Childhood Disorders and Old age Disorders

Amphetamines
are a class of central nervous system stimulant drugs that affect the levels of certain
chemicals in the brain. They are commonly used for the treatment of attention deficit
hyperactivity disorder (ADHD) and narcolepsy.
Indications:
- ADHD: Amphetamines can help increase attention span, decrease impulsiveness,
and control hyperactivity in individuals with ADHD.
- Narcolepsy: Amphetamines can help reduce excessive daytime sleepiness and improve
wakefulness in individuals with narcolepsy.
Contraindications:
- Cardiovascular issues: Amphetamines are contraindicated in individuals with a
history of heart disease, high blood pressure, or other cardiovascular problems.
- Hyperthyroidism: Amphetamines should be avoided in individuals with overactive thyroid.
- Glaucoma: Amphetamines can increase intraocular pressure and should not be used in
individuals with glaucoma.
- Anxiety or agitation: Amphetamines can worsen symptoms of anxiety or agitation and
should be used with caution in individuals with these conditions.
Pharmacology:
Amphetamines work by increasing the release and blocking the reuptake of certain
neurotransmitters, such as dopamine, norepinephrine, and serotonin. This leads to increased
levels of these neurotransmitters in the brain, which can enhance focus, attention, and
wakefulness.
Compound availability:
Amphetamines are available in various forms, including immediate-release tablets,
extended-release capsules, and oral solutions. These medications are usually available by
prescription and should be taken under the supervision of a healthcare professional.
Pharmacokinetics:
Amphetamines are well absorbed after oral administration. The onset of action is
generally rapid, and the duration of effect depends on the specific formulation used. The
drugs are metabolized in the liver and eliminated primarily through urine.
Adverse effects:
Common adverse effects of amphetamines include increased heart rate, elevated
blood pressure, loss of appetite, insomnia, restlessness, dry mouth, and headache. In some
cases, they can also cause more serious side effects such as cardiovascular problems,
psychiatric symptoms, and growth suppression in children.
Dopaminergic pathways:
Amphetamines primarily act on the dopaminergic pathways in the brain. By
increasing dopamine levels, they can enhance motivation, reward, and pleasure, leading to
their potential for abuse and addiction.
Unwanted effects:
Amphetamines can have several unwanted effects, including increased anxiety,
irritability, paranoia, and aggression. They may also cause hallucinations, delusions, and
psychosis, particularly at higher doses or in susceptible individuals.
Drug interactions:
Amphetamines can interact with various medications, including antihypertensives,
antacids, antidepressants, and certain other stimulants. These interactions can affect the
effectiveness or safety of both the amphetamines and the other drugs, so it's important to
inform healthcare professionals about all medications being taken.
Dependency and withdrawal:
Amphetamines have a potential for dependence and addiction. Prolonged use or
misuse can lead to tolerance, where higher doses are needed to achieve the desired effect.
Abrupt discontinuation of amphetamines after prolonged use can result in withdrawal
symptoms such as fatigue, depression, and increased appetite.
Advice and management:
Amphetamines should be used as prescribed by a healthcare professional. Regular
monitoring of blood pressure, heart rate, and other vital signs is important during treatment.
It's crucial to follow the prescribed dosage and not to exceed it. If any concerning side effects
or withdrawal symptoms occur, it's important to consult a healthcare professional for
guidance and support.
Methylphenidate
Methylphenidate is a medication that belongs to the class of central nervous system
stimulants. It is primarily used for the treatment of attention deficit hyperactivity disorder
(ADHD) and narcolepsy.
Indications:
- ADHD: Methylphenidate helps improve attention span, decrease impulsiveness, and
manage hyperactivity in individuals with ADHD.
- Narcolepsy: Methylphenidate can reduce excessive daytime sleepiness and improve
wakefulness in individuals with narcolepsy.
Contraindications:
 Hypersensitivity: Methylphenidate should not be used in individuals with known
hypersensitivity or allergy to the drug or its components.
- Glaucoma: Methylphenidate can increase intraocular pressure and is contraindicated in
individuals with glaucoma.
- Severe anxiety or agitation: Methylphenidate may exacerbate symptoms of severe anxiety
or agitation and should be used with caution in these cases.
- History of drug dependence: Methylphenidate is contraindicated in individuals with a
history of substance abuse or dependence.
Pharmacology:
Methylphenidate works by increasing the levels of dopamine and norepinephrine in
the brain. It inhibits the reuptake of these neurotransmitters, leading to increased
concentration and prolonged action in the synaptic cleft. This mechanism enhances focus,
attention, and impulse control.
Compound availability:
Methylphenidate is available in various forms, including immediate-release tablets,
extended-release tablets, and transdermal patches. These formulations are typically available
by prescription and should be taken under the guidance of a healthcare professional.
Pharmacokinetics:
Methylphenidate is well-absorbed after oral administration. The onset of action
depends on the specific formulation used. The drug is metabolized in the liver and excreted
primarily through urine.
Adverse effects:
Common adverse effects of methylphenidate include decreased appetite, insomnia,
headache, stomachache, nervousness, and increased heart rate. Other potential side effects
include increased blood pressure, weight loss, mood changes, and dizziness.
Dopaminergic pathways:
Methylphenidate primarily acts on the dopaminergic pathways in the brain. By
increasing dopamine levels, it helps regulate attention, motivation, and reward processes.
Unwanted effects:
Unwanted effects of methylphenidate can include irritability, restlessness, anxiety,
and emotional lability. In some cases, it may induce psychiatric symptoms such as
hallucinations, aggression, or paranoia. These effects are typically dose-dependent and more
likely to occur at higher doses.
Drug interactions:
Methylphenidate can interact with various medications, including monoamine oxidase
inhibitors (MAOIs), antihypertensives, and certain antidepressants. These interactions can
alter the effectiveness or safety of both methylphenidate and the other drugs, so it's important
to inform healthcare professionals about all medications being taken.
Dependency and withdrawal:
Methylphenidate has a potential for dependence and addiction, particularly when
misused or taken in high doses. Tolerance can develop over time, requiring higher doses to
achieve the same effect. Abrupt discontinuation of methylphenidate can lead to withdrawal
symptoms such as fatigue, depression, and increased appetite.
Advice and management:
Methylphenidate should be used as prescribed by a healthcare professional. Regular
monitoring of vital signs, including blood pressure and heart rate, is important during
treatment. It's essential to follow the prescribed dosage and not to exceed it. If any concerning
side effects or withdrawal symptoms occur, it's crucial to consult a healthcare professional for
guidance and support.
Dosage
The dosage of methylphenidate can vary depending on the specific formulation, the
individual's age, weight, and response to the medication, as well as the condition being
treated. It is important to follow the prescribed dosage instructions provided by a healthcare
professional. The following dosage information provides a general overview:
1. Immediate-release tablets:
- ADHD in children (6 years and older): The initial dose is usually 5 mg taken orally 2-3
times a day. The dosage can be gradually increased by 5-10 mg per week based on the
individual's response and tolerability, up to a maximum daily dose of 60 mg.
- ADHD in adolescents and adults: The initial dose is typically 5-10 mg taken orally 2-3
times a day. The dosage can be increased by 5-10 mg per week as needed, up to a maximum
daily dose of 60 mg.
2. Extended-release tablets:
- ADHD in children (6 years and older): The initial dose is usually 18-36 mg taken orally
once daily in the morning. The dosage can be adjusted in increments of 18 mg at weekly
intervals, up to a maximum daily dose of 72 mg.
- ADHD in adolescents and adults: The initial dose is typically 18-36 mg taken orally once
daily in the morning. The dosage can be adjusted in increments of 18 mg at weekly intervals,
up to a maximum daily dose of 72 mg.
Atomoxetine
Atomoxetine is a medication primarily used for the treatment of attention deficit
hyperactivity disorder (ADHD) in children, adolescents, and adults. It is a selective
norepinephrine reuptake inhibitor (SNRI) and has unique pharmacological properties
compared to other ADHD medications.
Indications:
- ADHD: Atomoxetine is indicated for the treatment of ADHD in individuals aged 6 years
and older.
Contraindications:
- Hypersensitivity: Atomoxetine should not be used in individuals with known
hypersensitivity or allergy to the drug or its components.
- Concurrent use of monoamine oxidase inhibitors (MAOIs) or within 14 days of
discontinuing an MAOI: Combining atomoxetine with MAOIs can lead to serious or
potentially life-threatening reactions.
- Glaucoma: Atomoxetine can increase intraocular pressure and is contraindicated in
individuals with glaucoma.
- Severe cardiac or vascular disorders: Atomoxetine should be used with caution in
individuals with a history of cardiovascular problems.
Pharmacology:
Atomoxetine works by selectively inhibiting the reuptake of norepinephrine, a
neurotransmitter involved in regulating attention and impulse control. Unlike stimulant
medications used for ADHD, atomoxetine does not directly affect dopamine levels.
Compound availability:
Atomoxetine is available in oral capsule form. It is typically available by prescription
and should be taken under the guidance of a healthcare professional.
Dosage:
The dosage of atomoxetine is determined by the individual's weight, response to
the medication, and the prescribing healthcare professional's instructions. The
recommended starting dose for children, adolescents, and adults is usually 0.5 mg/kg
once daily or 40 mg, whichever is less. The dosage may be gradually increased over
time, based on the individual's response and tolerability, up to a maximum daily dose of
1.4 mg/kg or 100 mg, whichever is less.
Tolerance:
Tolerance to atomoxetine may occur, and the dosage may need to be adjusted over
time to maintain its effectiveness. Regular monitoring and communication with the
prescribing healthcare professional are important to optimize treatment.
Mechanism of action:
Atomoxetine selectively inhibits the reuptake of norepinephrine in the brain. By
increasing norepinephrine levels, it helps regulate attention, impulse control, and
hyperactivity associated with ADHD.
Pharmacokinetics:
 Atomoxetine is well-absorbed after oral administration and reaches peak plasma
concentrations within 1-2 hours. It is extensively metabolized in the liver and excreted
primarily through urine. The half-life of atomoxetine ranges from 3 to 20 hours, depending
on individual factors.
Adverse effects:
Common adverse effects of atomoxetine include nausea, stomach upset, decreased
appetite, dry mouth, constipation, headache, dizziness, and insomnia. Less common but
potentially serious side effects may include liver problems, cardiovascular effects, psychiatric
symptoms, and allergic reactions.
Dopaminergic pathways:
Atomoxetine does not directly affect dopamine levels, unlike stimulant medications
used for ADHD. Its primary mechanism of action is through the selective inhibition of
norepinephrine reuptake.
Unwanted effects:
Unwanted effects of atomoxetine can include mood swings, irritability, anxiety, and
increased suicidal ideation, particularly in individuals with a history of depression or other
psychiatric disorders. It may also cause changes in blood pressure and heart rate.
Drug interactions:
Atomoxetine can interact with certain medications, including MAOIs, other
antidepressants, and drugs that affect liver enzymes. These interactions can affect the
effectiveness or safety of atomoxetine, so it's important to inform healthcare professionals
about all medications being taken.
Dependency and withdrawal:
Atomoxetine is not associated with physical dependence or withdrawal symptoms
upon discontinuation. However, abrupt discontinuation of atomoxetine after long-term use
may lead to rebound symptoms of ADHD. Therefore, it is generally recommended to
gradually taper the dose under the guidance of a healthcare professional.
Advice and management:
Atomoxetine should be used as prescribed by a healthcare professional. Regular
monitoring of vital signs, including blood pressure and heart rate, is important during
treatment. It's essential to follow the prescribed dosage and not to exceed it. If any concerning
side effects or symptoms occur, it's crucial to consult a healthcare professional for guidance
and support. Regular communication with the prescribing healthcare professional is
important for ongoing management and adjustment of the treatment plan.

Alcoholic Delirium Tremens (DTs):

Alcoholic Delirium Tremens, commonly known as DTs, is a severe and potentially
life-threatening alcohol withdrawal syndrome that can occur in individuals with a history of
heavy and prolonged alcohol use. It typically develops within 2-5 days after the last drink and
is characterized by symtoms such as severe agitation, confusion, hallucinations, tremors, and
autonomic instability. DTs require immediate medical attention and treatment in a hospital
setting. Benzodiazepines are commonly used to manage the symptoms of DTs and prevent
complications.

Poly Drug Abuse:

Poly drug abuse refers to the concurrent abuse of multiple substances, often including
alcohol, illicit drugs, prescription medications, or a combination of these substances. It can
complicate the diagnosis and treatment of substance use disorders. Poly drug abuse increases
the risk of adverse effects, drug interactions, and overdose. The specific effects and
consequences of poly drug abuse can vary depending on the combination of substances used.
Short-Term Effects of Alcohol Abuse:
1. Intoxication: Alcohol intoxication can result in impaired judgment, coordination, and
slowed reaction times. It can lead to accidents, injuries, and risky behaviors.
2. Impaired cognitive function: Alcohol can impair cognitive functions such as memory,
attention, and decision-making.
3. Gastrointestinal disturbances: Alcohol can cause nausea, vomiting, and stomach pain.
4. Emotional and behavioral changes: Alcohol can lead to mood swings, increased
aggression, and disinhibition.
5. Blackouts: Excessive alcohol consumption can result in memory loss or "blackouts," where
individuals have no recollection of events that occurred during intoxication.
Long-Term Effects of Alcohol Abuse:
1. Physical health problems: Long-term alcohol abuse can lead to various health issues,
including liver disease (such as cirrhosis), cardiovascular problems, pancreatitis, and
increased risk of certain cancers.
2. Cognitive impairments: Chronic alcohol abuse can cause cognitive deficits, including
memory problems, decreased attention span, and difficulties with problem-solving and
decision-making.
3. Mental health disorders: Alcohol abuse is associated with an increased risk of developing
mental health disorders such as depression, anxiety, and alcohol use disorder itself.
4. Social and interpersonal problems: Alcohol abuse can strain relationships, lead to social
isolation, and negatively impact work or academic performance.
5. Tolerance and dependence: Prolonged alcohol abuse can lead to the development of
tolerance, requiring higher amounts of alcohol to achieve the desired effects. It can also result
in physical dependence, where abrupt discontinuation of alcohol leads to withdrawal
symptoms.
Psycho pharmacology considerations:
In the treatment of alcohol use disorders, psycho pharmacological interventions play a
significant role:
1. Medications for alcohol withdrawal: Benzodiazepines such as diazepam or lorazepam are
commonly used to manage alcohol withdrawal symptoms, including those seen in DTs.
2. Medications for alcohol dependence: Medications like naltrexone, acamprosate, and
disulfiram may be prescribed to assist in reducing alcohol cravings, promoting abstinence,
and preventing relapse.
3. Comorbid mental health disorders: If individuals with alcohol use disorders have co-
occurring mental health disorders such as depression or anxiety, appropriate psycho
pharmacological treatment may be prescribed to address these conditions.
4. Harm reduction strategies: Psycho pharmacological interventions can also be used in harm
reduction approaches, such as the use of medications like naloxone for opioid overdose
prevention in individuals with poly drug abuse involving opioids.