ADHD

Question 1

Pharm Treatment in ADHD

Answer 1

First Line: Methylphenidate
Second Line: alpha-agonist or as adjunct to stimulant
Third Line: atomoxetine and bupropion

• Most children do best with stimulants *

Question 2

Stimulant Formulations

Answer 2

Immediate Release:

• Cheaper
• Less insomnia
• Fewer Growth effects
• Need 2-3 doses/day
• higher risk of abuse

Sustained Release:

• Better adherence
• Convenient
• 8-12 hours of control

Question 3

Stimulant Side Effects and Management (6)

Answer 3

• Loss of appetite and weight loss: Give high cal meals when stimulant at lowest (morning and night), can also give appetite stimulant like cyphroeptadine
• Stomach upset and nausea: Give with food
• Insomnia: Give in morning and lower dose in evening
• Headache: Divide daily dose in evening or sleep aid (guanfacine, clonidine, melatonin, cyphroeptadine)
• Rebound Symptoms: Use longer acting (SR) or prescribe antidepressant
• Irritability: Evaluate for other psychiatric condition

Question 4

Stimulant Abuse

Answer 4

• Higher reported abuse in short acting
• DEA Schedule C-11 Drug
• Children with ADHD have 2.5x risk for any substance abuse disorder
  » Treatment of ADHD delays onset of substance abuse in teenagers
• “Pharming”
• Who is at risk of Abuse???
  » Those who require higher doses
  » Follow up with urine drug testing at every visit

Question 5

Non Stimulants

Answer 5

Atomoxetine
Bupropion
Clonidine
Guanfacine

Question 6

Atomoxetine

Answer 6

• Slower response times than stimulants
• Non scheduled drug so less potential for abuse
• Side effects similar to stimulants
• More expensive than stimulants

Question 7

Bupropion

Answer 7

• Not as effective as stimulants
• S/E: nausea, rash, insomnia
• Increased risk of seizures