Review Question - QID 107033

This patient has intoxication with the medication used to treat his attention deficit disorder, dextroamphetamine (Adderall). Amphetamines function by increasing presynaptic dopamine and norepinephrine release from vesicles.

Amphetamine/dextroamphetamine are widely abused stimulants that decrease the need for sleep. At low doses, they primarily cause increased norepinephrine release, but at higher doses, serotonin release is increased as well (a lesser mechanism of action includes acting as a reuptake inhibitor). The potential for abuse is high, as the increase in dopamine can be addictive. At high doses, amphetamines can produce euphoria, prolonged wakefulness/attention, impaired judgement, psychomotor agitation, tachycardia, fever, hypertension, pupillary dilation, decrease in appetite, and cardiac arrhythmias. Withdrawal symptoms can occur when taken at high doses and abruptly stopped, which may include depression, lethargy, headache, stomach cramps, hunger, and hypersomnolence. Note that these are similar withdrawal symptoms to methamphetamine abuse.

Elia et al. reviews a comparison of methylphenidate and dextromphetamine in the treatment of hyperactivity. Both drugs were determined to be efficacious in treating hyperactivity with some patients experiencing more benefits with one drug over the other (though not in a consistent manner). It was also concluded that not responding was a very rare occurrence with the use of these drugs in the treatment of hyperactivity.

DeSantis et al. surveyed 1,811 undergraduates at a public university to determine the illicit use of ADHD stimulants. They found that 34% of those surveyed used the stimulants in an illegal manner specifically during academically stressful times as it "reduced their fatigue while increasing reading comprehension, interest, cognition, and memory."

Incorrect Answers:
Answer 2: Guanethidine replaces the norepinephrine inside the neurotransmitter vesicles and depletes the vesicles of it.
Answer 3: Tetrahydrocannabinol (THC) binds to cannabinoid receptors. Patient will demonstrate decreased focus, slowed speech, inappropriate laughter, impaired short term memory and conjunctival injection.
Answer 4: PCP blocks NMDA receptors. These patient's present with aggression, violence and often injury from trauma as a result of their behavior. It is important to put these patients in a low stimulus environment (quiet, dark), restrain the patient so they can not harm themselves or others, and potentially administer an anti-psychotic.
Answer 5: Heroin activates mu opioid receptors. These patient's can present with respiratory depression, constipation, and pinpoint pupils. Respiratory depression can be fatal in these patient so be sure to protect their airways.