ADHD meds

Question 1

MOA of amphetamines

Answer 1

release DA and NE

Question 2

moa of atomoxetine

Answer 2

selective NE reuptake inhibitor centrally and peripherally

Question 3

dexmehtyphenidate

methylphenidate

Answer 3

block reuptake of DA and NE

Question 4

clonidine and guanfacine

Answer 4

improved PFC function through post-synaptic alpha-2 receptor AGONIST effects in the PFC

Question 5

moa of haloperidol

Answer 5

blocks post-synaptic D2 receptors

Question 6

what are the six ADEs of stimulant ADHD drugs

Answer 6

1. depression + withdrawal
2. appetite suppression + delayed sleep onset
3. wearing off + tics

Question 7

management of ADHD is comprised of 4 phases what are they?

Answer 7

1. counsel
2. titrate
3. maintenance
4. potential termination

Question 8

what are the more common amphetamine ADE?

HILA

Answer 8

Headache

Insomnia

Loss of appetite

Abdominal pain

Question 9

less common ADE of amphetamines:

WANTEd

Answer 9

W-weight loss

A-anxiety

N- nervousness

T-tachycardia

E-emotional lability

D -

Question 10

atomoxetine ADE

HID

SCAD

Answer 10

dry mouth

headache

abdominal pina

decreased appetite

cough

somonolence

vomiting

insomnia

Question 11

methylphenidate ADE

HID N/V and AB pain

Answer 11

Headache

Abdominal pain

Decreased appetite(patch)

Insomina

N/V

Question 12

what are the ABSOLUTE C/I in to stimulant use? (6 of them)

Answer 12

MAOI + psychosis

glaucoma + underlying caridac conditions: early arrhythimic death (mild increase in pulse and BP)

existing liver disease

history of stimulant drug dependance

Question 13

effectof amphetamine with acetazolamine and NA bicarbonate?

Answer 13

alkaline urine favors reuptake of drug in renal tubules –> increse serum drug levels

Question 14

amphetamine + ammonium chloride?

Answer 14

acidic urine favors renal elimination –>decrease serum drug levels

Question 15

amphetamine + chlorpormazine +haloperidol?

Answer 15

dopamine receptor blockers DIMINISH effects of amphetamines

Question 16

dextromethorphan + amphetamine

Answer 16

increased impaired judgement + erratic euphoria

Question 17

dixogin + amphetamine

Answer 17

increase pro-arrhythmogenic effect

Question 18

MAOIs + amphetamine

Answer 18

increase serum drug levels + toxicitiy

Question 19

CYP2D6 ind/inh + amphetamines

Answer 19

serum drug levels increase or decrease

Question 20

atomoxetine + albuterol

Answer 20

accentuate CV ADE

Question 21

epinephrine + atomoxetine

Answer 21

further Increase in BP

Question 22

MAOIs + atomoxetine + methylphenidate

Answer 22

increase toxicity; allow 2-week interval btw each drug

Question 23

alcohol + methyphenidate

Answer 23

increase production of toxic metabolite. –>functional inability to concentrate(drive)

Question 24

what is the MC comorbid condition in ppl w/tic s and tourette syndrome?

Answer 24

ADHD

Question 25

which drugs are the 1st choice for ADHD+Tourettes? 2nd choice? 3rd choice?

Answer 25

1st choice: alpha-2 agonists significantly improve tics and ADHD 2nd choice: stimulants have rapid activity against ADHD but no activity against tis 3rd choice: methylphenidate + alpha-2 agonist combo

Question 26

which drugs are the beset for reducing tic?

Answer 26

antipsychotic

Question 27

what is the problem with using antipsychotics in to tx tics?

Answer 27

antipscychotics agents have a considerabl worse side-effect profile compared to alpha-2 agonist medications and behavioral therapy.

Question 28

alpha-2 agonists demonstrated similar or slightly larger benefit in reducing tics but only among subjects with comorbid ADHD

Answer 28

note: alpha 2 agonsits do not really reduce tics in subjects w/out ADHD

Question 29

clonidine guanfacine + cyclosporine

Answer 29

increase serum levels of interact

Question 30

buproprion + clycosporine/guanfacine

Answer 30

grand mal seizures

Question 31

do clonidine/guanfacine have CYP mediated interactions?

Answer 31

NOT really

Question 32

Haloperidol - how is it metalobized? what is two ADEs?

Answer 32

1. metabolized by CYP2D6 and CYP3A4 ADE: 1. prolong QT interval and hepatically mediated drug interactions

Question 33

Amphetamine/methylphenidate tox is primarily pormientn neurological and cardiovascular effects, but secondary complications can involve renal, muscle, pulmonary and GI effects how would you manage this?

Answer 33

management is supportive, with judicious use of BNZs

Question 34

atomoxetine tox = generally mild (drowsiness, agitation, hyperactivity, GI upset, tremor, hyperreflexia, tachycardia hypertension, and seizure) how do you manage?

Answer 34

supportive w/focus on sedation, and control of dyskinesia and seizure

Question 35

clonidine OD may produce paradoxical short term HTN, but usally hypotension. How do you manage this? which drug for the HTN? for the support of hypotension?

Answer 35

HTN = atropine support of hypotension = dopamine

Question 36

guanfacine produces mixed picture, depending on central and peripheral effects initaly presentation may be drowsienss, lethargy, dry mouth, diaphoresis. CV effects may present as hyotension or HTN -how do you manage?

Answer 36

management of guanfacine OD = largerly supportive with a focus on support of BP