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Therapeutics > ADHD & Neuropathic Pain > Flashcards

ADHD & Neuropathic Pain Flashcards

1
Q

diagnosis of ADHD is made with onset of symptoms before age __ with how many symptoms for children vs older adolescents/adults

A

before age 12
children- 6 or more symptoms
older adolescents/adults- 5 symptoms

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2
Q

symptoms of adhd with wandering off task, lacking persistence, having difficulty remaining focused, and being disorganized

A

inattention

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3
Q

symptom of adhd with excessive motor activity, fidgeting, tapping, talkativeness, extreme restlessness, and wearing others out

A

hyperactivity

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4
Q

adhd symptoms with desire for immediate rewards, social intrusiveness, making decisions without considering long term

A

impulsivity

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5
Q

if predominant ADHD diagnosis, which agents are first line? if poor response to one of these?

A

MPH, d-MPH, or AMP/mixed AMP

poor response- switch to another

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6
Q

if poor response to 1st line ADHD agents, what is next step?
and if that fails?

A

atomoxetine, viloxazine, guanfacine, clonidine, bupropion

fails –> combo treatment or TCA

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7
Q

what is used 1st line for ADHD if sub abuse disorder

A

atomoxetine, viloxazine, guanfacine, clonidine, bupropion

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8
Q

what is 1st line for ADHD diagnosis with predominant TOURETTES? if that fails?

A
  1. DA antagonist or a2 agonist
  2. add stim, atomoxetine, a2 agonist
  3. alternatives of 1
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9
Q

what is 1st line for ADHD diagnosis with predominant BPD/AGGRESSION? if that fails?

A
  1. atypical APS, lithium, anticonv
  2. add stim
  3. alt or add mood stabilizer
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10
Q

what is 1st line for ADHD diagnosis with predominant ANZIETY/DEPRESSION? if that fails?

A
  1. antidepressant
  2. add stim
  3. alt antidepressant
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11
Q

which is more potent? MPH or AMP?

A

AMP more potent (smaller dose needed if switch from MPH)

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12
Q

benefits of IR stimulants

A

low cost, less insomnia, less growth AEs

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13
Q

psychiatric AEs of stimulants include

A

psychosis, aggression, severe anxiety

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14
Q

cardiac AEs of stimulants
which agent may be preferred

A

inc HR & BP
caution with CV conditions- MPH may be preferred

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15
Q

growth AEs of stimulants include

A

slow height inc, weight deficit
appetite suppression

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16
Q

how to manage reduced appetite/weight loss with stimulants

A

high cal meal when stim effect low
cyproheptadine at bedtime

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17
Q

how to manage stomachache with stimulants

A

take on full stomach, lower dose

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18
Q

how to manage insomnia with stimulants

A

dose earlier, lower last dose, add sedating QHS med (guan, clon, melatonin, cyprohep)

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19
Q

how to manage HA with stimulants

A

divide dose, give with food, analgesic

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20
Q

how to manage irritability with stimulants

A

assess comorbidities, reduce dose, add mood stabilizer/APS

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21
Q

how to manage euphoria, zombie-like, tics, HTN with stimulants

A

reduce dose, change med

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22
Q

how to manage hallucinations with stimulants

A

d/c stim, reassess diagnosis, mood stabilizer/APS

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23
Q

some DDI of MPH include

A

TCAs, antacids, PPI, H2RA

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24
Q

some DDI of AMP include

A

antacids, PPI, acidic agents, cyp2D6

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25
Q

DDI for both AMP and MPH

A

MAOI, psychostimulants, alcohol

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26
Q

MPH is only FDA APPROVED for those how old? can it be used in younger anyways?

A

6 and up
ok to use in 3 and up anyways

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27
Q

which stimulant is preferred in children

A

MPH

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28
Q

which stimulant has less DDIs

A

MPH

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29
Q

do males or females have increased bioavailability of MPH

A

males

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30
Q

which MPH products are 30IR/70ER (3)?

A

ER, ER chewable, CD

(Metadate ER, Quillichew, Metadate CD)

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31
Q

which MPH products are 50IR/50ER (2)?

A

Long acting (LA), dex-MPH XR

(Ritalin LA, Focalin XR)

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32
Q

which MPH product is best for severe AM symptoms

A

MPH LA (Ritalin LA)

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33
Q

MPH XR suspension (quillivant XR) requires

A

vigorous shaking, reconstitution

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34
Q

MPH product with less symptom rebound and is hard to abuse

A

OROS (Concerta, Relexxii)

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35
Q

which MPH product is best for rebound afternoon symptoms

A

ER multilayer bead (MLR)
(Aptensio XR)

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36
Q

MPH ER capsule (Jornay PM) must be administered

A

between 6:30 and 9:30 pm

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37
Q

which MPH have no easy 1:1 dosing conversion

A

XR ODT (Contempla)
ER capsule (Jornay PM)

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38
Q

MPH patch (Daytrana) can be applied where? how long?

A

hip only for 9 hours

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39
Q

MPH and d-AMP patches should be removed at least __ hrs before bed

A

3

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40
Q

which stimulant patch retains >50% drug after removal, which should be kept in mind for disposal

A

MPH (daytrana)

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41
Q

which AE is more common in the MPH transderm patch

A

tics

42
Q

MPH patch (daytrana) BBW

A

skin reactions

43
Q

dex-MPH is how much of a dose of MPH?

A

1/2 the MPH dose

44
Q

which MPH agent has a risk for suicidal ideation

A

dex-MPH/Ser-Dex-MPH (Aztarys)

45
Q

which 3 AMP products are approved in 3 and up

A

mixed AMP IR salts (adderall)
AMP sulfate IR (Evekeo)
d-AMP IR (Dexedrine, zenzedi)

46
Q

which AMP product is approved only in 13 and older

A

AMP sulfate XR (mydayis)

47
Q

which AMP product is 50IR/50ER

A

mixed amp XR salts (adderall XR)

48
Q

which 4 AMP products do not have 1:1 dose conversion

A

amp sulfate XR soln (dyanavel XR)
amp sulfate XR ODT, ER suspension (Adzenys XR-ODT,ER)
amp sulfate XR (mydayis)

49
Q

AE of amp sulf xr solution (dyanavel xr)

A

epistaxis, upper abd pain, allergic rhinitis

50
Q

which amp product has low abuse potential

A

lisdexamfetamine (vyvanse)

51
Q

where can d-AMP patch be applied and for how long

A

hip, upper arm, chest, upper back, flank
9 hours

52
Q

2 NE reuptake inhibitors used for ADHD

A

atomoxetine (strattera)
viloxazine ER (qelbree)

53
Q

AE of NE reuptake inhibitors (atomoxetine, viloxazine)

A

upset stomach, psych, CV, fatigue, sedation, dizziness

54
Q

BBW for NE reuptake inhibitors (atomoxetine, viloxazine)

A

new onset suicidality

55
Q

2 potential effects of atomoxetine

A

initial worsening of behavior
potential for liver tox w/ long term use

56
Q

what may require dose adjustment for viloxazine

A

renal dysfunction

57
Q

effect of NE reuptake inhibitors (atomoxetine, viloxazine) is seen in

A

~6 weeks

58
Q

alpha agonists used for adhd

A

clonidine ER
guanfacine ER

59
Q

adhd alpha agonists take how long to work

A

1-2 months

60
Q

AE of clonidine and guanfacine

A

hypotension, heart block, sedation, dizzy, constipation

61
Q

bupropion is good for adhd with concomitant __?
should be tried for?

A

depression
try 6 weeks

62
Q

major AE/CI of bupropion

A

seizures

63
Q

3 TCAs used for adhd?
how long of trial to work?

A

desipramine, imipramine, nortriptyline
4 weeks

64
Q

AEs of TCAs

A

heart block, dizzy, constipation, overdose toc, rapid heartbeat, weight gain

65
Q

which APS can be used for adhd w/ concomitant bpd/conduct disorder

A

chlorpromazine, haloperidol, risperidone, olanzapine, quetiapine, ziprasidone, aripiprazole

66
Q

TCAs used for neuro pain (4)

A

nortriptyline, desipramine, amitriptyline, imipramine

67
Q

important counseling point when initiating neuro pain treatment

A

onset of action may be days to weeks

68
Q

advantages of TCAs for neuro pain

A

lots of data
concomitant insomnia or depression

69
Q

disadvantages of TCAs for neuro pain

A

anticholinergic, cardiotoxic
avoid in elderly

70
Q

3 SNRIs used for neuro pain

A

duloxetine, venlafaxine, milnacipran

71
Q

advantages of duloxetine and venlafaxine for neuro pain

A

good AE profile
good for concomitant depression

72
Q

disadvantages of duloxetine and venlafaxine for neuro pain

A

serotonin syndrome

73
Q

duloxetine CI for use in

A

hepatic impairment and ESRD

74
Q

advantages of milnacipran for neuro pain

A

well tolerated
improves fatigue

75
Q

disadvantages of milnacipran for neuro pain

A

HTN AE

76
Q

2 gabapentinoids use for neuro pain

A

gabapentin pregabalin

77
Q

advantages of gabapentin for neuro pain

A

low DDI and AE incidence

78
Q

disadvantages of gabapentin for neuro pain?
what requires special dosing?

A

CNS depression, renal dysfunction dosing

79
Q

advantages of pregabalin for neuro pain

A

low AE and DDI incidence, good for concomitant anxiety

80
Q

disadvantages of pregabalin for neuro pain

A

CV (euphoria, dependency), CNS depression, renal insufficiency

81
Q

2 opiate options used for neuro pain

A

tramadol, tapentadol

82
Q

DDIs with tramadol

A

carbamazepine, quinidine, TCAs, SSRIs

83
Q

AEs of tramadol

A

dizzy, GI, constipation, abuse potential, seizure risk

84
Q

advantages and disadvantages of tapentadol for neuro pain

A

+ no active metabolites
- CII, weak anticholinergic

85
Q

2 topical options for neuro pain

A

capsaicin, lidocaine

86
Q

counseling for capsaicin

A

GLOVES OR WASH HANDS
DONT GET IT INTO A BAD PLACE ITLL BURN

87
Q

RX 8% Qutenza (capsaicin) is used how often? pretreat?

A

pretreat w/ local anesthetic used Q3M

88
Q

lidocaine works for neuro pain in

A

5-10 mins

89
Q

what 4 classes are 1st line for neuro pain

A

TCA, SNRI, gabapentinoids, topicals

90
Q

2nd line options for neuro pain

A

tramadol or combo 1st line

91
Q

4 major types of neuropathic pain

A

painful diabetic neuropathy
post-herpetic neuralgia
low back pain
fibromyalgia

92
Q

preferred treatment options for PDN (5)

A

TCA, SNRI, gabapentinoids, Na channel blocker, topicals

93
Q

do not use what for PDN

A

opioids, tramadol, tapentadol

94
Q

what is preferred for post-herp neuralgia treatment (5)

A

TCA, antiepileptics, tramadol, lidocaine, capsaicin

95
Q

topicals should only be used for neuro pain if the pain is

A

focal

96
Q

agents for acute low back pain (2)

A

NSAIDs, skeletal muscle relaxants

97
Q

agents for chronic low back pain

A

1st- NSAIDs
2nd- tramadol, duloxetine

98
Q

3 agents for severe pain in fibromyalgia

A

duloxetine, pregabalin, tramadol

99
Q

3 agents for sleep problems with fibromyalgia

A

low dose amitriptyline, pregabalin, cyclobenzaprine

100
Q

what should not be used to treat neuro pain

A

opioids

Therapeutics (29 decks)

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