ADHD Pharm Flashcards
ADHD etiology
- diff’s in neuro-pathways in frontal/prefrontal cortex
- NTs- DA, NE
- polymorphisms in DATs
Stimulants- drugs
(amphetamine derivatives)
- amphetamine
- dextroamphetamine
- lisdexamfetamine (pro-drug
- methylphenidate, dexmethylphenidate
Non-stimulants- drugs
- Atomoxetine
- Clonidine
- Guanfacine
Stimulants- moa
enhance Nt transmission- non-catecholamine sympathomimetics
- block presynaptic reuptake
- interfere w VMAT
- inc in NT release (NE, then DA, then 5-HT each at inc doses)
Stimulants- other moa
- D-isomers- more CNS activity
- Methylphenidate- inhibition of DA reuptake and inhibition of NT pre-synaptic reuptake (doesnt stim release of NTs)
Amphetamine- meds
- Adzenys XR-ODT
- Dyanavel XR (oral suspension)
Adzenys
(XR-ODT) (d,l-amphetamine)
-50% IR, 50% XR
Dyanavel
(XR liquid) (d,l-amphetamine)
-% XR, % IR- not provided
Dextroamphetamine- meds
- Dexedrine (IR and XR)
- ProCentra (IR oral)
Dexedrine Spansules
(dextroamphetamine)
- % IR, % XR not provided
- can sprinkle spansule-contents on food
Lisdexamfetamine- meds
(pro-drug of dextroamphetamine)
-Vyvanse
Vyvanse
(lisdexamfetamine- pro-drug of dextroamphetamine)
-capsules
Mixed amphetamine salts
-Adderall (IR), Adderall XR
Adderall XR
(d,l-amphetamine/dextroamphetamine- mixed!!!)
- 50% IR and 50% XR
- beads
Methylphenidate- meds
- Concerta
- Ritalin LA
- Metadate CD
- Aptensio XR
- Daytrana (patch!!)
- Quillivant XR (oral suspension!!)
- Quillichew ER (chewable table!!)
- Focalin XR
Concerta
(d,l-methylphenidate)
-22% IR, 78% ER
Ritalin LA
(d,l-methylphenidate)
- 50% IR, 50% LA
- beads
Metadate CD
(d,l-methylphenidate)
- 30% IR, 70% CD
- capsule
Aptensio XR
(d,l-methylphenidate)
- 40% IR, 60% XR
- capsule
Daytrana
(d,l-methylphenidate)
-patch!!!!
QuilliChew ER
(d-methylphenidate)
- 30% IR, 70% XR
- chewable tablet
Quillivant XR
(d-methylphenidate)
- 20% IR, 80% XR
- XR oral suspension
Focalin XR
(dexmethylphenidate)
- 50% IR, 50% XR
- beads
Dexmethylphenidate- meds
-Focalin (IR), Focalin XR
stimulants- onset?
- onset usually 24 hrs
- controlled substances (1 month supply only, no refills, no samples)
SE’s
- dyspepsia/ GI distress
- HA
- dec appetite
- insomnia
- anxiety/jitterness
- irritability/aggression/agitation- motor/vocal tics!
- elevated BP/HR
- sudden cardiac death!!!- always assess for cardiac structural abnormalities!!!!!!
- stroke and MI!!!
Non-stimulants- drugs
- atomoxetine
- clonidine
- guanfacine
Non-stimulants- moa
- inhibition of NE pre-synaptic reuptake- Atomoxetine
- agonists of CNS alpha2A adrengeric R’s- guanfacine, clonidine
Non-stimulants- onset of activity
-1-4+ wks (Vs stimulants- 24 hrs)
Atomoxetine
- NET blocker
- capsules
Atomoxetine- SE’s
- no motor/vocal tics (vs stimulants)
- suicidal ideations!!!!!
- severe liver injury/jaundice!!!!
Guanfacine, Clonidine
- alpha2-agonists
* downward dose titration when discontinuing!!- risk of rebound HTN
Guanfacine, Clonidine- SE’s
- hypotension/bradycardia!!!
- cardiac conduction abnormalities
