ADHD Flashcards
What is the duration of action for Methylphenidate (Ritalin)?
short - requires 2 to 3 doses per day
What is the duration of action of Dexmethylphenidate (Focalin)?
short - requires 2 to 3 doses
No benefit over methylphenidate IR
What is the duration of action for methylphenidate SR/ER?
8 hours - requires BID dosing for afternoon control
What is the duration of action for methylphenidate OROS (Concerta)
Released over 10 hours
can only give >/= 6y/o, do not crush, 10 to 12 hour duration for QD dosing
What is the duration of action for dexmethylphenidate ER (Focalin XR)?
bimodal release @ 1.5 and 6.5 hours. Faster onset than OROS but shorter duration (not superior for afternoon control)
What class of medication is first line for ADHD?
Stimulants
Methylphenidate or Amphenatime
What medication is used for patients with ADHD and tics?
guanfacine
What is the “ramp effect” with methylphenidate containing products?
The behavioral effects that are proportional to the rate of methylphenidate absorption into the CNS.
What is the duration of action for methylphenidate modified release?
6 to 8 hours
QD dosing for >/= to 6 y/o
Which ADHD medications are for >/= to 6yo?
Methylphenidate modified release, methylphenidate ER, Methylphenidate transdermal, and amphentamine
What is the duration of action for methylphenidate transdermal?
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.
methylphenidate containing products should be used with caution in which patients?
glaucoma, tics, psychosis, and concominant MAOI
What are the common SE of methylphenidate containing products?
HA, stomachache, loss of appetite, and insomnia
What is Lisdexamfetamine?
prodrug of D-amphetamine covalently bound to L=lysine (less abuse potential)
What is the duration of action for Lisdexamfetamine?
10 hours - not superior to other amphetamine containing agents.
What are common SE to amphetamine agents?
loss of appetite, insomnia, abdominal pain, nervousness
What are the warnings/precautions with amphetamines?
may exacerbate HTN and tics, sudden cardiac death – avoid in pt with structural heart defects.
What are the AAP recommendations for stimulant therapy and Sudden cardiac death?
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
When will non-stimulant therapy be first line in ADHD?
- active substance abuse 2. comorbid anxiety 3. tics
What is the black box warning for atomoxetine?
suicidal ideation in children and adolescents
Does atomoxetine require hepatic function monitoring?
No
What is the MOA for atomoxetine?
Norepi reuptake inhibitor
How is atomoxetine metabolized?
CYP2D6
What antidepressants are non-FDA approved for ADHD?
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
