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Psychiatry > ADHD meds > Flashcards

ADHD meds Flashcards

1
Q

MOA of amphetamines

A

release DA and NE

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2
Q

moa of atomoxetine

A

selective NE reuptake inhibitor centrally and peripherally

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3
Q

dexmehtyphenidate

methylphenidate

A

block reuptake of DA and NE

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4
Q

clonidine and guanfacine

A

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

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5
Q

moa of haloperidol

A

blocks post-synaptic D2 receptors

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6
Q

what are the six ADEs of stimulant ADHD drugs

A
  1. depression + withdrawal
  2. appetite suppression + delayed sleep onset
  3. wearing off + tics
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7
Q

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

A
  1. counsel
  2. titrate
  3. maintenance
  4. potential termination
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8
Q

what are the more common amphetamine ADE?

HILA

A

Headache

Insomnia

Loss of appetite

Abdominal pain

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9
Q

less common ADE of amphetamines:

WANTEd

A

W-weight loss

A-anxiety

N- nervousness

T-tachycardia

E-emotional lability

D -

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10
Q

atomoxetine ADE

HID

SCAD

A

dry mouth

headache

abdominal pina

decreased appetite

cough

somonolence

vomiting

insomnia

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11
Q

methylphenidate ADE

HID N/V and AB pain

A

Headache

Abdominal pain

Decreased appetite(patch)

Insomina

N/V

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12
Q

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

A

MAOI + psychosis

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

existing liver disease

history of stimulant drug dependance

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13
Q

effectof amphetamine with acetazolamine and NA bicarbonate?

A

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

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14
Q

amphetamine + ammonium chloride?

A

acidic urine favors renal elimination –>decrease serum drug levels

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15
Q

amphetamine + chlorpormazine +haloperidol?

A

dopamine receptor blockers DIMINISH effects of amphetamines

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16
Q

dextromethorphan + amphetamine

A

increased impaired judgement + erratic euphoria

17
Q

dixogin + amphetamine

A

increase pro-arrhythmogenic effect

18
Q

MAOIs + amphetamine

A

increase serum drug levels + toxicitiy

19
Q

CYP2D6 ind/inh + amphetamines

A

serum drug levels increase or decrease

20
Q

atomoxetine + albuterol

A

accentuate CV ADE

21
Q

epinephrine + atomoxetine

A

further Increase in BP

22
Q

MAOIs + atomoxetine + methylphenidate

A

increase toxicity; allow 2-week interval btw each drug

23
Q

alcohol + methyphenidate

A

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

24
Q

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

A

ADHD

25
Q

which drugs are the 1st choice for ADHD+Tourettes?

2nd choice?

3rd choice?

A

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

26
Q

which drugs are the beset for reducing tic?

A

antipsychotic

27
Q

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

A

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

28
Q

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

A

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

29
Q

clonidine guanfacine + cyclosporine

A

increase serum levels of interact

30
Q

buproprion + clycosporine/guanfacine

A

grand mal seizures

31
Q

do clonidine/guanfacine have CYP mediated interactions?

A

NOT really

32
Q

Haloperidol -

how is it metalobized?

what is two ADEs?

A
  1. metabolized by CYP2D6 and CYP3A4

ADE: 1. prolong QT interval and hepatically mediated drug interactions

33
Q

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?

A

management is supportive, with judicious use of BNZs

34
Q

atomoxetine tox = generally mild

(drowsiness, agitation, hyperactivity, GI upset, tremor, hyperreflexia, tachycardia hypertension, and seizure)

how do you manage?

A

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

35
Q

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?

A

HTN = atropine

support of hypotension = dopamine

36
Q

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?

A

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

Psychiatry (11 decks)

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