor stimulants, their mechanisms, clinical uses, and toxicities.

What is the primary mechanism of action for synthetic cathinones ("bath salts") that explains symptoms like severe agitation and hypertension?

Increased catecholamine release and monoamine reuptake blockade of dopamine, norepinephrine, and serotonin.

Why is modafinil considered to have a lower abuse potential compared to traditional amphetamines?

It is an atypical stimulant with weak $DAT$ inhibition, resulting in less euphoria and autonomic stimulation.

Which pharmacokinetic feature of lisdexamfetamine ($Vyvanse^{\circledR}$) reduces its reinforcement and euphoria?

It is a prodrug requiring enzymatic hydrolysis in red blood cells ($RBCs$), which produces a slower onset and smoother plasma concentrations.

Which recreational drug is most likely responsible for a patient presenting with tachyarrhythmia, severe hypertension, and nasal septal perforation?

Cocaine.

Antagonism of which receptor primarily contributes to the increased alertness and wakefulness associated with caffeine?

Adenosine $A_1$ receptor.

How do oral contraceptives ($OCPs$) affect the metabolism of caffeine?

They inhibit $CYP1A2$ metabolism of caffeine, which increases caffeine plasma concentrations and effects.

What is the main difference in the mechanism of action between methylphenidate and amphetamine salts?

Methylphenidate is a reuptake blocker of dopamine and norepinephrine, while amphetamine is a neurotransmitter releaser that reverses $DAT$ and $NET$.

What contributes to the high neurotoxicity and addictive potential of methamphetamine according to the lecture notes?

Greater $CNS$ penetration and prolonged monoamine release.

Which three symptoms are most characteristic of a patient experiencing a withdrawal "crash" after abrupt discontinuation of chronic amphetamine use?

Depression, hypersomnia, and increased appetite.

Which drug acts as both a psychomotor stimulant and a topical local anesthetic by blocking voltage-gated sodium channels?

Cocaine.

Why does pseudoephedrine produce fewer $CNS$ stimulant effects compared to its enantiomer ephedrine?

It has minimal blood-brain barrier ($BBB$) penetration.

What is the first-line pharmacologic management for a patient presenting with severe agitation, hyperthermia, and hypertension from a stimulant overdose?

Benzodiazepines.

According to the "Rapid Buzzword Identification Chart," what is the abuse potential and $DEA$ schedule for Modafinil?

Lower abuse potential and Schedule $IV$.

Which chronic toxicity finding is a unique buzzword for methamphetamine use?

"Meth mouth" (severe dental decay).

What are the common clinical findings in a synthetic cathinone overdose that distinguish it as particularly severe?

Violent behavior, extreme hyperthermia ($105^\circ\text{F}$), rhabdomyolysis, and serotonin syndrome.