1. CNS STIMULANTS SAMUEL AGUAZIM

2. What is the definition of a CNS stimulant? A CNS stimulant is a drug that increases motor activity, causes excitement and decreases feelings of fatigue. CNS stimulants include the methyxanthines, nicotine, and the amphetamines

3. CNS stimulant PSYCHOMOTOR STIMULANTS CAUSE EXCITEMENT & EUPHORIA INCREASE MOTOR ACTIVITY PSYCHOTOMIMETIC DRUGS PROFOUND CHANGES IN THOUGHT PATTERNS AND MOOD FEW DRUGS USED CLINICALLY IMPORTANT AS DRUGS OF ABUSE

6. METHYLXANTHINES What are methyxanthines? A group of psychomotor stimulants include: Caffeine Theophylline Theobromine ( found in cocoa but of little interest)

7. How do methyxanthines work? Research indicates that methyxanthines increases cyclic guanosine monophosphate (cGMP) and cyclic adenosine monophosphate (cAMP) by inhibiting phosphodiesterase and blocking adenosine receptors.

8. CAFFEINE What are the physiologic effects of caffeine? Caffeine effects a number of organ systems within the body: CNS - caffeine increases motor activity and alertness Cardiovascular- caffeine increases heart rate and contractility

9. CAFFEINE Smooth muscle- caffeine and its derivatives relax the smooth muscles of the bronchioles. Genitourinary- caffeine can ac as weak diuretic and increase urinary output of Na+, CI- and K+ Gastrointestinal – caffeine stimulates secretion from the gastric mucosa. Therefore, patients who have peptic ulcer disease should be counseled to avoid caffeine

10. Adverse Effects of chronic caffeine use? At low doses- insomnia and agitation can occur At higher doses (8-10g)- Emesis, convulsion and even cardiac arrhythmias can occur. Do methyxanthines cross the placenta? Yes, and they are secreted into the mother’s milk. Patients should be advised to avoid them during pregnancy and while nursing

11. THEOPHYLLINE THERAPEUTIC ROLE OF THEOPHYLLINE: It can be used in the treatment of asthma, but currently it is not being used frequently because it has a very narrow therapeutic index and is not effective as the new beta agonist

12. NICOTINE How are the physiological effects of nicotine related to the dose? In low doses, nicotine causes ganglionic stimulation by depolarization. At high doses it causes ganglionic blockade

13. NICOTINE What are the physiologic actions of nicotine on the central nervous system? At low doses- arousal, relaxation and improved attention At high doses- central respiratory paralysis caused by disruption of medullary function

14. NICOTINE How does nicotine affect the peripheral nervous system? At low doses- increase in blood pressure and heart rate; constriction of blood vessels to the digits and impairment of flow At high doses- decrease in blood pressure and in action of GI and GU tract due to ganglionic blockade NOTE: NICOTINE HAS NO THERAPEUTIC USES

15. NICOTINE What is nicotine’s route of administration? Absorption occurs through oral mucosa by inhalation and transdermally. What are its adverse effects? CNS - irritability and tremors Peripheral - intestinal cramps, diarrhea, and increased heart rate and blood pressure

16. NICOTINE What withdrawal symptoms do nicotine addicts experience? A craving for tobacco is accompanied by irritability, restlessness, anxiety and gastrointestinal pain.

17. AMPHETAMINES Name three examples of this drug class. 1. methylphenidate ( ritalin) 2. methamphetamine ( methedrine)-”speed” 3. dextroamphetamine ( dexedrine)

18. AMPHETAMINES How do these drugs work? Amphetamines work by releasing neuronal stores of catecholamines especially norepinephrine and dopamine

19. AMPHETAMINES What are the physiologic actions of these drugs? Euphoria Decrease in fatigue Increase in blood pressure Increase in rate of respiration Decrease in appetite

20. AMPHETAMINES What is their clinical use? Attention deficit hyperactivity disorder(ADHD)-METHYLPHENIDATE is used to alleviate this problem Appetite control- amphetamines decrease appetite by blocking the receptors in the lateral hypothalamus Narcolepsy

21. AMPHETAMINES What is the route of administration? Oral Where are amphetamines metabolized? In the liver Does physiologic and psychological dependence occur with amphetamine use? Yes- amphetamines can be very addictive

22. AMPHETAMINES What are the adverse effects of these drugs? Amphetamines like caffeine and nicotine affects multiple organ systems. CNS -insomnia, irritability, convulsions; chronic use can lead to a psychotic state resembling schizophrenia Gastrointestinal- anorexia, nausea, dry motuh Cardiovascular- palpitations, angina, arrhythmias, hypertension

23. AMPHETAMINES Amphetamines are contraindicated with what group of drugs? The monoamine Oxidase (MAO) inhibitors How is amphetamine overdose managed? Chlorpromazine is beneficial in amphetamine overdose because it blocks the alpha receptors which are responsible for the CNS disturbances and hypertension