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Therapeutics 3 > ADHD > Flashcards

ADHD Flashcards

1
Q

What are the main symptoms of ADHD that are targets for pharmacotherapy?

A

-inattention
-hyperactivity
-impulsivity

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2
Q

What are the first line treatment options for ADHD?

A

stimulants (amphetamine and methylphenidate)

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3
Q

What is the second line treatment option for ADHD?

A

norepinephrine reuptake inhibitors

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4
Q

What symptoms of ADHD do stimulants improve?

A

all 3 of the major symptoms: attention, hyperactivity, and impulsivity, but can also improve self-control, aggression, and academic performance

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5
Q

What are the baseline assessments needed before initiation of stimulant therapy?

A

-mental health and social assessment
-cardiovascular history, baseline EKG may be warranted
-height and weight (although there is no evidence that growth is effected)

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6
Q

What stimulant is preferred in patients with low weight (< 16kg)?

A

methylphenidate

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7
Q

What are the contraindications of methylphenidate?

A

-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

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8
Q

What are the contraindications of amphetamine?

A

-cardiovascular disease
-hyperthyroidism
-glaucoma
-agitation
-history of substance abuse
-MAOI use within 14 days
-OROS formulation if history of GI abnormalities

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9
Q

What are the precautions of stimulant therapy?

A

-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

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10
Q

What formulation of methylphenidate can cause chemical leukoderma and why?

A

transdermal patch due to dose dumping

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11
Q

What stimulant has less misuse potential?

A

lisdexamphetamine (VYVANSE), bc it is a prodrug

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12
Q

What are the common adverse effects to stimulants?

A

-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

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13
Q

What symptoms of ADHD does Atomoxetine address?

A

all 3 of the main symptoms: inattention, hyperactivity, and impulsivity

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14
Q

What is the dosing regimen of Atomoxetine?

A

adults= 40mg/day to max 100mg/day, children is weight based

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15
Q

What are the drug interactions of Atomoxetine?

A

metabolized by CYP2D6 so strong inhibitors (fluoxetine, paroxetine, etc) can increase plasma concentrations

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16
Q

What are the contraindications of Atomoxetine?

A

MAOI use within 14 days, severe cardiovascular disease, history of pheochromocytoma, narrow angle glaucoma

17
Q

What is the black box warning of Atomoxetine?

A

increased risk of suicidal ideation in children and young adults

18
Q

What are the adverse effects of Atomoxetine?

A

-risk of hepatoxicity
-GI discomfort, headache, insomnia, irritability, loss of appetite, dizziness
-BP changes are rare

19
Q

What non-stimulant ADHD therapy greatly increases BP?

A

voloxazine (Qelbree)

20
Q

For what ages is Voloxazine approved for?

A

ages 6-17

21
Q

What is the black box warning of Voloxazine?

A

suicidal ideation

22
Q

What symptoms of ADHD does ER Alpha-2 agonists address?

A

hyperactivity, some impulsivity, no help for attention

23
Q

What non-stimulant ADHD therapy may take weeks to see effects?

A

ER alpha-2 agonists and bupropion (Wellbutrin)

24
Q

What drugs are ER alpha-2 agonists used in ADHD?

A

clonidine and guanfacine

25
Q

What are the common adverse effects of ER alpha-2 agonists?

A

-sedation (dosed at night due to this)
-hypotension
-bradycardia
-dizziness
-DO NOT stop abruptly due to risk of hypertensive rebound

26
Q

What are the adverse effects of bupropion?

A

insomnia, appetite suppression (contraindicated in eating disorder pt), lowered seizure threshold

27
Q

What drugs are norepinephrine reuptake inhibitors?

A

Atomoxetine and Voloxazine

Therapeutics 3 (14 decks)

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