ADHD pharmacology

Question 1

Boxed Warning Stimulants

Answer 1

Rx sudden cardiac death, not well proven

Question 2

Methylphenidate

Answer 2

Stimulant

1) MOA: block NE & Dopamine reuptake
- possible effects on serotonergic dopamine receptors
2) once daily patch option
3) ER better to evade tolerance issues

NOT approves in ages < 6 yrs

FIRST LINE FOR CHILDREN

Question 3

Bupropion

Answer 3

1) antidepressant

2) off label ADHD

Question 4

Stimutlants

Answer 4

FIRST LINE TREATMENT ADHD, 90% response rate

Question 5

Clonidine ER

Answer 5

Non-stimulant

1) MOA: alpha 2 receptor agonist, blocks NE release AND increased blood flow to prefrontal cortex
2) useful in pt. with ADHD AND aggressive behavior
3) AE: somnolence, bradycardia, sedative, dry mouth
4) 1-2 WEEK ONSET FOR EFFICACY

Question 6

Dexamethylphenidate

Answer 6

Stimulant

1) D-entaniomer methylphenidine 
DOUBLE potency 
2) MOA: Strong block dopamine NE reuptake 
3) capsule form* easy to hide 
4) not studied ages < 6 yrs

Question 7

Lisdexamphetamine

Answer 7

Stimulant

1) MOA: block NE & dopamine reuptake
2) NOT active until first pass metabolism through liver
- PRODRUG dextroamphetamine

Question 8

Nortriptyline

Answer 8

1) TCA

2) off label ADHD

Question 9

Amitryptyline

Answer 9

1) TCA

2) off label use ADHD

Question 10

Guanfacine ER

Answer 10

non-stimulant

1) MOA: central Alpha 2a receptor agonist
- more selective for receptor subtype than clonidine
2) less effect on BP
3) SE: somnolence, bradycardia, HOTN, sedative effect*

Question 11

compiramine

Answer 11

1) SNRI

2) off label ADHD

Question 12

Amoxetine

Answer 12

Non-stimulant

1) MOA: inhibit reuptake NE
2) PGx dosing (more accurate than wt.)
3) AE: somnolence, GI upset
4) no known abuse potential
5) 2-4 WEEKS FOR EFFECTS TO KICK IN*
6) BW
- increased rx suicide ideation
- liver damage-d/c if jaundice
7) CAUTION: Cv disease, cardiac abnormalities, HTN, tachycardia

Question 13

Dextroamphetamine

Answer 13

Stimulant

1) MOA: greater affinity for dopamine receptor > NE receptor
- more potent form amphetamine
2) ER NOT for children ages < 6 years
3) IR for children 3-5 years

Question 14

SE/Caustions stimulants

Answer 14

1) increased BP and HR
2) psychosis?
3) growth retardation?
4) dysphoria
5) HA
6) abdominal pain
7)abuse concern
IR/short acting> ER/long acting

Question 15

Viloxazine

Answer 15

Non-stimulant

1) MOA: NE reuptake inhibitor and 5HT2 receptor effects
2) AE: somnolence, decreased appetite, N/V, insomnia, irritability
3) CYPIA2 inhibitor
-weak 2D6/3A4 inhibition
DRUG INTERACTIONS
4)BW*: Suicide Ideation risk
5) Monitor BP, HR

Question 16

Amphetamine/Dextroamphetamine

Answer 16

Stimulant

1) MOA: directly increase dopamine release into synapse
2) Peak necessary for effectiveness
3) IR ages 3-5
4) ER NOT for children ages < 6 yrs

Question 17

Modafinil

Answer 17

1) stimulant tx for narcolepsy

2) off label ADHD

Question 18

Transcyclopromine

Answer 18

1) MOAI

2) off label ADHD

Question 19

Benzedrine

Answer 19

First release as decongestant

• cotntained racemic amphetamine
• popularly used recreational

Question 20

Amphetamine salt

Answer 20

Preferred in adults

Question 21

Reccomentations 4-5 years

Answer 21

1) should rx behavioral therapy

2) can rx methylphenidate

Question 22

6-11 years

Answer 22

1) Should rx FDA approved Meds

2) and behavioral therapy

Question 23

12-18 yrs

Answer 23

1) should rx fda approved meds

2) encouraged to provide behavioral therapy