ADHD

Question 1

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

Answer 1

short - requires 2 to 3 doses per day

Question 2

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

Answer 2

short - requires 2 to 3 doses

No benefit over methylphenidate IR

Question 3

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

Answer 3

8 hours - requires BID dosing for afternoon control

Question 4

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

Answer 4

Released over 10 hours

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

Question 5

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

Answer 5

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

Question 6

What class of medication is first line for ADHD?

Answer 6

Stimulants

Methylphenidate or Amphenatime

Question 7

What medication is used for patients with ADHD and tics?

Answer 7

guanfacine

Question 8

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

Answer 8

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

Question 9

What is the duration of action for methylphenidate modified release?

Answer 9

6 to 8 hours

QD dosing for >/= to 6 y/o

Question 10

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

Answer 10

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

Question 11

What is the duration of action for methylphenidate transdermal?

Answer 11

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.

Question 12

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

Answer 12

glaucoma, tics, psychosis, and concominant MAOI

Question 13

What are the common SE of methylphenidate containing products?

Answer 13

HA, stomachache, loss of appetite, and insomnia

Question 14

What is Lisdexamfetamine?

Answer 14

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

Question 15

What is the duration of action for Lisdexamfetamine?

Answer 15

10 hours - not superior to other amphetamine containing agents.

Question 16

What are common SE to amphetamine agents?

Answer 16

loss of appetite, insomnia, abdominal pain, nervousness

Question 17

What are the warnings/precautions with amphetamines?

Answer 17

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

Question 18

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

Answer 18

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

Question 19

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

Answer 19

1. active substance abuse 2. comorbid anxiety 3. tics

Question 20

What is the black box warning for atomoxetine?

Answer 20

suicidal ideation in children and adolescents

Question 21

Does atomoxetine require hepatic function monitoring?

Answer 21

No

Question 22

What is the MOA for atomoxetine?

Answer 22

Norepi reuptake inhibitor

Question 23

How is atomoxetine metabolized?

Answer 23

CYP2D6

Question 24

What antidepressants are non-FDA approved for ADHD?

Answer 24

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

Question 25

What non-stimulants are used for ADHD?

Answer 25

Atomoxetine, bupropion, imipramine, nortriptyline, clonidine, guanfacine

Question 26

What are the benefits of clonidine in ADHD

Answer 26

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

Question 27

What is Guanfacine FDA approved for?

Answer 27

ADHD in 6 to 17 y/o

Question 28

What are the benefits of Guanfacine in ADHD?

Answer 28

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