ADHD- MPH DI/Clinical Pearls

Question 1

MPH is the preferred product for use in what patient population?

Answer 1

Children/adolescents

Question 2

MPH MoA

Answer 2

Selectively inhibits presynaptic reuptake of DA and NE –> increased neurotransmitter activity in the CNS

Question 3

The time to peak for MPH can be delayed by what?

Answer 3

High-fat meals

Question 4

MPH dosing/titration

Answer 4

Titrate qweek until clinical response observed

Question 5

How often are MPH IR products dosed?

Answer 5

At least BID

Question 6

IR MPH products are recommended in what patients?

Answer 6

Patients weighing <16kg

Question 7

How soon before bedtime should afternoon MPH IR doses be given?

Answer 7

<6 hours

Question 8

Ramp effect of MPH

Answer 8

Behavioral effects are proportional to the rate of MPH absorption into the CNS

Question 9

Tics happen more with what formulation of MPH?

Answer 9

TD patch

Question 10

One formulation of MPH has a BBW. What formulation/product is it and what is the BBW?

Answer 10

The TD patch has a BBW for skin reactions (chemical leukoderma, a permanent loss of skin color)

Question 11

Use MPH with caution in what disease states/conditions?

Answer 11

Glaucoma, tics, psychosis, concurrent MAOI use

Question 12

MPH are safe/effective in what disease state?

Answer 12

Epilepsy

Question 13

Weird side effect of MPH and when it occurs

Answer 13

Priapism, reported in pediatrics and adults after prolonged exposure, dose increases, or drug withdrawal

Question 14

Clinical pearls: MPH IR

Answer 14

Need to be dosed BID-TID

Question 15

Clinical pearls: MPH ER Chew

Answer 15

tablets are scored and can be halved

Question 16

Clinical pearls: MPH CD

Answer 16

30% IR, 70% ER beads
Can be opened and put on applesauce

Question 17

Clinical pearls: MPH LA

Answer 17

50% IR, 50% ER beads
Can open and put on applesauce

Question 18

MPH LA is best for what?

Answer 18

Severe morning symptoms

Question 19

Clinical pearls: MPH XR suspension

Answer 19

Requires vigorous shaking for at least 10 seconds
Needs to be reconstituted by a pharmacist
Stable for 4 months

Question 20

Clinical pearls: MPH OROS

Answer 20

Swallow whole, don’t chew or crush
Will see ghost shell in the stool

Question 21

The OROS tablet isn’t good for patients with what?

Answer 21

Strictures in their GI tract

Question 22

Clinical pearls: MPH MLR

Answer 22

better for rebound afternoon symptoms due to a larger ER ratio

Question 23

Clinical pearls: MPH XR-ODT (Cotempla XR-ODT)

Answer 23

Don’t push the tablet through the foil; peel back the blister pack and dissolve the table on the tongue with no liquid. Don’t chew or swallow whole

Question 24

Clinical pearls: MPH PM (Jornay PM)

Answer 24

No more than 5% of the total drug is absorbed in the first 10 hours, administer between 6:30-9:30 PM

Uses the DELEXIS drug delivery system with multiple-layer beads inside the capsule

Take consistently with or without food

Not recommended to convert mg-to-mg from other MPH products

Question 25

Jornay PM: what to do if you miss a dose

Answer 25

Skip the dose, take it the next day

Question 26

Clinical pearls: MPH TD patch

Answer 26

Dose isn’t equivalent to PO
Drug active for 3 hours after removal; apply 2 hours prior to desired onset but may be worn for up to 9 hours
May be worn while swimming/bathing
Don’t cut the patches!

Question 27

Clinical pearls: dex-MPH IR

Answer 27

Dose is 1/2 that of MPH, needs to be dosed BID-TID
No greater benefit over MPH
CAN’T BE CHANGED 1:1

Question 28

Clinical pearls: dex-MPH XR

Answer 28

50% IR, 50% ER beads
Peak serum 1.5 and 6.5 hours after dose taken
Afternoon symptom control not as good as OROS
CAN’T BE CHANGED 1:1

Question 29

If a patient doesn’t respond to MPH, will they respond to dex-MPH products?

Answer 29

Probably not

Question 30

Clinical pearls: dex-MPH/Ser-dex-MPH

Answer 30

Ser is the prodrug of dex!