ADHD Pharm

Question 1

ADHD etiology

Answer 1

• diff’s in neuro-pathways in frontal/prefrontal cortex
• NTs- DA, NE
• polymorphisms in DATs

Question 2

Stimulants- drugs

Answer 2

(amphetamine derivatives)

• amphetamine
• dextroamphetamine
• lisdexamfetamine (pro-drug
• methylphenidate, dexmethylphenidate

Question 3

Non-stimulants- drugs

Answer 3

• Atomoxetine
• Clonidine
• Guanfacine

Question 4

Stimulants- moa

Answer 4

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)

Question 5

Stimulants- other moa

Answer 5

• D-isomers- more CNS activity

- Methylphenidate- inhibition of DA reuptake and inhibition of NT pre-synaptic reuptake (doesnt stim release of NTs)

Question 6

Amphetamine- meds

Answer 6

• Adzenys XR-ODT

- Dyanavel XR (oral suspension)

Question 7

Adzenys

Answer 7

(XR-ODT) (d,l-amphetamine)

-50% IR, 50% XR

Question 8

Dyanavel

Answer 8

(XR liquid) (d,l-amphetamine)

-% XR, % IR- not provided

Question 9

Dextroamphetamine- meds

Answer 9

• Dexedrine (IR and XR)

- ProCentra (IR oral)

Question 10

Dexedrine Spansules

Answer 10

(dextroamphetamine)

• % IR, % XR not provided
• can sprinkle spansule-contents on food

Question 11

Lisdexamfetamine- meds

Answer 11

(pro-drug of dextroamphetamine)

-Vyvanse

Question 12

Vyvanse

Answer 12

(lisdexamfetamine- pro-drug of dextroamphetamine)

-capsules

Question 13

Mixed amphetamine salts

Answer 13

-Adderall (IR), Adderall XR

Question 14

Adderall XR

Answer 14

(d,l-amphetamine/dextroamphetamine- mixed!!!)

• 50% IR and 50% XR
• beads

Question 15

Methylphenidate- meds

Answer 15

• Concerta
• Ritalin LA
• Metadate CD
• Aptensio XR
• Daytrana (patch!!)
• Quillivant XR (oral suspension!!)
• Quillichew ER (chewable table!!)
• Focalin XR

Question 16

Concerta

Answer 16

(d,l-methylphenidate)

-22% IR, 78% ER

Question 17

Ritalin LA

Answer 17

(d,l-methylphenidate)

• 50% IR, 50% LA
• beads

Question 18

Metadate CD

Answer 18

(d,l-methylphenidate)

• 30% IR, 70% CD
• capsule

Question 19

Aptensio XR

Answer 19

(d,l-methylphenidate)

• 40% IR, 60% XR
• capsule

Question 20

Daytrana

Answer 20

(d,l-methylphenidate)

-patch!!!!

Question 21

QuilliChew ER

Answer 21

(d-methylphenidate)

• 30% IR, 70% XR
• chewable tablet

Question 22

Quillivant XR

Answer 22

(d-methylphenidate)

• 20% IR, 80% XR
• XR oral suspension

Question 23

Focalin XR

Answer 23

(dexmethylphenidate)

• 50% IR, 50% XR
• beads

Question 24

Dexmethylphenidate- meds

Answer 24

-Focalin (IR), Focalin XR

Question 25

stimulants- onset?

Answer 25

• onset usually 24 hrs

- controlled substances (1 month supply only, no refills, no samples)

Question 26

SE’s

Answer 26

• 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!!!

Question 27

Non-stimulants- drugs

Answer 27

• atomoxetine
• clonidine
• guanfacine

Question 28

Non-stimulants- moa

Answer 28

• inhibition of NE pre-synaptic reuptake- Atomoxetine

- agonists of CNS alpha2A adrengeric R’s- guanfacine, clonidine

Question 29

Non-stimulants- onset of activity

Answer 29

-1-4+ wks (Vs stimulants- 24 hrs)

Question 30

Atomoxetine

Answer 30

• NET blocker

- capsules

Question 31

Atomoxetine- SE’s

Answer 31

• no motor/vocal tics (vs stimulants)
• suicidal ideations!!!!!
• severe liver injury/jaundice!!!!

Question 32

Guanfacine, Clonidine

Answer 32

• alpha2-agonists

* downward dose titration when discontinuing!!- risk of rebound HTN

Question 33

Guanfacine, Clonidine- SE’s

Answer 33

• hypotension/bradycardia!!!

- cardiac conduction abnormalities