2/24 Rx: ADHD drugs

Question 1

ADHD side effects to look out for when managing/adjusting doses

Answer 1

appetite suppression, delayed sleep onset, “wearing off” phenomenon, “tics,” depression, social w/drawal

Question 2

amphetamines

Answer 2

release DA and NE

Question 3

atomoxetime

Answer 3

selective NE reuptake inhibitor centrally and peripherally

Question 4

dexmethylphenidate, methylphenidate

Answer 4

block reuptake of DA and NE

Question 5

clonidine

guanfacine

Answer 5

animal studies show improved prefrontal cortical fx through post-synaptic alpha-2-receptor agonist effects in the PFC

Question 6

haloperidol

Answer 6

blocks post-synaptic D2 receptors

Question 7

amphetamine/dextroamphetamine + acetazolamide, Na Bicarb

Answer 7

alkaline urine favors reuptake of drug in renal tubules, inc serum drug levels

Question 8

amphetamine/dextroamphetamine + ammonium chloride

Answer 8

acidic urine favors renal elimination; dec serum drug levels

Question 9

amphetamine/dextroamphetamine + chlorpromazine, haloperidol

Answer 9

dopamine receptor blockers diminish effects of amphetamines

Question 10

amphetamine/dextroamphetamine + dextromethorphan

Answer 10

inc impaired judgement, erratic euphoria

Question 11

amphetamine/dextroamphetamine + digoxin

Answer 11

inc pro-arrhythmogenic effect

Question 12

amphetamine/dextroamphetamine + MAOIs

Answer 12

inc serum drug levels and toxicity

Question 13

amphetamine/dextroamphetamine + CYP2D6 ind/inhib

Answer 13

serum drug levels inc or dec

Question 14

common amphetamine AEs

Answer 14

abdominal pain, HA, insomnia, LOA, inc BP

Question 15

if stimulants don’t work for ADHD pts, what’s the next tx option?

Answer 15

atomoxetine

Question 16

which med for ADHD is useful w/comorbid dz presentations (e.g. substance use or mood DOs)?

Answer 16

bupropion

Question 17

atomoxetine/methylphenidate + albuterol

Answer 17

accentuates CV adverse effects

Question 18

atomoxetine/methylphenidate + epinephrine

Answer 18

further inc in BP

Question 19

atomoxetine/methylphenidate + MAOIs

Answer 19

inc toxicity, allows 2-wk interval b/w drugs

Question 20

atomoxetine/methylphenidate + alcohol

Answer 20

inc production of toxic metabolite –> fxal inability to concentrate (drive)

Question 21

atomoxetine/methylphenidate + phenytoin

Answer 21

inc blood levels of phenytoin in some pts

Question 22

atomoxetine/methylphenidate + ergotamine, pseudoephedrine

Answer 22

exacerbates pressor agent effect on BP

Question 23

atomoxetine/methylphenidate + CYP2D6 ind/inhib

Answer 23

both serum drug levels inc or dec

Question 24

atomoxetine AEs

Answer 24

dry mouth, HA, abd pain, dec appetite, cough, somnolence, vomiting, insomnia

Question 25

methylphenidate AEs

Answer 25

HA, insomnia, dec appetite (patch), n/v, abd pain

Question 26

absolute contraindications to stimulant use!!

Answer 26

MAOIs, psychosis, glaucoma, underlying cardiac conditions, existing liver DOs, hx of stimulant drug dependence

Question 27

ADHD + tics/tourettes: tx

Answer 27

1) DOC: a2 agonists 2) stimulants, but only helps ADHD 3) methylphenidate + a2 agonist combo

Question 28

just tics/tourettes: tx

Answer 28

antipsychotics

Question 29

drugs causing tics/tourettes

Answer 29

drugs that inc dopamine | -amphetamines, dexmethylphenidate/methylphenidate

Question 30

clonidine/guanfacine + haloperidol have significant drug interactions and the same AEs. what are the AEs?

Answer 30

skin rxns, dry mouth, somnolence, HA, fatigue, drowsiness, dizziness, anxiety, abd pain

Question 31

tx for atomoxetine/methylphenidate intoxication

Answer 31

support, w/judicious use of BNZs

Question 32

tx for atomoxetine toxicity

Answer 32

support, w/focus on sedation, and control of dyskinesias and seizures

Question 33

clonidine overdose: sxs and respective tx

Answer 33

paradoxical short-term HTN: nitroprusside | hypOTN: dopamine (pressors) for support of hypotension

Question 34

guanfacine overdose

Answer 34

largely supportive, w/focus on support of BP (hypOTN or HTN)