ADHD Drugs Flashcards by Christina Provenza

brain area for attentiveness

cingulo-fronto-parietal attention network

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brain area for mind wondering

default mode network (DMN)

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main NTs of ADHD

DA, NE in prefrontal cortex

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normal attentiveness functioning

auto receptors decrease DA and NE phasic release

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transporters involved in ADHD

vesicular monoamine transporter 2- pumps NT into storage vesicles
DAT
NET

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axon terminal autoreceptors

D2, alpha2

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postsynaptic receptors

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issue in ADHD

increased DAT activity results in less tonic DA to bind to the auto receptors that decrease phasic DA release –> too much DA in the mind wondering area and not enough activation of the CFP area

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2 major effects of ADHD drugs

increase tonic levels of DA

increase noradrenergic signaling to increase stimulation of post alpha2 receptors

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amphetamine examples

amphetamine
dextroamphetamine
lisdexamfetamine

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lisdexamfetamine

prodrug to reduce risk of overdose and abuse

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MOA of amphetamines

DAT inhibition
VMAT2 inhibition
TAAR1 activation

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TAAR1

activated by amphetamines

phosphorylates DAT which makes it run in reverse to move DA INTO the synapse –> increase tonic action

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amphetamine side effects

nervous
insomnia
anorexia
abdominal pain
headache
dullness/fatigue
emotional lability
dry mouth
tic worsening
increased BP
growth inhibition
sudden death

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withdrawal symptoms of amphetamines

dysphoria
sleep disturbances
psychomotor changes
increased appetite

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signs of supra therapeutic amphetamine dose

supranoramalization
anxiety
dilated pupils
sweating, flushing, pallor
hyperthermia
tremor

toxic amphetamine dose

arrhythmia
heart block
circulatory collapse
rhabdomyolysis
seizures
coma
death

contraindication to amphetamines

eating disorders
substance abuse
advanced CVD
moderate/severe HTN
structural heart defects
hyperthyroidism
glaucoma
breastfeeding

amphetamine interactions

sympathomimetics

antipsychotics (Li)

methylphenidate, dexmethylphenidate

stimulants with a shorter duration of action

MOA methylphenidate

blocks DAT and NET

side effects of methylphenidate

nervousness
insomnia
dullness/fatigue
emotional lability
worsening of tics
growth inhibition

which has more CV issues

amphetamines more than methylphenidate

which are scheduled drugs

amphetamines

methylphenidate

alpha2 agonist MOA

alpha2 agonist- decreases phasic release

guanfacine ADR

``` sleepiness hypotension bradycardia syncope fatigue depression ```

cautions for alpha2 agonists

hypotension | anxiety with abrupt stop

interactions for agonists

hypotensive agents MAOI cyp metabolism

clonidine ADR

nasal congestion and irritation throat irritation worse sleepiness and hypotension than guanfacine

alpha2 agoinsts

guanfacine | clonidine

atamoxetine

non stimulant for ADHD | second line

atamoxetine MAO

selective NET inhibition

adr atamoxetine in kids

GI upset | increased suicidal thoughts/behaviors

adr atamoxetine adults

insomnia anticholinergic effects GI upset sexual effects

contraindications of atamoxetine

glaucoma | jaundice

interactions of atamoxetine

MAOI | cyp

second line drugs for ADHD

antidepressants anxiolytics modafinil

antidepressants/anxiolytics for ADHD

TCA bupropion buspirone

modafinil

stimulant for narcolepsy