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Lecture Sixteen

Cognitive Enhancers

Whats the 476 definition of cognitive enhances? drugs used in an attempt to optimize mental function by enhancing one or more of the following: *learning and memory *attention *executive function
What are the 3 primary reasons for use of cognitive enhancers? (1) To counter mild cognitive impairment (MCI) or dementia (2) To counter ADD/ADHD-linked deficits in attention (3) To try and improve your own performance/productivity
CEs and dementia: dementia is a p____________ and p______________ deficit in ____________ with other deficits. persistent, progressive, memory
CEs and dementia: What CE drugs are used for dementia cases? Acetylcholinesterase inhibitors and NMDA receptor antagonist.
What CE drugs are used in cases of ADD/ADHD? Ritalin, Adderall, Dexedrine, Wellbutrin (SDRI) and Strattera (SNRI)
There are 5 types of CE drugs that can be used for personal cognitive performance. What are they? 1) Cortisol (your bodies natural compound) 2) caffeine (most commonly used psychoactive drug) 3) Ritalin, adderall, provigil (prescription drugs) 4) Piracetam (supplements) 5) next generation drugs still to be discovered
Cortisol can be a natural CE. What induces release of cortisol and where does cortisol release from? Stress induces the release of cortisol from the adrenal glands
How much of an increase in cortisol increases cognitive performance? Only acute increases (chronically high levels lead to cognitive impairments)
Stress also causes activation of the ____________ nervous system/release of ________________ (EPI). sympathetic, epinephrine
Stress also causes activation of the sympathetic nervous system/release of epinephrine (EPI). This get you ready for fight/flight which can initiate clinical anxiety in certain people. What do people use to reduce this anxiety? Beta blockers
Described beta-blockers mxn of action, mode of action and whether they are considered a CE or PE? mxn of action = beta-adrenergic receptor antagonists. mode = reduce subjective feelings of stress/anxiety. And don't match PE or CE definition but could argue that it does match CE definition as they divert attention to cognitive activities.
Purinergic stimulants (caffeine) are CE and found in what plants? coffee, cocoa, guarana, mate kola
What's the mechanism of action of caffeine? Adenosine receptor antagonist
How much caffeine do you need for CE? 50-300mg generally enhance academic performance (varies a lot between people)
What are the predominate effects of caffeine (main reasons for why it helps you study)? due to its enhancement of attention, vigilance and wakefulness
Why do we use caffeine so much normally? Easy access, cheap, acceptable and safe
Methylphenidate such as _______ is a Rx drug used as a CE. What is the mxn of action? blocks presynaptic DA transporter (DAT) and may slightly increase release of DA + NE.
What is the ROA of ritalin? those who manipulate ROA (crush it up and snort it) manipulate the mode of action and getter more alert for _______ performance Oral for Rx purposes , sports performance
What are the serious side effects of Ritalin? Death, stroke, heart attack, psychiatric problems, slowing of growth in children - both height and weight (youth under 18 are the biggest consumers!!), seizures, visual impairment
What is a common but less serious side effect of ritalin? Comment on this Trouble sleeping. We need sleep! If no sleep this hampers cognition and memory so not sleeping with Ritalin may not work so great for CE
What type of warning does Ritalin carry? A black box warning for abuse and dependence
Amphetamine such as Adderall is another PX that can be used as a CE. What is its mechanism of action? Promotes vescular release of newly synthesized NE and DA
What it the ROA of Adderall? oral for Rx purposes
What are the serious side effects of Adderall? Sudden death, heart attack, stroke, psyciatric problems, slowing of growth (height and weight) in children, seizures, visual impairments (so same as ritalin!)
What are the non serious but common side effects of Adderall? Restlessness, insomnia (again sleep trouble), dyskinesia, dysphoria, and depression.
What type of warning does Adderall carry? A LONGER black box warning for abuse and dependence AND fatality risk! So more serious risk to health
What are the serious side effects of Modafinil (Provigil)? Serious rash (life threatening rash), psyciatric symptoms, and symptoms of heart problems.
What are the less serious but common side effects of Provigil? anxiety, insomnia
What type of warning does Provigil carry? Black box warning for abuse and dependence as well as a warning that it is not suitable for us in children (due to a number of side effects in children)
What may the confusion over the mxn of action for the supplement CE called Piracetam, stem from? 1) from trying to group racetams together... 2) and/or highly variable doses 3) and /or examining the drug in the highly variables brains....e.g. post-stroke vs normal, old vs young, high functioning brain vs low functioning brain
Data best support that Piracetam is an effective CE in what cases? Instances of clinical encephalopathy e.g. older people, people with decline in cognitive post disease, disorders, surgery
What are the 5 mechanisms of action that are being targeted in current CE pharmaceutical development? 1) Adenosine receptor antagonists. 2) H3 receptor inverse agonists. 3) AMPAKINES 4) CREB inducers 5) Phosphodiesterase inhibitors (PDE inhibitors)
Who is using off label CEs? University students and academics, Military shooters, pilots, special operations, Shift Workers in hospitals, factorie,s police, School academics and extramurals and for recreational highs.
Do Rx nootropics work?? Can find convincing studies in BOTH directions.
Although you get speedy though from CEs, this may not be ______ thought (you can make _________) and you still need to do the ______! wise thought, mistakes, study.
Overall what are the 3 issues with Nootropic use in relation to health risks? 1) Black box warnings and side effects. 2) Long term effects (we don't know what happens if take for a long time. 3) Effects on 'normal brain' and young brain is uncertain.
Overall what are the 3 issues with Nootropic use in relation to abuse/addiction potential? 1) they hold potential for physical addiction for stimulants. 2)n hold potential for psychological addiction (not being able to study without them) 3) hold recreational potential
Overall is the issue with Nootropic use in relation to ethics of human enhancement? age of cosmetic neurology?
What is the 4th overall issue of Nootropic use not mentioned yet? Fairness
What is a key natural cognitive enhancement other than cortisol? Behavioural modification/CBT
Describe the inverted curve for efficacy As dose increases, efficacy of the nootropic increases to a certain level and then declines.
Describe the J curve for safety As dose increases safety risk increases
Describe the relationship between the inverted U curve and the j curve? With higher dose levels efficacy is less and safety risks is more
Created by: alice476