ADHD Diagnosis and Pharmacotherapy Flashcards
ADHD Pathophysiology
Decreased activation in basal anglion and anterior frontal lobe
Dopamine and NE are cleared too quickly
Dopamine limits and selects sensory information arriving from the thalamus to forebrain
Frontal lobe projects future cosnequences and choice between good and bad - also impulse control and similarities v differences determination
Methylphenidate Effect on brain
Increases extracellular dopamine in brain and changes areas of function in frontal lobe
Will only help treat patients w/ ADHD
ADHD Treatment
Stimulants - Ritalin, Adderall, Concerta are TOC
Atomoxetine is an alternate non-stimulant
Behavioral therapy + medications are effective
Refer <6yo to specialist for treatment
Refer concomitant seizure disorder to specialist for Tx
Meds help with self-control and ability to focus - have pt specific goals
Stimulants
Schedule II Controlled Substance
1st line therapy for ADHD
Methylphenidate
Amphetamines
Methylphenidate
Onset 20-60 minutes
Short and long acting
Ritalin and Methylin - SA
Focalin XR - LA
Ritalin
Methylphenidate - SA
Lasts 3-4 hours
May cause jitters after snorting
Focalin XR
Methylphenidate - LA
Lasts 8-12 hours
SE: Loss of appetite, jitters, HA
Approximate BID dosing w/ Ritalin
LA Methylphenidate
Osmotic release
Oral suspension
Transdermal
Osmotic release: Concerta - lasts 12 hours
Oral suspension: Quillivan XR - lasts 12 hours
TransdermalL Daytrana - lasts 12 hrs, effective 3 hrs after patch removal
Amphetamines
Dextroamphetamine/Amphetamine-dextro (Adderall)
Lisdexamfetamine (Vyvanse)
Increase dopamine levels in the brain
Risk of Sudden cardiac death
Most effective ADHD treatment
Adderall
3-4 hours; XR - 8-12 hours
More addictive than Vyvanse
Can impact sleep patterns
Vyvanse
Lisdexamphetamine
Lasts 8-12 hours - prodrug of dextroamphetamine
Less addictive, still schedule two
Smoother absorption than Adderall - also blocks reuptake
Can drastically suppress appetite
Atomoxetine
Strattera
Non-stimulant - works on NE
BBW suicidality - may be less effective than stimulants
SE: Chest pain, SOB, Psychosis, N, abdominal pain, jaundice
XR Guanfacine
Intuniv - non-stimulant
Alpha-2 adrenergic agent - 3rd line for ADHD
SE: Fast/slow HR, chest tightness, numbness, fainting, depression, hypotension
Caution w/ kidney or liver disease
1st, 2nd, and 3rd line Treatment for ADHD
1st: Stimulant - Adderall, Ritalin
2nd: Atomoxitine/Straterra
3rd: Intuniv, TCA (Ipipramine, desipramine), Buproprion
Drug holidays with ADHD meds
Only with stimulant meds
Not for atomoxetine or alpha-2 due to extended 1/2 life
