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Psychopharmacotherapy > ADHD > Flashcards

ADHD Flashcards

1
Q

Which medication class had been tested in preschool children?

A

Methylphenidate

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2
Q

What side effects were worse in preschool children on methylphenidate?

A 
Sadness
Irritability
Clinging
Insomnia
Anorexia
Repetitive behaviors
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3
Q

What are the 4 basic stimulant classes?

A

Methylphenidate
Dexmethylphenidate
Dextroamphetamine
Mixed amphetamine salts

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4
Q

What drugs are methylphenidate derivatives?

A 
Methylin (IR & ER)
Ritalin (IR, SR, & LA)
Metadate (ER & CD)
Concerta
Daytrana- Transdermal patch
Generic (IR & SR)
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5
Q

What are the dexmethylphenidate derivatives?

A

Focalin
Focalin XR
Generic IR

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6
Q

What are the dextroamphetamine derivatives?

A 
Dextrostat (IR & Spansule)
Dexedrine
LiquADD
Vyvanse- Lisdexamfetamine dimesylate; Prodrug
Generic (IR)
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7
Q

What are the mixed amphetamine salt derivatives?

A

Adderall (IR & XR)

Generic (IR & XR)

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8
Q

Prior to starting someone on stimulants it is important to review patient and family history for what type of condition?

A

Any cardiovascular disease

  • Structural
  • Palpatations
  • Chest pain
  • Fainting
  • Arrythmias
  • Sudden cardiac death
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9
Q

Is an ECG always indicated prior to stimulant therapy?

A

ECG is not indicated if there is no positive history of physical exam findings

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10
Q

What stimulants should be the first to try?

A

Methyphenidate or amphetamine

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11
Q

When should a switch to a different stimulant be considered?

A

Suboptimal response

Side effects

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12
Q

What are the doses of methylphenidate?

A

5, 10, 15, and 20 mg

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13
Q

What are the doses for amphetamine and dexmethylphenidate?

A

Half those of methylphenidate

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14
Q

What kind of dosing can be used?

A

3 times a day

7 days a week

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15
Q

At what age will children process the drug similar to an adult?

A

3

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16
Q

When should students have an annual medication free trial?

A

During the summer if symptoms are not present

17
Q

How long should the drug free trial last?

A

At least 2 weeks

18
Q

What is the black box warning for amphetamine preparations?

A

Abuse potential

Sudden death or cardiovascular events if misused

19
Q

What are the common side effects of stimulants?

A 
Anorexia
Weight loss
Irritability
Abdominal pain
Headaches
Emotional oversensitvity
20
Q

What are less common side effects of stimulants?

A 
Insomnia
Dysphoria
Decreased social interest
Rebound overactivity and irritability
Anxiety
Nervous habits
Hypersensitivity
21
Q

What are the withdrawal effects of stimulants?

A

Rebound ADHD symptoms

Depression

22
Q

Rare, but serious side effects?

A 
Motor or vocal tics
Tourette's
Depression
Growth retardation
Tachycardia
HTN
Hallucinations
Compulsions
23
Q

What formulations are recommended in the case of abuse?

A

Concerta
Vyvanse
Daytrana

24
Q

What are the alpha2 agonists used for ADHD?

A

Clonidine
Guanfacine
Short acting- Catapres and Tenex
Long acting- Kapvay and Intuniv

25
Q

What patient population would benefit from clonidine?

A 
Highly aroused
Hyperactive
Impulsive
Defiant
Labile 
Comorbidity with Tics
26
Q

What should be evaluated in a patient before starting an alpha2?

A

Blood pressure
Pulse
ECG- with positive history or physical
Fasting glucose

27
Q

What are the side effects of alpha2 agonists?

A 
Sedation
Irritability
Dry mouth
Nausea
Photophobia
Hypotension
Dizziness
Decreased glucose tolerance
Headache
28
Q

What is the MOA of atomoxetine?

A

NE uptake inhibitor (Non-stimulant)

29
Q

When should atomoxetine be considered?

A

After a trial of stimulants has failed or undesirable side effects exist

30
Q

What is the initiat does of atomoxetine?

A

0.3 mg/kg/day

31
Q

What is the maintenance dose of atomoxetine?

A

1.2 mg/kg/day

32
Q

What is the max dose?

A

1.4 mg/kg/day (

33
Q

What are common side effects of atomoxetine?

A 
Abdominal pain
Headache 
Irritability 
Mood lability
Dizziness
Somnolence
Fatigue
Decreased appetite
Nausea and vomiting
34
Q

What are the two FDA bolded warnings for atomoxetine?

A

Liver injury- LFTs are not recommended

Hostility and aggression or SI

35
Q

What enzyme metabolizes atomoxetine?

A

CYP2D6

Psychopharmacotherapy (8 decks)

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