ADHD- MPH DI/Clinical Pearls Flashcards
MPH is the preferred product for use in what patient population?
Children/adolescents
MPH MoA
Selectively inhibits presynaptic reuptake of DA and NE –> increased neurotransmitter activity in the CNS
The time to peak for MPH can be delayed by what?
High-fat meals
MPH dosing/titration
Titrate qweek until clinical response observed
How often are MPH IR products dosed?
At least BID
IR MPH products are recommended in what patients?
Patients weighing <16kg
How soon before bedtime should afternoon MPH IR doses be given?
<6 hours
Ramp effect of MPH
Behavioral effects are proportional to the rate of MPH absorption into the CNS
Tics happen more with what formulation of MPH?
TD patch
One formulation of MPH has a BBW. What formulation/product is it and what is the BBW?
The TD patch has a BBW for skin reactions (chemical leukoderma, a permanent loss of skin color)
Use MPH with caution in what disease states/conditions?
Glaucoma, tics, psychosis, concurrent MAOI use
MPH are safe/effective in what disease state?
Epilepsy
Weird side effect of MPH and when it occurs
Priapism, reported in pediatrics and adults after prolonged exposure, dose increases, or drug withdrawal
Clinical pearls: MPH IR
Need to be dosed BID-TID
Clinical pearls: MPH ER Chew
tablets are scored and can be halved
Clinical pearls: MPH CD
30% IR, 70% ER beads
Can be opened and put on applesauce
Clinical pearls: MPH LA
50% IR, 50% ER beads
Can open and put on applesauce
MPH LA is best for what?
Severe morning symptoms
Clinical pearls: MPH XR suspension
Requires vigorous shaking for at least 10 seconds
Needs to be reconstituted by a pharmacist
Stable for 4 months
Clinical pearls: MPH OROS
Swallow whole, don’t chew or crush
Will see ghost shell in the stool
The OROS tablet isn’t good for patients with what?
Strictures in their GI tract
Clinical pearls: MPH MLR
better for rebound afternoon symptoms due to a larger ER ratio
Clinical pearls: MPH XR-ODT (Cotempla XR-ODT)
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
Clinical pearls: MPH PM (Jornay PM)
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
Jornay PM: what to do if you miss a dose
Skip the dose, take it the next day
Clinical pearls: MPH TD patch
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!
Clinical pearls: dex-MPH IR
Dose is 1/2 that of MPH, needs to be dosed BID-TID
No greater benefit over MPH
CAN’T BE CHANGED 1:1
Clinical pearls: dex-MPH XR
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
If a patient doesn’t respond to MPH, will they respond to dex-MPH products?
Probably not
Clinical pearls: dex-MPH/Ser-dex-MPH
Ser is the prodrug of dex!
