ADHD Flashcards
What is ADHD
A neurodevelopmental disorder characterized by difficulties with attention, hyperactivity, and impulsivity.
Treatment - 5+ and young adults
1st line = methylphenidate (CD2)
2nd line = lisdexamfetamine (CD2)
- Consider dexamfetamine for patients intolerant of longer effect profile.
Alternatives: Atomoxetine, Guanfacine
Treatment - Adults
1st line: Methylphenidate/Lisdexamfetamine
- Consider dexamfetamine for patients intolerant of longer effect profile.
Alternative: Atomoxetine
Methylphenidate - MoA
Potent CNS stimulant.
Increased dopamine and noradrenaline levels in the brain.
Methylphenidate - Side effects
- Appetite/weight loss
- Insomnia
- Increased HR + BP
- Tics and Tourette’s syndrome
- Growth restriction in children (monitor height and weight. Allow drug-free periods to grow)
Methylphenidate - Monitoring
Monitor on initiation, every 6 months and after a dose change.
- Pulse
- BP
- Appetite
- Weight
- Height
Also monitor for psychiatric symptoms e.g. depression, psychosis and suicidal ideation.
Methylphenidate - contraindications
CVD
Hyperthyroidism
Severe hypertension
Uncontrolled BPD
Severe depression
Methylphenidate - MHRA (2022)
Caution when switching between MR preparations.
Prescribe by brand.
MR preparations contian immediate release and modified release components. Different preparations contain different proportions of immediate-release and modified-release components = different release profiles.
Dexamfetamine & Lisdexamfetamine - MoA
Potent CNS stimulant.
Increases dopamine and noradrenaline levels in the brain.
Dexamfetamine & Lisdexamfetamine - Side effects
- Appetite/weight loss
- Anorexia
- Increased HR + BP
- Tics and Tourette’s syndrome
- Growth restriction in children (monitor height and weight. Allow drug-free periods to grow)
Dexamfetamine & Lisdexamfetamine - Overdose signs
- Wakefulness
- Hyperactivity
- Paranoia
- Hallucinations
- Hypertension
Followed by: - Exhaustion
- Convulsions
- Hyperthermia
- Coma
Dexamfetamine & Lisdexamfetamine - Monitoring
Monitor on initiation, every 6 months and after a dose change.
- Pulse
- BP
- Appetite
- Weight
- Height
Also monitor for psychiatric symptoms e.g. depression, psychosis and suicidal ideation.
Dexamfetamine & Lisdexamfetamine - Contraindications
- CVD
- Hyperthyroidism
- Moderate/severe hypertension
- Agitated states
Atomoxetine
Noradrenaline reuptake inhibitor
Causes increased levels of noradrenaline at the synaptic cleft
Noradrenaline - Side effects
Suicidal ideation
- counsel pt to report suicidal thoughts, self-harming behaviour, irritability, anxiety or depression.
Hepatotoxicity
- counsel pt to report signs of toxicity e.g. N + V, malaise, dark urine, abdominal pain, jaundice
QT prolongation
- Avoid concomitant drugs that prolong QT interval
