ADHD

Question 1

Which stimulants are used in ADHD

Answer 1

Dexamfetamine / lisdexamfetamine
Methylphenidate

Question 2

Dexamfetamine / lisdexamfetamine mechanism

Answer 2

Increases synaptic levels of dopamine and noradrenaline

Question 3

Dexamfetamine / lisdexamfetamine contraindications

Answer 3

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

Question 4

Dexamfetamine / lisdexamfetamine common s/e

Answer 4

• decreased appetite
• reduced weight gain and weight loss during prolonged use in children
• insomnia
• nervousness

Question 5

Dexamfetamine / lisdexamfetamine interactions

Answer 5

Minimal effect on CYP

Question 6

Methylphenidate mechanism

Answer 6

Increases synaptic levels of dopamine and noradrenaline

Question 7

Methylphenidate contraindications

Answer 7

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

Question 8

Methylphenidate common SE

Answer 8

• decreased appetite
• insomnia
• nervousness
• headache
• nausea
• dry mouth

Question 9

t/f Methylphenidate has a significant effect on CYP

Answer 9

false

Question 10

Non stimulant ADHD medications

Answer 10

Atomoxetine
Guanfacine
Clonidine

Question 11

Atomoxetine mechanism

Answer 11

Increasing NA levels in the synaptic cleft

Question 12

Atomoxetine contraindications

Answer 12

Use of MAO inhibitors
Glaucoma
Pheochromocytoma
Significant cardiovascular disorders
Cerebrovascular disorders

Question 13

Atomoxetine common SE

Answer 13

• appetite decreased
• headache
• somnolence
• abdominal pain (includes epigastric discomfort)
• vomiting
• nausea
• blood pressure increased
• heart rate increased

Question 14

Atomoxetine is metabolised by

Answer 14

CYP2D6

Question 15

Guanfacine mechanism

Answer 15

Selective agonist of α2A-adrenergic receptors. Binds to postsynaptic α2A-adrenergic receptors, mimicking NA

Question 16

Guanfacine contrainidcations

Answer 16

No specific contraindications other than hypersensitivity to the drug

Question 17

Guanfacine common SE

Answer 17

somnolence (40%)
- headache (27%)
- fatigue (18%)
- abdominal pain (12%)

Question 18

Guanfacine metabolism and interactions

Answer 18

Metabolised by CYP3A4/5
Can increase levels of valproic acid

Question 19

Clonidine mechanism

Answer 19

Agonist of α2-adrenergic receptors, mimic NA

Question 20

Clonidine contraindications

Answer 20

Severe bradyarrhythmia resulting from either sick-sinus syndrome or AV block of 2nd or 3rd degree

Question 21

Clonidine SE

Answer 21

• dizziness
• sedation
• orthostatic hypotension
• dry mouth

Question 22

Clonidine metabolism

Answer 22

No significant effect on CYP
Much of the drug excreted unchanged in urine

Question 23

Mechanism of Lisdexamfetamine

Answer 23

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

Question 24

Mechanism of Dexamfetamine

Answer 24

Inhibiting DA (dopamine) and NA (noradrenaline) reuptake

Question 25

Mechanism of Methylphenidate

Answer 25

Inhibiting DA and NA reuptake