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PR - CNS > ADHD > Flashcards

ADHD Flashcards

1
Q

What is ADHD?

A

A neurodevelopmental disorder characterized by difficulties with attention, hyperactivity, and impulsivity.

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2
Q

Treatment in children 5+

A
  1. Methyphenidate
  2. If not tolerated after 6 weeks = lisdexamfetamine
    o This causes prolonged duration of sfx
  3. If this is an issue for pt = dexamfetamine
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3
Q

Treatment in children 5+ if both methylphenidate and lisdexamfetamine CI

A

atomoxetine or guanfacine

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4
Q

Treatment in adults

A
  1. Methyphenidate or lisdexamfetamine
    o Lisdexamfetamine causes prolonged duration of sfx
    o If this is an issue for pt = dexamfetamine
  2. Atomoxetine
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5
Q

Methyphenidate or lisdexamfetamine

A

o Lisdexamfetamine causes prolonged duration of sfx
o If this is an issue for pt = dexamfetamine

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6
Q

Methylphenidate - MOA

A

Potent CNS stimulant.
Increased dopamine and noradrenaline levels in the brain.

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7
Q

Methylphenidate is a CNS stimulant: Side effects

A

Causes sympathetic pathways to be excited
* High bp, Tachycardia, Arrythmias
* Behaviour and mood changes, Drowsiness and sleep disorder
* Decreased appetite, Growth retardation, Weight loss

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8
Q

Methylphenidate monitoring

A

Monitoring = following dose adjustments then 6 monthly
* Pulse
* Bp
* Psychiatric symptoms
* Appetite
* Weight
* Height at initiation

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9
Q

Methylphenidate - contraindications

A

CVD
Hyperthyroidism
Severe hypertension
Uncontrolled BPD
Severe depression

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10
Q

Methylphenidate - MHRA (2022)

A

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.

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11
Q

MR preps preferred due to

A
  • Pharmacokinetic profile
  • Convenience – take less a day
  • Improved adherence

Should be prescribed as brand only

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12
Q

methylphenidate - if effect wears off in evening with rebound hypersensitivity, the following may be appropriate

A

dose at bed time may be appropriate - establish need with trial bedtime dose

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13
Q

generic methylphenidate is used for ADHD, and also for this indication (unlicensed) (using IR meds)

A

narcolepsy

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14
Q

Take in morning with breakfast for these two brands of methylphenidate

A

Medikinet, Equasym

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15
Q

A patient has arrhythmias - are they suitable for treatment with methylphenidate

A

No it is contraindicated in arrhythmias

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16
Q

If a patient has dysphagia, the following three brands of methylphenidate do not have appropriate dose form due to restricted GI lumen

A

concerta xl, demlosart PR tabs, xaggitin xl

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17
Q

Methylphenidate causes growth retardation in children -T or F

A

True

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18
Q

Why should alcohol be avoided with methylphenidate

A

it might increase conc of methylphenidate

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19
Q

TCAs interaction with methylphenidate

A

methylphenidate may increase conc of TCAs e.g. amitriptyline, imipramine, doxepin, dosulepin etc
use with caution and adjust dose

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20
Q

interaction - MAOB inhibitor and methylphenidate

A

selegiline, rasagiline
these are predicted to increase risk of hypertensive crisis when given with methylphenidate - avoid

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21
Q

interaction between methylphenidate and MAOIs

A

Methylphenidate causes a hypertensive crisis when given with Tranylcypromine, isocarboxazid, phenelzine

Manufacturer advises avoid and for 14 days after stopping the MAOI.

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22
Q

avoid this high risk abx because methylphenidate may increase risk of elevates BP when given with it

A

linezolid

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23
Q

Lisdexamfetamine and dexamfetamine MOA

A

Potent CNS stimulant.
Increases dopamine and noradrenaline levels in the brain.

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24
Q

Lisdexamfetamine and dexamfetamine side effects

A

Similar SFx to methylphenidate

25
Q

Lisdexamfetamine and dexamfetamine overdose

A
  • Wakefulness, excessive acitivity, paranoia, hallucinations
  • Hypertension
  • Followed by: exhaustion, convulsion, hypothermia, coma
26
Q

dexamfetamine can be used (unlicensed) for refractory ADHD, initiated under specialist supervision. If the following syndrome occurs, discontinue

A

tics

27
Q

Monitor these two parameters as growth restriction can occur during prolonged therapy with dexamfetamine

A

height and weight

28
Q

What can you do to reduce risk of growth restriction with prolonged therapy with dexamfetamine

A

Drug free periods may allow catch up in growth by withdraw slowly to avoid inducing depression or renewed hyperactivity

29
Q

Dexamfetamine interaction with MAOIs (2)

A

Predicted to increase the risk of a hypertensive crisis when given with MAOIs. Manufacturer advises avoid and for 14 days after stopping the MAOI. Also increased risk of serotonin syndrome

30
Q

Dexamfetamine interactions with MAO-B inhibitors. (2)

A

Rasagiline, selegiline is predicted to increase the risk of severe hypertension when given with Dexamfetamine. Manufacturer advises avoid. Also increased risk of serotonin syndrome

31
Q

Dexamfetamine and -perazine antipsychotics interaction

A

They are predicted to decrease the effects of dexamfetamine and dexamfetamine is predicted to decrease their effects

32
Q

Dexamfetamine and SSRIs, SNRIs (dulox, venlfax), bupropion, TCAs, ondansetron, lithium, methadone, triptams, pethidine, vortioxetine etc

A

can increase the risk of serotonin syndrome

33
Q

A patient presents to A&E. You are told that initially, they were very hyperactive and had hallucinations. They now seem to be very exhausted, dizzy and hyperthermic. You look at their medication list: sertraline 50mg OD, dexamfetamine 10mg OD, salamol 2 puffs up to QDS prn. What do you suspect?

A

Amfetamine overdose - cause akefulness, excessive activity, paranoia, hallucinations, and hypertension followed by exhaustion, convulsions, hyperthermia, and coma.

34
Q

Lisdexamfetamine relationship with dexamfetamine

A

Lisdexamfetamine is a prodrug of dexamfetamine.

35
Q

Lisdexamfetamine is contraindicated in hypo or hyperthyroidism

A

HYPER

36
Q

Discontinue amphetamines if the following occurs

A

seizures

37
Q

Lisdexamfetamine warning labels

A

This medicine may make you sleepy. If this happens, do not drive or use tools or machines.
Swallow this medicine whole. Do not chew or crush.

38
Q

Atomoxetine MOA

A

Noradrenaline reuptake inhibitor
Causes increased levels of noradrenaline at the synaptic cleft

39
Q

When should atomoxetine dose be taken?

A

morning
if given as divided dose, last dose should be no later than early evening

40
Q

Atomoxetine - children max licensed dose

A

100mg daily

41
Q

Atomoxetine - adults max licensed dose

A

dose max of 120mg not licensed

42
Q

Atomoxetine - CI

A

phaeochromocytoma
severe CVD
severe cerebrovascular disease

43
Q

Avoid this drug class, and for 2 weeks after stopping it, because it is predicted to increase the risk of adverse effects when given with atomoxetine

A

MAOIs - tranylcypromine, phenelzine, isocarboxazid

44
Q

Atomoxetine side effects

A

o Causes QT prolongation
- Avoid concomitant drugs that prolong QT interval
o Hepatotoxicity
- counsel pt to report signs of toxicity e.g. N + V, malaise, dark urine, abdominal pain, jaundice
o Suicidal ideations
- counsel pt to report suicidal thoughts, self-harming behaviour, irritability, anxiety or depression.

45
Q

Atomoxetine - monitoring

A

Monitor on initiation, every 6 months and after a dose change.

Pulse
BP
Appetite
Weight
Height

46
Q

Atomoxetine - dose adjustments in HI

A

1/2 dose in moderate impairment
1/4 dose in severe

47
Q

Atomoxetine is …toxic so patients and carers should be advised of the rare risk and be told how to recognise symptoms; prompt medical attention should be sought in the case of ….

A

Hepatotoxic
Jaundice, unexplained n/v, malaise, dark urine, abdominal pain

48
Q

Atomoxetine - label

A

This medicine may make you sleepy. If this happens, do not drive or use tools or machines

49
Q

Atomoxetine is associated with sexual dysfunction - T or F

A

True

50
Q

Guanfacine - cautions

A

Bradycardia (risk TDP)
Heart block (risk TDP)
History CVD
History QT interval prolongation
Hypokalaemia (risk TDP)

51
Q

Guanfacine - Signs of overdose

A

hypotension, initial hypertension, bradycardia, lethargy, and respiratory depression
patients who develop lethargy should be observed for development of more serious toxicity for up to 24 hours

52
Q

Guanfacine - contraception

A

Contraception needed?
effective contraception in females of childbearing potential

53
Q

True of false - you need to measure BMI after treatment for Guanfacine

A

false
take BMI before, then every 3 months for 1 year, then every 6 months

54
Q

True or false - you need to monitor BP and pulse regularly in pt taking guanfacine

A

False - monitor these during dose downward titration and following discontinuation of treatment

55
Q

True or false - unlike the amphetamines and atomoxetine, you can abruptly withdraw guanfacine

A

False - avoid abrupt withdrawal; consider dose tapering to minimise potential withdrawal effects.

56
Q

Is there any special directions for administration for guanfacine?

A

Manufacturer advises avoid administration with high fat meals (may increase absorption).

57
Q

Guanfacine labels

A

Warning: This medicine may make you sleepy. If this happens, do not drive or use tools or machines.
Do not drink alcohol.
Swallow this medicine whole. Do not chew or crush.

58
Q

Do ADHD drugs cause weight GAIN or weight LOSS

A

weight loss

PR - CNS (61 decks)

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