ADHD pharmacological treatment (short ppt) Flashcards
What are the criteria for inattention in ADHD?
At least 6 of the below symptoms must occur often:
- Careless
- Difficulty sustaining attention in activity
- Doesn’t listen
- No follow through
- Avoids/dislikes tasks requiring sustained mental effort
- Can’t organize
- Loses important items
- Easily distractible
- Forgetful in daily activities
What are the hyperactive/impulsive criteria for ADHD?
At least 6 of the below symptoms must occur often:
- Squirms and fidgets
- Can’t stay seated
- Runs/climbs excessively
- Can’t play/work quietly
- On the go, “driven by a motor”
- Talks excessively
- Blurts out answers
- Can’t wait for turn
- Intrudes/interrupts others
What are the 3 main subtypes of ADHD?
- Primarily Inattentive subtype
- Primarily Hyperactive subtype
- Combined subtype
Describe the neurobiological basis for ADHD.
Dysregulation of dopamine (DA) or norepinephrine (NE) neurotransmission, especially in the central nervous system, leads to ADHD
What is the evidence for the catecholamine hypothesis as the neurobiological basis for ADHD (3)?
- Most genes linked to ADHD are related to catecholaminergic activity
- Neuroimaging studies report differences in CNS regions involved in DA & NE activity in ADHD:
- Structural: reduced volumes in fronto-cortical regions;
- Functional: under- or inefficient anterior activity (e.g.prefontal cortex, globus pallidus, striatum)
- Animal models: ablating various regions related to DA or NE function leads to “ADHD” behaviors
What are the 3 major classes of medications used in ADHD?
1) Stimulants => 1st line therapy
- Including methylphenidate, amphetamine
- The only class of medications approved for treatment of ADHD by the FDA
2) Antidepressants (off label use)
- No FDA-approved indication including tricyclics and other classes (bupropion)
3) Alpha 2-adrenergic agonists (antihypertensives)
- Including clonidine and guanfacine
What symptoms of ADHD do stimulants most effectively treat?
Improvements are observed in the core symptoms of inattention, hyperactivity, and impulsivity, which improves compliance, social interaction, academic efficiency, and accuracy
*Overall response rate 75%
What is the half life of Ritalin/ Methylphenidate (and other amphetamines)?
Ritalin has a relatively short half-life and is cleared from the body in about 3.5 to 4 hours, requiring multiple daily doses
What is Focalin and what is its primary advantage?
Focalin is a new short-acting methylphenidate formulation that uses the active isomer of methylphenidate, allowing for all the efficacy at half the dose
What is the mechanism/benefit of long acting Ritalin?
Ritalin LA utilizes SODAS™ technology to deliver methylphenidate in a bimodal release pattern.
- Beaded capsules contain 50% immediate release beads and 50% polymer coated beads, which permits a second release of methylphenidate approximately 4 hours after administration which allows for efficacy over a school day
What is Adderall?
Adderall XR™ is a once-daily extended-release formulation of mixed amphetamine salts (methylphenidate- stimulant)
- Adderall => 4-5 hrs (half life)
- Adderall XR=> 10-12 hrs (half life)
How is metadate CD released?
Metadate® CD uses a biphasic-release profile that delivers an initial rapid release of methylphenidate followed by a second continuous-release phase
What is the longest acting methylphenidate?
Concerta
How is Concerta released?
Concerta® uses osmotic pressure to deliver methylphenidate at a constantly increasing rate so that the appropriate dosage is administered over the entire day, allowing once-daily dosing.
- A single dose lasts 12 hours — equivalent to 3 doses of the conventional MPH
What is the shortest acting amphetamine?
Dexedrine is the shortest acting d-amphetamine, 4-5 hr duration
- Dexedrine span => Extended-release capsule form of d-AMPH (6-8 hrs)
