ADHD Flashcards
What are the main symptoms of ADHD that are targets for pharmacotherapy?
-inattention
-hyperactivity
-impulsivity
What are the first line treatment options for ADHD?
stimulants (amphetamine and methylphenidate)
What is the second line treatment option for ADHD?
norepinephrine reuptake inhibitors
What symptoms of ADHD do stimulants improve?
all 3 of the major symptoms: attention, hyperactivity, and impulsivity, but can also improve self-control, aggression, and academic performance
What are the baseline assessments needed before initiation of stimulant therapy?
-mental health and social assessment
-cardiovascular history, baseline EKG may be warranted
-height and weight (although there is no evidence that growth is effected)
What stimulant is preferred in patients with low weight (< 16kg)?
methylphenidate
What are the contraindications of methylphenidate?
-cardiovascular disease
-thyrotoxicosis
-marked anxiety, tension, and agitation
-family history or diagnosis of Tourette syndrome or other tic disorder
-OROS formulation if history of GI abnormality
What are the contraindications of amphetamine?
-cardiovascular disease
-hyperthyroidism
-glaucoma
-agitation
-history of substance abuse
-MAOI use within 14 days
-OROS formulation if history of GI abnormalities
What are the precautions of stimulant therapy?
-CV effects (HTN, tachycardia, sudden cardiac death (seen in older pts)
-history of substance use disorder
-growth suppression (not really)
-lowered seizure threshold
-worsening of psychiatric disorders
What formulation of methylphenidate can cause chemical leukoderma and why?
transdermal patch due to dose dumping
What stimulant has less misuse potential?
lisdexamphetamine (VYVANSE), bc it is a prodrug
What are the common adverse effects to stimulants?
-appetite suppression (take after breakfast)
-insomnia
-GI discomfort (take with food)
-irritability (decrease dose or change to non-stimulant)
-headache
DRUG HOLIDAYS ARE ALWAYS AN OPTION
What symptoms of ADHD does Atomoxetine address?
all 3 of the main symptoms: inattention, hyperactivity, and impulsivity
What is the dosing regimen of Atomoxetine?
adults= 40mg/day to max 100mg/day, children is weight based
What are the drug interactions of Atomoxetine?
metabolized by CYP2D6 so strong inhibitors (fluoxetine, paroxetine, etc) can increase plasma concentrations
What are the contraindications of Atomoxetine?
MAOI use within 14 days, severe cardiovascular disease, history of pheochromocytoma, narrow angle glaucoma
What is the black box warning of Atomoxetine?
increased risk of suicidal ideation in children and young adults
What are the adverse effects of Atomoxetine?
-risk of hepatoxicity
-GI discomfort, headache, insomnia, irritability, loss of appetite, dizziness
-BP changes are rare
What non-stimulant ADHD therapy greatly increases BP?
voloxazine (Qelbree)
For what ages is Voloxazine approved for?
ages 6-17
What is the black box warning of Voloxazine?
suicidal ideation
What symptoms of ADHD does ER Alpha-2 agonists address?
hyperactivity, some impulsivity, no help for attention
What non-stimulant ADHD therapy may take weeks to see effects?
ER alpha-2 agonists and bupropion (Wellbutrin)
What drugs are ER alpha-2 agonists used in ADHD?
clonidine and guanfacine
What are the common adverse effects of ER alpha-2 agonists?
-sedation (dosed at night due to this)
-hypotension
-bradycardia
-dizziness
-DO NOT stop abruptly due to risk of hypertensive rebound
What are the adverse effects of bupropion?
insomnia, appetite suppression (contraindicated in eating disorder pt), lowered seizure threshold
What drugs are norepinephrine reuptake inhibitors?
Atomoxetine and Voloxazine
