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662 > ADHD > Flashcards

ADHD Flashcards

1
Q

Metadote CD, Ritalin LA, Quillivant XR/Quillichew ER, Concerta are all?

A

Long acting methylphenidates

10-12 hours

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2
Q

Ritalin SR, Metadote ER, Methylin ER are all?

A

3-8 hours intermidiate

Methylphenidates

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3
Q

Dexedrine Spansule what is it and what is its DOA?

A

Dextroamphetamine

6-8 hours

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4
Q

Adverse effects of stimulants?

A
  • Anorexia - GI distress - Insomnia - Rebound symptoms - Irritability - Dysphoria - Zombie state
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5
Q

What is the delay with Daytrana?

A

2 hour delay

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6
Q

DSM-5 6 or more of the following

A
  • Careless
  • Difficultly sustaining attention in activity
  • Unable to listen
  • Fails to finish school work, doesnt follow through with instructions
  • Difficulty organizing tasks
  • Loses important things
  • Easily distracted
  • Forgetful in daily activities
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7
Q

Adderall XR (50/50)

is a? what is its DOA?

A

Levoamphetamine and dextroamphetamine

8-12 hours

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8
Q

Ritalin, Methylin, Methylin Oral Liquid are all?

A

Short acting methylphenidates

3-5 hours

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9
Q

What are the advantages of long acting stimulants?

A
  • Once daily dosing
  • Extra coverage for extracurricular activities
  • Privacy issues
  • Store them at home so you know theyre taking it.
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10
Q

What are the disadvantages of methylphenidate?

A
  • Intermediate acting are too short acting for most patients
  • – Erratic peaks and troughs w/ intermediate acting
  • – Concerta- risk of obstruction in patients with GI narrowing
  • – Transdermal – slow onset (2 hours)
  • – Redness from the patch
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11
Q

Nonpharm treatment for ADHD

A
  • Behavioral interventions
  • Individualized education program
  • Shorter homework Adults
  • Organizers and regular schedules
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12
Q

Daytrana transdermal is?

A

Long acting 10-12 hours Methylphenidate

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13
Q

Non-stimulant medications?

A
  • Atomoxetine
  • Bupropion
  • TCA
  • Clonidine ER (Kapvay)
  • Guanfacine XR (Intuniv)
  • Atomoxetine, Clonidine, Guanfacine are FDA approved
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14
Q

Dosing principles for psychostimulants?

A
  • Start low
  • Increase every 3-4 days or weekly until there is a response
  • Initial response is typically rapid
  • Drug holidays
  • If one fails you can switch to another
  • If there isnt a response reconsider diagnosis
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15
Q

Adderall is a? what is its DOA?

A

5-7 its a levoamphetamine or Dextroamphetamine

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16
Q

Subtypes of ADHD?

A

Inattention Hyperactivity or impulsivity.

17
Q

Counseling tips for patients

A
  • How to take the meds/ what its for
  • What ADHD is, risk of untreated ADHD
  • When to expect results
  • SEs
  • Risk of abuse
  • growth delay
18
Q

Lisdexamphetamines?

A

Vyvanse 10 hour duration,

19
Q

Dexmethylphenidate

Brand names?

Durations?

A

Focalin- 6 hours

Focalin XR- 10-12

20
Q

TCAs

A
  • Response in the first 2 weeks
  • Effective in adult ADHD
  • Imipramine, Desipramine
  • Disadvantages: Increase SEs, Risk of death in OD, Monitor EKG
21
Q

ADHD and abuse

Basically patients with ADHD are more likely to have substance abuse

A
22
Q

AEs of stimulants?

A
  • Anorexia
  • GI distress
  • Insomnia
  • Rebound symptoms
  • Irritability
  • Dysphoria
  • Zombie state

Tics, HTN, Hallucinations, and cardiovascular events, rare

23
Q

Medications for aggression and explosive behavior?

Refractory ADHD cases with severe aggression?

A
  • Lithium
  • Valproate
  • Carbamazepine

Antipsychotics

24
Q

What are the advantages of methylphenidate?

A
  • Most Studied
  • – Least effects on worsening tics, appetite and mood
  • – Potential for less abuse?
  • – Less regulatory requirements? –
  • Transdermal - alter the duration of its effects (wear time)
  • – Potentially less BP changes
25
Q

Clonidine XR and Guanfacine

Adjuncts for?

Monitor?

SEs?

Do what when stopping?

A
  • For sleep and aggression
  • Monitor EKG
  • Sedation, Hypotension, Constipation
  • Taper
26
Q

Pharm treatment for ADHD?

A
  • Stimulants
  • Atomoxetine
  • Clonidine/ Guanfacine
  • Antidepressants
  • Cognitive treatment
27
Q

Atomoxetine

Onset of action, what line of treatment?

metabolized by?

SEs?

Black box

A
  • 2nd line ofr treatment
  • Onset is 2-4 weeks
  • full in 6-8 week s
  • 2D6
  • Increase LFT, BP and P, Nausea, decreased appetite
  • Suicide in children
28
Q

Stimulants should be avoided in patients with?

A
  • Serious structural cardiac abnormalities
  • Cardiomyopathy
  • Serious heart rhythm abnormalitites
29
Q

Symptoms need to be present in multiple?

Stimulant medications are?

Non-stimulant medication benefits include?

A
  • Settings
  • First line
  • No abuse potential, less growth effects and less sleep disturbances
30
Q

Bupropion what line? Advantages for who?

Contraindications?

A
  • 2nd line
  • Less toxicity than TCA, less appetite suppression than stimulants
  • For adults
  • No seizures
31
Q

Phychostimulants

A
    • Methylphenidate
    • Dexmethylphenidate
    • Dextroamphetamine
    • Mixed amphetamine
    • Lisdexamfetamine
32
Q

How is ADHD diagnosed?

A
  • Symptom onset prior to age 12
  • Symptoms must be present in multiple settings for at least 6 months
  • Need to rule out other causes like a learning disability
33
Q

Dexedrine and Dextrostat are both? And what is their DOA?

A

Dextroamphetamines

3-5 hours

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