ADHD drugs Flashcards
what is ADHD and what are the symptoms?
Noted by the persons inability to exercise age-appropriate inhibition of behavior
Impairs academic achievement and development
Symptoms my include:
Hyperactivity, impulsivity, inattention
what is the best txt therapy for ADHD?
meds and behavioral therapy
what are the 3 main drug classes for txt of ADHD?
- amphetamines
- amphetamine-like drugs
- norepi reuptake inhibitors
what are the two groups of misc. drugs for ADHD txt?
- central alpha agonist
- anti-depressants
what are the 3 amphetamine (stimulants) drugs?
Dextroamphetamine (Dexedrine)
Amphetamine/dextroamphetamine (Adderall)
Lisdexamfetamine (Vyvanse)
all end in “amphetamine”
what are the amphetamine-like (stimulants) drugs?
Methylphenidate (Ritalin and others)
Dexmethylphenidate (Focalin)
both end in “phenidate” like they wanna “date” the “amPHEtamines”
what is the NE reuptake inhibitor drug?
strattera
what is the central alpha agonist drug?
Guanfacine (Tenex/Intuniv)
clonidine (Kapvay)
what are the anti-depressants used for ADHD?
Tricyclic’s (imipramine, desipramine)
Buproprion (Wellbutrin)
what is the MOA of methylphenidate?
CNS stimulants: inhibit the reuptake of both NE and DA in the prefrontal cortex
Increases NTs in synaptic cleft and increase stimulation
what are the effects of NE and DA in the synaptic cleft? (kinda weeds)
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.
what is the downside of ER vs CR methlyphenidates?
ER- may wear off by the time kids get home (DOA: 6-8hrs)
CR- (controlled release): better for school AND home control
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)
Apply to hip 2 hrs before effect needed
Remove after 9 hrs (max 16 hrs)
Last 3 hrs after patch removed
what is the MOA of the amphetamines?
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)
do amphetamines or methylphenidates have a longer DOA ( in general)?
amphetamines (ER are 10-12 hrs)
* as opposed to methylphenidates which are more 6-8 hrs
which amphetamine is designed for less abuse potential?
vyvanse
what two isomers are often found in combo for amphetamines? (Weeds)
dextro- and levo-
* (dextro is more potent, combine for efficacy)
what are 3 different formulations for varied release of ADHD drugs?
- 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
a 10mg patch of methylphenidate contains how much total active drug?
27.5mg
5 ADRs of stimulants (amphetamines and amphetamin-like)
- decreased appetite
- insomnia
- GI upset
- irritable, sad, moody
- HA
how can you txt/avoid these ADRs? : decreased appetite, insomnia, GI upset, irritable/moody, HA
- decreased appetite- high calorie bfast and dinner
- insomnia - change time they take it
- GI upset- take with food
- irritable, sad, moody - reduce dose, change to non-stimulant, a mood stabilizer or 2nd gen anti-pysch
- HA - divide dose, give with food, or lower. Give analgesic
boxed warning for amphetamines AND methylphenidates?
abuse potential, dependence
boxed warning for ONLY amphetamines
misuse can cause SUDDEN CARDIAC ARREST
- contraindicated in those with heart issues
what are some things we need to monitor for with ADHD meds?
- HTN and tachy
- exacerbation of pyschosis
- seizures
- blurry vision
- tics
amphetamines and methylphenidates (stimulants drugs) will be what control schedule?
II- potential for abuse
what are two methylphenidate-specific ADRs
- priapism
- severe allergic rxn to patch
what is stratrera not a first line agent?
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
what is the black box warning for strattera?
Black Box Warning: increase risk of suicidal ideation in children and young adults; potential for severe liver injury
what is the MOA of the central alpha agonists?
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
what is the major ADR of central alpha agonists?
sedation
what are central alpha agonists used for?
not used on their own, add-ons for hyperactivity/tics
what is the major difference among the central alpha agonists?
guanfacine is less sedating than clonidine
what is the MOA of wellbutrin?
NE & DA reuptake inhibitor
what are the 3 major ADRs of wellbutrin?
- increase risk for seizure
- increase risk of suicide
- exacerbates tics
*also nausea and insomnia
why would wellbutrin be used for ADHD?
some providers may start here if they want to avoid stimulant
(not as selective as methylphenidate)
what is the MOA of the tricyclic anti-depressants (imipramine, desipramine) ?
Inhibit the reuptake of norepinephrine and serotonin
what is the major ADR of tricyclics?
Significant risk of cardiovascular AE (slowing of intraventricular conduction, orthostatic hypotension, induction of arrhythmias)
when would tricyclics be used for ADHD?
really,.. never
what are the 1st and 2nd line txts?
1st: Stimulant medications
2nd: Non-stimulant medications
amphetamine vs amphetamine-like efficacy?
Methylphenidate and amphetamine products are considered equally efficacious
If treatment failure occurs with 1 stimulant class at therapeutic dose, what do you try next?
other stimulant medications should be tried before moving to 2nd line treatments
do you want to max out stimulant meds?
NO! they should be titrated for the individual- for max efficacy and minimal ADRs
what major factors do you consider when choosing an ADHD drug?
- length of time for coverage
- ADRs
- abuse potential
Children with ADHD are more or less likely to have a concurrent substance use disorder than those without ADHD?
more!
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?
Less!
