ADD/ADHD

Question 1

Describe the mechanism by which stimulant medications are beneficial in ADD/ADHD.

Answer 1

The problem in ADD/ADHD is the brain cannot organize the multitude of sensory information that is coming in. Stimulants activate the parts of the brain responsible for organizing sensory input.

Question 2

By what age is ADD/ADHD typically diagnosed and what is required for diagnosis?

Answer 2

Usually presents by age 7 and must have impairment across multiple settings.

Question 3

What is the fastest growing drug of abuse in the US and in what setting is abuse most common?

Answer 3

Methylphenidate - especially on college campuses

Question 4

List three primary symptoms of ADD/ADHD that are improved by methylphenidate.

Answer 4

Inattention, impulsivity, motor over-activity

Question 5

What control schedule is methylphenidate and what is unique about this?

Answer 5

C-2 –> one of the only non-opioid drugs in C-2

Question 6

How is methylphenidate dosed and used in the treatment of ADD/ADHD?

Answer 6

Dosing is individualized based on patient response and should be combined with some type of counseling or therapy, like CBT.

Question 7

How is the efficacy of drug therapy in ADD/ADHD assessed?

Answer 7

Drug holiday –> stop the drug periodically to see if it is still needed.

Question 8

Describe the advantage and disadvantage of methylphenidate being available in various dosage forms.

Answer 8

Adv: kids have varied methods to which they will adhere to medication forms
Disadv: Different dosage forms may have different potency –> double check the dose when switching dosage forms

Question 9

What is the advantage and disadvantage of the methylphenidate patch?

Answer 9

Adv: increased adherence and can be applied close to the time when ADD/ADHD is worst for the patient
Disadv: associated with chemical leukoderma –> limited places to place the patch on kids

Question 10

T/F: Methylphenidate is used to treat depression.

Answer 10

True: can be used as an adjunct in major depression

Question 11

With what drug class might methylphenidate interact?

Answer 11

MAOIs decrease the metabolism of many of the stimulants

Question 12

In patients with what conditions would you be cautious in prescribing methylphenidate?

Answer 12

HTN and seizures

Question 13

What affect will methylphenidate have on appetite and growth?

Answer 13

Decreased appetite and growth

Question 14

List 5 amphetamine or amphetamine derivative medications (other than methylphenidate) that can be used in the treatment of ADD/ADHD.

Answer 14

Dexmethylphenidate, Dextroamphetamine, Adderall, Dextromethamphetamine, Lisdexamfetamine

Question 15

Adderall is a combination of what two products?

Answer 15

Amphetamine and dextroamphetamine

Question 16

T/F: All amphetamine and amphetamine derivatives discussed in class are C-2.

Answer 16

True

Question 17

What is the only non-stimulant option for treatment of ADD/ADHD discussed in class?

Answer 17

Atomoxetine

Question 18

Describe the mechanism of action of atomoxetine.

Answer 18

Norepinephrine reuptake inhibitor

Question 19

What is the control schedule of atomoxetine?

Answer 19

Not controlled –> no abuse potential

Question 20

When is atomoxetine used in the management of ADD/ADHD?

Answer 20

Second-line –> not as effective as the stimulant medications

Question 21

What is the off-label use of atomoxetine?

Answer 21

Nocturnal enuresis (bed-wetting)

Question 22

What are the precautions associated with use of atomoxetine?

Answer 22

Risk of SI

Weight loss –> less so than the stimulants

Question 23

List 6 medications or classes of medications used as an adjunct in treating ADD/ADHD.

Answer 23

Clonidine
TCAs
SSRIs
Bupropion 
Venlafaxine
Valproic Acid

Question 24

When might an adjunct to ADD/ADHD treatment be used?

Answer 24

When the patient has issues - severe ADD/ADHD