ADHD Flashcards
GP is currently taking Catapres for his high BP, which is well controlled. His Dr wants to begin medication for his newly diagnosed ADHD. Which med should be avoided?
a. Adderall
b. Daytrana
c. Kapvay
d. Strattera
e. Ritalin
c
Kapvay and Catapres contains the same active ingredient and shouldn’t be used together
A mother reports that her child is having trouble sleeping since beginning methylphenidate BID approximately 2 weeks ago. Which med can be used to help improve the child’s sleep?
a. Strettera
b. Fish oil
c. Vyvanse
d. Clonidine IR
e. Guanfacine ER
d
Clonidine IR, OTC diphenhydramine and melatonin can be given at bedtime to help improve sleep.
Which of the following stimulant meds is available as a chewable tablet?
a. Vyvanse
b. Ritalin LA
c. Adderall XR
d. Concerta
e. Daytrana
a
Vyvanse, QuilliChew ER, and methylphenidate IR are available as a chewable tablet.
Which formulation best describes Concerta?
a. Oral suspension
b. ER capsule
c. Orally-disintegrating tablet
d. OROS tablet
e. Transdermal patch
d
OROS = osmotic oral release system
The outer tablet coating dissolves fast for immediate effects, and the rest is released slowly, allowing for once-daily dosing in the morning.
All stimulants are schedule _____ controlled substances.
C-II
MJ is an 8 y/o boy who’s visiting his psychiatrist for a follow-up. He’s been experiencing racing heartbeat, irritability, and trouble sleeping since he started Concerta 3 weeks ago. His mom is concerned about these side affects and would like to have the psychiatrist switch him to a medication that’s non-stimulating.
Switching MJ to which med will address the mother’s request?
a. Daytrana
b. Kapvay
c. Vyvanse
d. Concerta
e. Adderall XR
b
Kapvay (clonidine) is a centrally acting alpha-2 adrenergic receptor agonist that doesn’t act as a stimulant.
Methylphenidate is available in which of the following formulations?
a. Transdermal patch
b. Orally-disintegrating tablet
c. Oral suspension
d. Sublingual tablet
e. Chewable tablet
f. Subcutaneous injection
a, b, c, e
Which of the following is an alpha-2 adrenergic receptor agonist?
a. Concerta
b. Intuniv
c. Vyvanse
d. Strattera
e. Adderall
b
Which of the following best describes the role of atomoxetine in the tx of ADHD?
a. 1st line, d/t enhanced efficacy compared to stimulants
b. 2nd line, after failing 2-3 trials of stimulants
c. Last line, d/t the potential for abuse and dependence
d. As an add-on to stimulants for synergistic effects
e. As an add-on to stimulants to counteract the side effects
b
-It’s used alone and isn’t currently approved for use in combo with stimulants.
-In pts who are considered to have a risk for abuse, atomoxetine can be used 1st line.
Which neurohormone is a primary target for stimulant meds used to treat ADHD?
a. Acetylcholine
b. Dopamine
c. Epinephrine
d. Epinephrine
e. Serotonin
b
Which med requires a slow taper upon discontinuation?
a. Adderall XR
b. Concerta
c. Intuniv
d. Strattera
e. Vyvanse
c
Intuniv (guanfacine ER) is well-tolerated overall, but it shouldn’t be d/c abruptly d/t the risk of rebound HTN.
A pt starting Vyvanse tells the pharmacist they have difficulty swallowing capsules. What can the pt mix the capsule contents with easier administration?
a. Applesauce, peanut butter, or milk
b. Orange juice, water, or yogurt
c. Grape juice, pudding, or soda
d. Rice, oatmeal, or mashed potatoes
e. Jello, mashed banana, or eggs
b
Vyvanse isn’t mixed with applesauce. Instead, the contents can be mixed with a small amount of water, orange juice, or yogurt if swallowed right away (the beads shouldn’t be chewed). The mixture shouldn’t be left stored or long-acting beads will dissolve.
Stimulant meds to treat ADHD have which of the following safety concerns?
a. Development of lymphoma or other cancers
b. Exacerbation of psychiatric conditions
c. Severe skin rashes
d. Seizures
e. A prolonged erection in males
f. Delayed growth in children
b, d, e, f
Stimulants have a number of safety concerns including priapism (erection lasting > 4 hrs), new-onset or worsening psychosis or mania, seizures, and a loss of appetite (which can contribute to delayed growth in children)
An appropriate starting dose for Concerta is:
a. 9 mg daily
b. 18 mg daily
c. 45 mg daily
d. 54 mg daily
e. 72 mg daily
b
Concerta should be started at a dose of 18-36 mg daily. It can be increased by 18 mg/day at weekly intervals, as needed.
Strattera has a BBW d/t the risk of:
a. Rebound HTN
b. Acute kidney injury
c. Hemorrhagic stroke
d. Suicidal ideation
e. Abuse and dependence
d
