ADHD Flashcards

1
Q

What is the duration of action for Methylphenidate (Ritalin)?

A

short - requires 2 to 3 doses per day

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2
Q

What is the duration of action of Dexmethylphenidate (Focalin)?

A

short - requires 2 to 3 doses

No benefit over methylphenidate IR

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3
Q

What is the duration of action for methylphenidate SR/ER?

A

8 hours - requires BID dosing for afternoon control

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4
Q

What is the duration of action for methylphenidate OROS (Concerta)

A

Released over 10 hours

can only give >/= 6y/o, do not crush, 10 to 12 hour duration for QD dosing

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5
Q

What is the duration of action for dexmethylphenidate ER (Focalin XR)?

A

bimodal release @ 1.5 and 6.5 hours. Faster onset than OROS but shorter duration (not superior for afternoon control)

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6
Q

What class of medication is first line for ADHD?

A

Stimulants

Methylphenidate or Amphenatime

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7
Q

What medication is used for patients with ADHD and tics?

A

guanfacine

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8
Q

What is the “ramp effect” with methylphenidate containing products?

A

The behavioral effects that are proportional to the rate of methylphenidate absorption into the CNS.

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9
Q

What is the duration of action for methylphenidate modified release?

A

6 to 8 hours

QD dosing for >/= to 6 y/o

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10
Q

Which ADHD medications are for >/= to 6yo?

A

Methylphenidate modified release, methylphenidate ER, Methylphenidate transdermal, and amphentamine

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11
Q

What is the duration of action for methylphenidate transdermal?

A

apply the patch 2 hours before the effect is needed. May remain on for 9 to 16 hours. Duration lasts 3 hours post patch removal.

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12
Q

methylphenidate containing products should be used with caution in which patients?

A

glaucoma, tics, psychosis, and concominant MAOI

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13
Q

What are the common SE of methylphenidate containing products?

A

HA, stomachache, loss of appetite, and insomnia

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14
Q

What is Lisdexamfetamine?

A

prodrug of D-amphetamine covalently bound to L=lysine (less abuse potential)

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15
Q

What is the duration of action for Lisdexamfetamine?

A

10 hours - not superior to other amphetamine containing agents.

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16
Q

What are common SE to amphetamine agents?

A

loss of appetite, insomnia, abdominal pain, nervousness

17
Q

What are the warnings/precautions with amphetamines?

A

may exacerbate HTN and tics, sudden cardiac death – avoid in pt with structural heart defects.

18
Q

What are the AAP recommendations for stimulant therapy and Sudden cardiac death?

A

target cardiac history and careful physical exam before starting
routine ECG is NOT recommended unless h/p suggests heart disease
for healthy children do NOT with hold if not able to obtain ECG or check by pedi cardiology

19
Q

When will non-stimulant therapy be first line in ADHD?

A
  1. active substance abuse 2. comorbid anxiety 3. tics
20
Q

What is the black box warning for atomoxetine?

A

suicidal ideation in children and adolescents

21
Q

Does atomoxetine require hepatic function monitoring?

A

No

22
Q

What is the MOA for atomoxetine?

A

Norepi reuptake inhibitor

23
Q

How is atomoxetine metabolized?

A

CYP2D6

24
Q

What antidepressants are non-FDA approved for ADHD?

A

1.Nonadrenergic antidepressants - Bupropion (but not for children with active seizures)
2. tricyclics - Imipraminem or Nortriptyline (ECG before start and dose increase
Desipramine — sudden cardiac death

25
Q

What non-stimulants are used for ADHD?

A

Atomoxetine, bupropion, imipramine, nortriptyline, clonidine, guanfacine

26
Q

What are the benefits of clonidine in ADHD

A

decrease severity of tics with methylphenidate
better for hyperactivity than inattention
causes sedation

27
Q

What is Guanfacine FDA approved for?

A

ADHD in 6 to 17 y/o

28
Q

What are the benefits of Guanfacine in ADHD?

A

improve tic disorders
less sedation and longer duration than clonidine
abrupt dc of ER can cause rebound HTN