ADD, CNS Stimulants

Question 1

What are the 3 components to ADD and ADHD?

Answer 1

inattention, impulsivity, motor over-activity

Question 2

Symptoms of ADD/ADHD must be present before the age of _____ and cause impairment…..

Answer 2

7

across multiple settings

Question 3

What is a first line agent used in children >6 years of age?

Answer 3

Methylphenidate (Ritalin, Concerta)

Question 4

What schedule are most stimulants? (fasting growing drug of abuse on college campuses)

Answer 4

C2

Question 5

Methylphenidate is a derivative of ______.

Answer 5

amphetamine

Question 6

T or F. Most patients will take the same dose of methylphenidate.

Answer 6

F - based on patient response

Question 7

T or F. Methylphenidate alone is sufficient treatment for ADD/ADHD.

Answer 7

F - need counseling too

Question 8

How do patients and providers gauge continued need or efficacy of methylphenidate?

Answer 8

drug holidays

Question 9

T or F. Switching from one methylphenidate product to another is acceptable.

Answer 9

F - caution because they can act differently

Question 10

Name an option that may be helpful for a patient with adherence problems?

Answer 10

Methylphenitdate Patch

Question 11

Name the drug that is sometimes used as an adjunct to the treatment of MDD and narcolepsy.

Answer 11

Methylphenitdate

Question 12

Patient with a PMHx of seizures needs a stimulant. Which option would you NOT prescribe them?

Answer 12

Methylphenitdate

Question 13

Why is Methylphenidate used cautiously with a patient with coexisting HTN?

Answer 13

because it is an amphetamine - stimulants Epi and NE

Question 14

Which drug was used for weight loss in the 60s?

Answer 14

Methylphenitdate

Question 15

T or F. Methylphenidate is associated with increased pediatric growth and appetite.

Answer 15

F - decreased

Question 16

T or F. The tx for methylphenidate OD is bicarb.

Answer 16

F - patients respond to BDZ or haloperidol

Question 17

When adding methylphenidate to an MAOI regimen for a MDD patient, what should you monitor?

Answer 17

BP because it can cause HTN

Question 18

What is the isomer of methylphenidate?

Answer 18

Dexmethylphenidate

Question 19

What is the less commonly employed alternative to methylphenidate for treatment of ADD and narcolepsy?

Answer 19

Dextroamphetapine

Question 20

What is in Adderall?

What is Vyvanse?

Answer 20

A - Amphetamine/Dextroamphetamine

V - Lisdexamfetamine

Question 21

For kids that cannot tolerate methylphenidate, what is the next best option?

Answer 21

Atomexetine (Strattera)

Question 22

How does Atomexatine work? Is it considered a stimulant?

Answer 22

NE reuptake inhibitor - increase NE

non-stimulant

Question 23

What is a benefit of using Atomexatine vs methylphenidate or Adderall?

Answer 23

No abuse potential (non-control)

Question 24

Which drug has an off-label use for nocturnal enuresis?

Answer 24

Atomexatine

Question 25

Short term studies have shown that ___________ has shown some increased risk of suicidality.

Answer 25

Atomexatine

Question 26

T or F. You don’t have to worry about pediatric growth/weight when using Atomexatine.

Answer 26

F - you still have to

Question 27

Because Atometaxine is a NE-reuptake blocker, what other med should be cautiously prescribed along with it?

Answer 27

MAOI - basically the same mechanism - increases concentration of monoamines (DA, Epi, NE, 5-HT)

Question 28

Why are Clonidine and Atomexatine paradoxical drugs?

Answer 28

Clonidine - alpha 2 agonist - increase NE reuptake

Atomexatine - NE reuptake blocker

Question 29

If you are using Clonidine in and ADD/ADHD patient, what should you monitor?

Answer 29

BP - Clonidine is an anti-HTN (it increases the reuptake of NE, thereby decreasing effects of NE on the alpha 1 receptor, which leads to vasodilation.

Question 30

What other drug class has been shown to help treat ADD/ADHD other than stimulants? What are the options?

Answer 30

Anti-depressants
TCAs
SSRIs
Buproprion
Venlafaxine

Question 31

Name the major side effect of using these drugs for ADD.
TCAs
SSRIs
Buproprion
Venlafaxine

Answer 31

TCAs - anticholinergic effects, sedation
SSRIs - suicide, sexual dysfunction
Buproprion - seizure and weight loss (bad for eating DO)
Venlafaxine - cardiac effects - HTN, lipids, tachy

Question 32

Other than the anti-depressants and Clonidine, what is one other additional option for ADD/ADHD?

Answer 32

VPA