ADHD

Question 1

Boxed Warnings for Stimulants

Answer 1

MED GUIDE
* C-II
* high potential for abuse & dependence

Question 2

Stimulant CI

Answer 2

• do not use within 14 days of MAOi
• risk of CVD events - do not use with HF, recent MI, arrythmias, mod-severe HTN
• marked anxiety, tension, agitation, glaucoma, herpthyroidism, hx of tourette’s or other tic disorders

Question 3

Stimulant Warnings

Answer 3

• increased HR/BP
• priapism
• Raynaud’s
• New onset psychosis/mania or exacerbation of pre-existing psychosis (mixed/manic episode in bipolar)
• may increase risk of seizures
• loss of appetite (decrease in growth in children)
• serotonin syndrome increased
• visual disturbances (blurry vision)

Question 4

Ritalin

Answer 4

IR tab
methylphenidate
5 mg PO BID (max 60 mg/day)

Question 5

Concerta

Answer 5

ER tab, OROS delivery (ghost tab in stool)
Do not use with GI narrowing conditions (small bowel disease, motility issues)
18-36 mg daily (max 72 mg/day)

Question 6

ER capsule types & doses

methylphenidate

Answer 6

Ritalin LA: 10-20 mg daily
Adhansia XR: 25 mg daily
Aptensio XR: 10 mg daily
Metadate CD: 20 mg daily (max 60 mg)
Jornay PM: 20 mg AT NIGHT (max 100 mg/day)

Question 7

ER oral suspension
ER chewable tab

methylphenidate

Answer 7

Quillivant XR
20 mg daily

Quillichew ER: 20 mg daily (max 60 mg daily)

Question 8

ER orally-disintegrating tab

methylphenidate

Answer 8

Contempla XR-ODT
17.3 mg daily for 6-17 yrs (max: 51.8 mg/day)

Question 9

Transdermal patch

methylphenidate

Answer 9

Daytrana
10 mg/9 hr patch qam (max 30 mg)
Warnings: loss of skin pigment in application sites and areas distant from application;allergic contact dermatitis

Apply 2 hrs before desired effect; remove after 9 hrs; alternate hips daily

Question 10

Dexmethylphenidate

Answer 10

Brand: Focalin, Focalin XR

Question 11

Adderall IR

Answer 11

dextroamphetamine/amphetamine
Start 5 mg qam or BID, 2nd dose 4-6 hrs later (max 40 mg/day)

Question 12

Adderall XR, Mydayis

Answer 12

dextroamphetamine/amphetamine
ER capsules
Start 5-10 mg (6-12 yrs)
10 mg (13-17 yrs)
10-20 mg (adults) daily (max 60 mg for adults, 30 mg children)

Question 13

Adzenys XR-ODT, Adzenys ER, Dynavel XR, Evekeo, Evekeo ODT

Answer 13

Adzenys ER, Dynavel XR (PO suspensions)

Question 14

Strattera

Dose

Answer 14

Atomoxetine
Capsule (do not open)
>70 kg: 40 mg daily
< 70 kg: 0.5 mg/kg/day (max 100 mg/day)
strong cyp2d6i – > max 80 mg/day

Question 15

Strattera warnings

Answer 15

• BW: suicidal ideation
• aggressive behavior, rare but severe hepatotox, serious CV events
• ht/wt of children can be reduced
  ADE: low appetite, insomnia, somnolence, dry mouth, HTN, tachy, HA

Question 16

Kapvay

Answer 16

clonidine ER tab
0.1 mg qhs, increase by 0.1 mg weekly or less (max: 0.4 mg/day)

Question 17

Intuniv

Answer 17

Guanfacine ER tab
1 mg daily and increase by 1 mg/weekly or less
Do not take with high fat meal (increases absorption)

Rare skin rash (d/c if occurs)
Dose adjust with CYP3A4i

Question 18

Guanfacine/clonidine warnings

Answer 18

dose-dependent CV effects (brady, hypotension, orthostasis, syncope); sedation, drowsiness

Do not d/c abruptly (rebound HTN). Must taper no more than 0.1 mg/day clonidine and 1 mg/day for guanfacine every 3-7 days

ADE: dry mouth, somnolence, fatigu, dizziness, constipation, low HR, hypotension