Review Question - QID 106930

Action	Numeric Key	Letter Key	Function Key
Choose 1	1
Choose 2	2
Choose 3	3
Choose 4	4
Choose 5	5
Submit Response			Enter
Previous Question			Left Arrow
Next Question		N	Right Arrow
Open/Close Bookmode		C
Open Image			Spacebar

Methylphenidate (Ritalin) QID: 106930 (M2.PY.14.81)

QID 106930 (Type "106930" in App Search)

A 9-year-old boy is brought by his primary care physician by his mother after the child was suspended from school for being disruptive during class. The teacher noted that the patient is always fidgeting, has difficulty concentrating, and does not complete assignments. His mother notes that he often gets up and runs around the house when she is trying to call everyone for dinner, and that this has been going on since he was 6 years old. The physician prescribes a first-line agent for the child's presumed condition. What is the effect of this medication on neurotransmitters?

Type & Select Correct Answer

Type in at least one full word to see suggestions list

Increased norepinepherine

63%

32/51

Decreased dopamine

12%

6/51

Increased GABA

4/51

Decreased glutamate

12%

6/51

Increased epinepherine

2/51

Select Answer to see Preferred Response

Review TC In New Tab

This patient's clinical presentation is consistent with attention deficit hyperactivity disorder (ADHD). The two first-line agents for treatment of this disorder are methylphenidate (Ritalin) and dextroamphetamine (Adderall), which increase norepinerphine and dopamine release.

The cornerstone of pharmacologic treatment for ADHD is stimulants, most notably methylphenidate and dextroamphetamine. Both medications increase levels of synaptic norepinepherine and dopamine in the prefrontal cortex, nucleus accumbens, and locus ceruleus. Although it can be counterintuitive to treat a disorder of hyperactivity with a stimulant, the concept is explained by the fact that the specific brain regions that are stimulated are those that help with impulse control and concentration.

Post and Kurlansik discuss the diagnosis and management of ADHD. They note that cognitive behavioral therapy may be an effective adjunctive treatment. In addition, they report the high comorbidity of ADHD and depression, and suggest that depression should be treated before ADHD in such cases.

Habel et al. conducted a retrospective, cohort trial of adults aged 25-64 to determine whether treatment with amphetamines increased risks of cardiovascular complications. One of the major side effects of stimulants is tachycardia and hypertension, but the significance of these effects are unknown. Among roughly 150k adults with ADHD who were prescribed stimulants, they found no increase in cardiovascular risk, compared to normal adults.

Illustration A is a chart illustrating the areas of the brain that are affected by ADHD, along with the unique behavioral features of each area. Illustration B shows the mechanism of action of methylphenidate.

Incorrect Answers:
Answer 2: Stimulants increase release of dopamine from pre-synaptic vesicles.
Answer 3: Valproic acid, an anti-epileptic drug, works by increasing synaptic GABA concentrations.
Answer 4: Cannabinoids decrease synaptic glutamate concentration.
Answer 5: Monoamine oxidase inhibitors increase availability of epinephrine for synaptic release.

ILLUSTRATIONS: