ADHD Flashcards
Which stimulants are used in ADHD
Dexamfetamine / lisdexamfetamine
Methylphenidate
Dexamfetamine / lisdexamfetamine mechanism
Increases synaptic levels of dopamine and noradrenaline
Dexamfetamine / lisdexamfetamine contraindications
Significant cardiovascular disorders
Cerebrovascular disorders
Use of MAO inhibitors
Hx of drug abuse
Hyperthyroidism
Glaucoma
Porphyria
Gilles de la Tourette syndrome or similar dystonias
Pregnancy and lactation
Psychosis or bipolar I (if not well controlled)
Anorexia
Significant suicidal ideation
Dexamfetamine / lisdexamfetamine common s/e
- decreased appetite
- reduced weight gain and weight loss during prolonged use in children
- insomnia
- nervousness
Dexamfetamine / lisdexamfetamine interactions
Minimal effect on CYP
Methylphenidate mechanism
Increases synaptic levels of dopamine and noradrenaline
Methylphenidate contraindications
Significant cardiovascular disorders
Cerebrovascular disorders
Glaucoma
Phaechromocytoma
Use of MAO inhibitors
Psychosis or bipolar I (if not well controlled)
Anorexia
Significant suicidal ideation
Hyperthyroidism or thyrotoxicosi
Methylphenidate common SE
- decreased appetite
- insomnia
- nervousness
- headache
- nausea
- dry mouth
t/f Methylphenidate has a significant effect on CYP
false
Non stimulant ADHD medications
Atomoxetine
Guanfacine
Clonidine
Atomoxetine mechanism
Increasing NA levels in the synaptic cleft
Atomoxetine contraindications
Use of MAO inhibitors
Glaucoma
Pheochromocytoma
Significant cardiovascular disorders
Cerebrovascular disorders
Atomoxetine common SE
- appetite decreased
- headache
- somnolence
- abdominal pain (includes epigastric discomfort)
- vomiting
- nausea
- blood pressure increased
- heart rate increased
Atomoxetine is metabolised by
CYP2D6
Guanfacine mechanism
Selective agonist of α2A-adrenergic receptors. Binds to postsynaptic α2A-adrenergic receptors, mimicking NA
Guanfacine contrainidcations
No specific contraindications other than hypersensitivity to the drug
Guanfacine common SE
somnolence (40%)
- headache (27%)
- fatigue (18%)
- abdominal pain (12%)
Guanfacine metabolism and interactions
Metabolised by CYP3A4/5
Can increase levels of valproic acid
Clonidine mechanism
Agonist of α2-adrenergic receptors, mimic NA
Clonidine contraindications
Severe bradyarrhythmia resulting from either sick-sinus syndrome or AV block of 2nd or 3rd degree
Clonidine SE
- dizziness
- sedation
- orthostatic hypotension
- dry mouth
Clonidine metabolism
No significant effect on CYP
Much of the drug excreted unchanged in urine
Mechanism of Lisdexamfetamine
Prodrug, absorbed by GI tract, converted to dexamfetamine which inhibits the reuptake of NA and DA. Converted by enzymes in red blood cells into dexamfetamine and L-lysine (amino acid). The activation of the prodrug results in longer action and a reduced abuse potential
Mechanism of Dexamfetamine
Inhibiting DA (dopamine) and NA (noradrenaline) reuptake
Mechanism of Methylphenidate
Inhibiting DA and NA reuptake
