ADHD

Question 1

Which medication class had been tested in preschool children?

Answer 1

Methylphenidate

Question 2

What side effects were worse in preschool children on methylphenidate?

Answer 2

Sadness
Irritability
Clinging
Insomnia
Anorexia
Repetitive behaviors

Question 3

What are the 4 basic stimulant classes?

Answer 3

Methylphenidate
Dexmethylphenidate
Dextroamphetamine
Mixed amphetamine salts

Question 4

What drugs are methylphenidate derivatives?

Answer 4

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

Question 5

What are the dexmethylphenidate derivatives?

Answer 5

Focalin
Focalin XR
Generic IR

Question 6

What are the dextroamphetamine derivatives?

Answer 6

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

Question 7

What are the mixed amphetamine salt derivatives?

Answer 7

Adderall (IR & XR)

Generic (IR & XR)

Question 8

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

Answer 8

Any cardiovascular disease

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

Question 9

Is an ECG always indicated prior to stimulant therapy?

Answer 9

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

Question 10

What stimulants should be the first to try?

Answer 10

Methyphenidate or amphetamine

Question 11

When should a switch to a different stimulant be considered?

Answer 11

Suboptimal response

Side effects

Question 12

What are the doses of methylphenidate?

Answer 12

5, 10, 15, and 20 mg

Question 13

What are the doses for amphetamine and dexmethylphenidate?

Answer 13

Half those of methylphenidate

Question 14

What kind of dosing can be used?

Answer 14

3 times a day

7 days a week

Question 15

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

Answer 15

3

Question 16

When should students have an annual medication free trial?

Answer 16

During the summer if symptoms are not present

Question 17

How long should the drug free trial last?

Answer 17

At least 2 weeks

Question 18

What is the black box warning for amphetamine preparations?

Answer 18

Abuse potential

Sudden death or cardiovascular events if misused

Question 19

What are the common side effects of stimulants?

Answer 19

Anorexia
Weight loss
Irritability
Abdominal pain
Headaches
Emotional oversensitvity

Question 20

What are less common side effects of stimulants?

Answer 20

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

Question 21

What are the withdrawal effects of stimulants?

Answer 21

Rebound ADHD symptoms

Depression

Question 22

Rare, but serious side effects?

Answer 22

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

Question 23

What formulations are recommended in the case of abuse?

Answer 23

Concerta
Vyvanse
Daytrana

Question 24

What are the alpha2 agonists used for ADHD?

Answer 24

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

Question 25

What patient population would benefit from clonidine?

Answer 25

``` Highly aroused Hyperactive Impulsive Defiant Labile Comorbidity with Tics ```

Question 26

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

Answer 26

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

Question 27

What are the side effects of alpha2 agonists?

Answer 27

``` Sedation Irritability Dry mouth Nausea Photophobia Hypotension Dizziness Decreased glucose tolerance Headache ```

Question 28

What is the MOA of atomoxetine?

Answer 28

NE uptake inhibitor (Non-stimulant)

Question 29

When should atomoxetine be considered?

Answer 29

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

Question 30

What is the initiat does of atomoxetine?

Answer 30

0.3 mg/kg/day

Question 31

What is the maintenance dose of atomoxetine?

Answer 31

1.2 mg/kg/day

Question 32

What is the max dose?

Answer 32

1.4 mg/kg/day (

Question 33

What are common side effects of atomoxetine?

Answer 33

``` Abdominal pain Headache Irritability Mood lability Dizziness Somnolence Fatigue Decreased appetite Nausea and vomiting ```

Question 34

What are the two FDA bolded warnings for atomoxetine?

Answer 34

Liver injury- LFTs are not recommended | Hostility and aggression or SI

Question 35

What enzyme metabolizes atomoxetine?

Answer 35

CYP2D6