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pharmacology > ADHD drugs > Flashcards

ADHD drugs Flashcards

1
Q

what is ADHD and what are the symptoms?

A

Noted by the persons inability to exercise age-appropriate inhibition of behavior
Impairs academic achievement and development
Symptoms my include:
Hyperactivity, impulsivity, inattention

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2
Q

what is the best txt therapy for ADHD?

A

meds and behavioral therapy

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3
Q

what are the 3 main drug classes for txt of ADHD?

A
  • amphetamines
  • amphetamine-like drugs
  • norepi reuptake inhibitors
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4
Q

what are the two groups of misc. drugs for ADHD txt?

A
  • central alpha agonist

- anti-depressants

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5
Q

what are the 3 amphetamine (stimulants) drugs?

A

Dextroamphetamine (Dexedrine)
Amphetamine/dextroamphetamine (Adderall)
Lisdexamfetamine (Vyvanse)

all end in “amphetamine”

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6
Q

what are the amphetamine-like (stimulants) drugs?

A

Methylphenidate (Ritalin and others)
Dexmethylphenidate (Focalin)

both end in “phenidate” like they wanna “date” the “amPHEtamines”

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7
Q

what is the NE reuptake inhibitor drug?

A

strattera

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8
Q

what is the central alpha agonist drug?

A

Guanfacine (Tenex/Intuniv)

clonidine (Kapvay)

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9
Q

what are the anti-depressants used for ADHD?

A

Tricyclic’s (imipramine, desipramine)

Buproprion (Wellbutrin)

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10
Q

what is the MOA of methylphenidate?

A

CNS stimulants: inhibit the reuptake of both NE and DA in the prefrontal cortex
Increases NTs in synaptic cleft and increase stimulation

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11
Q

what are the effects of NE and DA in the synaptic cleft? (kinda weeds)

A

NE & DA: improve attention, concentration, executive functions and wakefulness
DA in basal ganglia: improve hyperactivity
DA & NE in prefrontal cortex and hypothalamus: improve depression, fatigue and sleepiness.

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12
Q

what is the downside of ER vs CR methlyphenidates?

A

ER- may wear off by the time kids get home (DOA: 6-8hrs)

CR- (controlled release): better for school AND home control

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13
Q

Methylphenidate transdermal (Daytrana): what are the rules for use? (where to apply, how long before effect, how long to leave on, how long do effects last after you remove)

A

Apply to hip 2 hrs before effect needed
Remove after 9 hrs (max 16 hrs)
Last 3 hrs after patch removed

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14
Q

what is the MOA of the amphetamines?

A

Increases release of NE, DA, 5-HT from vesicular storage within presynaptic nerve terminal AND prevent reuptake
(as opposed to methylphenidate that only prevent reuptake)

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15
Q

do amphetamines or methylphenidates have a longer DOA ( in general)?

A

amphetamines (ER are 10-12 hrs)

* as opposed to methylphenidates which are more 6-8 hrs

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16
Q

which amphetamine is designed for less abuse potential?

A

vyvanse

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17
Q

what two isomers are often found in combo for amphetamines? (Weeds)

A

dextro- and levo-

* (dextro is more potent, combine for efficacy)

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18
Q

what are 3 different formulations for varied release of ADHD drugs?

A
  • spheroidal abs.: different polymer layers for delayed abs.
  • osmotic abs: drug exits only when osmotic pressure in stomach pushes it out
  • patch: 10mg patch equivalent to 10mg pill delivered over 10 hrs
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19
Q

a 10mg patch of methylphenidate contains how much total active drug?

A

27.5mg

20
Q

5 ADRs of stimulants (amphetamines and amphetamin-like)

A
  1. decreased appetite
  2. insomnia
  3. GI upset
  4. irritable, sad, moody
  5. HA
21
Q

how can you txt/avoid these ADRs? : decreased appetite, insomnia, GI upset, irritable/moody, HA

A
  1. decreased appetite- high calorie bfast and dinner
  2. insomnia - change time they take it
  3. GI upset- take with food
  4. irritable, sad, moody - reduce dose, change to non-stimulant, a mood stabilizer or 2nd gen anti-pysch
  5. HA - divide dose, give with food, or lower. Give analgesic
22
Q

boxed warning for amphetamines AND methylphenidates?

A

abuse potential, dependence

23
Q

boxed warning for ONLY amphetamines

A

misuse can cause SUDDEN CARDIAC ARREST

- contraindicated in those with heart issues

24
Q

what are some things we need to monitor for with ADHD meds?

A
  • HTN and tachy
  • exacerbation of pyschosis
  • seizures
  • blurry vision
  • tics
25
Q

amphetamines and methylphenidates (stimulants drugs) will be what control schedule?

A

II- potential for abuse

26
Q

what are two methylphenidate-specific ADRs

A
  • priapism

- severe allergic rxn to patch

27
Q

what is stratrera not a first line agent?

A

very long onset and DOA
-2 to 4 weeks versus 1 to 2 hours with stimulant medications- to see initial effect
Full benefit not seen for 6-8 weeks

28
Q

what is the black box warning for strattera?

A

Black Box Warning: increase risk of suicidal ideation in children and young adults; potential for severe liver injury

29
Q

what is the MOA of the central alpha agonists?

A

Selective presynaptic alpha2a agonist that reduces sympathetic nerve impulses resulting in reduced sympathetic outflow of NE
= Enhances working memory and helps behavioral inhibition thus improving ADHD associated symptoms

30
Q

what is the major ADR of central alpha agonists?

A

sedation

31
Q

what are central alpha agonists used for?

A

not used on their own, add-ons for hyperactivity/tics

32
Q

what is the major difference among the central alpha agonists?

A

guanfacine is less sedating than clonidine

33
Q

what is the MOA of wellbutrin?

A

NE & DA reuptake inhibitor

34
Q

what are the 3 major ADRs of wellbutrin?

A
  • increase risk for seizure
  • increase risk of suicide
  • exacerbates tics

*also nausea and insomnia

35
Q

why would wellbutrin be used for ADHD?

A

some providers may start here if they want to avoid stimulant
(not as selective as methylphenidate)

36
Q

what is the MOA of the tricyclic anti-depressants (imipramine, desipramine) ?

A

Inhibit the reuptake of norepinephrine and serotonin

37
Q

what is the major ADR of tricyclics?

A

Significant risk of cardiovascular AE (slowing of intraventricular conduction, orthostatic hypotension, induction of arrhythmias)

38
Q

when would tricyclics be used for ADHD?

A

really,.. never

39
Q

what are the 1st and 2nd line txts?

A

1st: Stimulant medications
2nd: Non-stimulant medications

40
Q

amphetamine vs amphetamine-like efficacy?

A

Methylphenidate and amphetamine products are considered equally efficacious

41
Q

If treatment failure occurs with 1 stimulant class at therapeutic dose, what do you try next?

A

other stimulant medications should be tried before moving to 2nd line treatments

42
Q

do you want to max out stimulant meds?

A

NO! they should be titrated for the individual- for max efficacy and minimal ADRs

43
Q

what major factors do you consider when choosing an ADHD drug?

A
  • length of time for coverage
  • ADRs
  • abuse potential
44
Q

Children with ADHD are more or less likely to have a concurrent substance use disorder than those without ADHD?

A

more!

45
Q

Children treated with stimulants at a younger age are more or less likely to misuse or abuse substances than those in whom treatment is delayed?

A

Less!

pharmacology (24 decks)

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