ADHD: Stimulants and Nonstimulants Flashcards
Five stimulant ADHD medications. All are derivatives of what?
All derivatives of amphetamine.
- Amphetamine, Dextroamphetamine
- Lisdexamfetamine (pro-drug)
- Methylphenidate and Dexmethylphenidate.
Three non-stimulant ADHD meds.
Atomoxetine, guanfacine, clonidine
Main effect of stimulant meds in treatment of ADHD.
How is methylphenidate different?
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
??(slide 7) Name the Immediate Release and XR stimulants.
Amphetamine salts (adderall)
Dextroamphetamine
Methamphetamine
___hrs for onset of stimulants.
What is special about prescription?
24
Controlled substances - 1mo supply, no refills, no samples
What is amphetamine/dextroamphetamine.
% of immediate release v. Delayed/ER.
What is the XR DoA?
Adderall - IR/XR
XR=50%IR and 50% XR beads. Sprinkle capsule onto food.
QD XR (8-12hrs duration) = BID IR
What amphetamine has a biphasic release?
DoA
Age
d/l - methylphenidate (concerta)
Phase1: 22%IR; Phase 2: 78% Delayed release
DoA 10-12 hrs
Age: >6 yo
> 3 years old v. >6 years old
> 3 years = amphetamine/dextroamphetamine (adderall), dextroamphetamine
6 years = lisdexamfetamine, d/l-methylphenidate (ritalin, metadate, aptensio, daytrana), dexmethylphenidate
d,l-methylphenidate (IR/LA)
DoA
% of immediate release v. Delayed/ER.
Ritalin:
8-10 hours DoA
LA=50% IR beads and 50% LA beads
Sprinkle in food (QD for LA or BID for IR)
Dosing, formulation, age for lisdexamfetamine (ro drug of dextroamphetamine)
contents into water, QD, for >6
d,l-methylphenidate (IR/CD)
DoA
% of immediate release v. Delayed/ER.
Metadate:
8-10 hrs DoA
CD=30% IR beads and 70% CD beads into food
d,l-methylphenidate (XR)
DoA
% of immediate release v. Delayed/ER.
Aptensio:
DoA:12hrs
XR=40% IR and 60% XR sprinkled onto food
d,l-methylphenidate (patch on HIP)
DoA
% of immediate release v. Delayed/ER.
Daytrana
DoA: onset w/i 2 hours for 12 hours of action
d-methylphenidate (what release?)
% of immediate release v. Delayed/ER.
Quillivant:
XR oral suspension, shkae well OR chew tablet
20% IR, 80% ER
dexmethylphenidate (what release?)
Focalin (IR/XR)
XR=50% IR beads and 50% XR beads sprinkled on food
Side effects of stimlants
- 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)
MOA of nonstimulants - atomoxetine
Inhibition of neurotransmitter pre‐synaptic reuptake (only
NE) (atomoxetine)
• Also has down‐stream impact on DA system due to overlap
MOA of nonstimulants guanfacine/clonidine
Activation of centrally‐located (CNS) alpha‐2 adrenergic receptors (guanfacine/clonidine)
• Post‐synaptic alpha‐2 inhibition in prefrontal areas
Onset of non-stimulant activity. When is it useful? Scheduled?
- Onset of activity 2‐4+ weeks
- Used when intolerant of stimulant effects or parents resistant to stimulant class
- Non‐scheduled, refills & samples possible
Atomoxetine, Guanfacine, Clonidine:
DoA
Admin
Age
18-24 hrs
Not sprinkled or in water. Not broken up.
> 6 years old
Dosing of clonidine
QD.
Side effects of non-stimulants
-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)
What non-stimulant has insomnia, suicidal ideation or liver injury (rare) as a side effect?
atomoxetine
What non-stimulants have sedation/somnolence, hypotension as a side effect?
guanfacine/clonidine
