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Behavioral Science > ADHD: Stimulants and Nonstimulants > Flashcards

ADHD: Stimulants and Nonstimulants Flashcards

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1
Q

Five stimulant ADHD medications. All are derivatives of what?

A

All derivatives of amphetamine.

  • Amphetamine, Dextroamphetamine
  • Lisdexamfetamine (pro-drug)
  • Methylphenidate and Dexmethylphenidate.
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2
Q

Three non-stimulant ADHD meds.

A

Atomoxetine, guanfacine, clonidine

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3
Q

Main effect of stimulant meds in treatment of ADHD.

How is methylphenidate different?

A

Uptake into cell via membranes, then interferes with vesicular monoamine transporter (VMAT), thereby
**increasing neurotransmitter release (NE/DA/5‐HT).

Methylphenidate’s - **inhibition of dopamine reuptake and doesn’t appear to stimulate release of neurotransmitters, as amphetamines

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4
Q

??(slide 7) Name the Immediate Release and XR stimulants.

A

Amphetamine salts (adderall)
Dextroamphetamine
Methamphetamine

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5
Q

___hrs for onset of stimulants.

What is special about prescription?

A

24

Controlled substances - 1mo supply, no refills, no samples

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6
Q

What is amphetamine/dextroamphetamine.

% of immediate release v. Delayed/ER.

What is the XR DoA?

A

Adderall - IR/XR

XR=50%IR and 50% XR beads. Sprinkle capsule onto food.

QD XR (8-12hrs duration) = BID IR

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7
Q

What amphetamine has a biphasic release?

DoA
Age

A

d/l - methylphenidate (concerta)

Phase1: 22%IR; Phase 2: 78% Delayed release

DoA 10-12 hrs
Age: >6 yo

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8
Q

> 3 years old v. >6 years old

A

> 3 years = amphetamine/dextroamphetamine (adderall), dextroamphetamine
6 years = lisdexamfetamine, d/l-methylphenidate (ritalin, metadate, aptensio, daytrana), dexmethylphenidate

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9
Q

d,l-methylphenidate (IR/LA)

DoA
% of immediate release v. Delayed/ER.

A

Ritalin:
8-10 hours DoA

LA=50% IR beads and 50% LA beads

Sprinkle in food (QD for LA or BID for IR)

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10
Q

Dosing, formulation, age for lisdexamfetamine (ro drug of dextroamphetamine)

A

contents into water, QD, for >6

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11
Q

d,l-methylphenidate (IR/CD)

DoA
% of immediate release v. Delayed/ER.

A

Metadate:
8-10 hrs DoA
CD=30% IR beads and 70% CD beads into food

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12
Q

d,l-methylphenidate (XR)

DoA
% of immediate release v. Delayed/ER.

A

Aptensio:
DoA:12hrs
XR=40% IR and 60% XR sprinkled onto food

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13
Q

d,l-methylphenidate (patch on HIP)

DoA
% of immediate release v. Delayed/ER.

A

Daytrana

DoA: onset w/i 2 hours for 12 hours of action

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14
Q

d-methylphenidate (what release?)

% of immediate release v. Delayed/ER.

A

Quillivant:
XR oral suspension, shkae well OR chew tablet

20% IR, 80% ER

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15
Q

dexmethylphenidate (what release?)

A

Focalin (IR/XR)

XR=50% IR beads and 50% XR beads sprinkled on food

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16
Q

Side effects of stimlants

A
  • Decreased appetite - Weight loss
  • Insomnia
  • HA/Abdominal pain
  • Irritability/Aggression - Tics and Psychoses
  • Cardiac - Elevated BP/HR (Stroke/MI in adults) or Sudden cardiac death (rare ,check for structural abnormalities)
17
Q

MOA of nonstimulants - atomoxetine

A

Inhibition of neurotransmitter pre‐synaptic reuptake (only
NE) (atomoxetine)
• Also has down‐stream impact on DA system due to overlap

18
Q

MOA of nonstimulants guanfacine/clonidine

A

 Activation of centrally‐located (CNS) alpha‐2 adrenergic receptors (guanfacine/clonidine)
• Post‐synaptic alpha‐2 inhibition in prefrontal areas

19
Q

Onset of non-stimulant activity. When is it useful? Scheduled?

A
  • Onset of activity 2‐4+ weeks
  • Used when intolerant of stimulant effects or parents resistant to stimulant class
  • Non‐scheduled, refills & samples possible
20
Q

Atomoxetine, Guanfacine, Clonidine:
DoA
Admin
Age

A

18-24 hrs

Not sprinkled or in water. Not broken up.

> 6 years old

21
Q

Dosing of clonidine

A

QD.

22
Q

Side effects of non-stimulants

A

-Decreased appetite - Weight loss
-Insomnia (atomoxetine)
Sedation/Somnolence (guanfacine/clonidine)
Headache/Abdominal pain
Dizziness
Suicidal ideation (rare; atomoxetine)
Liver injury (rare; atomoxetine)
Hypotension (guanfacine/clonidine)

23
Q

What non-stimulant has insomnia, suicidal ideation or liver injury (rare) as a side effect?

A

atomoxetine

24
Q

What non-stimulants have sedation/somnolence, hypotension as a side effect?

A

guanfacine/clonidine

Behavioral Science (16 decks)

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