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ADHDFC Flashcards

1
Q

methylphenidate IR

A

Ritalin, Methylin chewable, oral susp

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2
Q

methylphenidate long-acting

A

Ritalin LA

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3
Q

methylphenidate sustained release

A

Ritalin SR

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4
Q

mehtylphenidate ext-release

A

Methylin ER, Metadate ER, Quillivant XR-ext rel oral susp

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5
Q

methylphenidate IR-ext rel OROS system

A

Concerta

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6
Q

methylphenidate IR-ext rel (beads that dissolve at different rates)

A

Metadate CD

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7
Q

methylphenidate transdermal patch

A

Daytrana

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8
Q

dexmethylphenidate IR

A

Focalin

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9
Q

dexmethylphenidate ER

A

Focalin XR

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10
Q

dextroamphetamine and amphetamine IR

A

Adderall

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11
Q

dextroamphetamine and amphetamine ER

A

Adderall XR

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12
Q

dextroamphetamine IR

A

Dexedrine, Dextrostat

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13
Q

dextroamphetamine SR and IR

A

Dexedrine Spansules, ProCentra

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14
Q

lisdexamfetamine

A

Vyvanse

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15
Q

atomoxetine (not controlled)

A

Strattera (not controlled)

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16
Q

guanfacine ext-rel (not controlled)

A

Intuniv (not controlled)

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17
Q

clonidine ext-rel (not controlled)

A

Kapvay (not controlled)

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18
Q

modafinil (C4)

A

Provigil (C4)

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19
Q

armodafanil (C4)

A

Nuvigil (C4)

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20
Q

methylphenidate IR

A

Ritalin, Methylin chewable, oral susp

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21
Q

methylphenidate long-acting and dosing

A

Ritalin LA (1/2 IR, 1/2 SR in one capsule)
10-40mg LA caps

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22
Q

methylphenidate sustained-release tab dose

A

Ritalin SR 20mg SR tab

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23
Q

methylphenidate extended-release

A

Methylin ER, Metadate ER, Quillivant XR is oral susp
10-20mg ER tabs

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24
Q

methylphenidate IR/XR dosing

A

Concerta
OROS system
18,27,36,54 mg ER tabs

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25
Q

advantage of Concerta OROS system

A

somewhat harder to abuse because harder to crush/chew

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26
Q

methylphenidate IR/XR beads dosing

A

Metadate CD
10-60 mg ER caps
beads dissolve at different rates

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27
Q

methylphenidate transdermal patch dosing

A

Daytrana
1.1mg/hr (10mg/9hr) - 3.3mg/hr (30mg/9hr)

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28
Q

dexmethylphenidate IR dosing dosing

A

Focalin 2.5-10mg tabs, BID 4+ hrs apart, w/ or w/out food

29
Q

dexmethylphenidate ER dosing

A

Focalin XR
5-20mg caps QAM

30
Q

dextroamphetamine and amphetamine IR dosing

A

Adderall
5-30mg scored tabs QAM or BID without regard to meals. 1st dose at awakening, additional dose 4-6hrs later

31
Q

dextroamphetamine and amphetamine ER

A

Adderall XR
5-30mg ER caps QAM w/ or w/out food

32
Q

dextroamphetamine IR dosing

A

Dexedrine, Dextrostat
5-10mg tabs QAM or BID w/ or w/out food

33
Q

dextroamphetamine IR and SR

A

Dexedrine Spansules, ProCentra
5,10,15mg SR caps
QAM w/ or w/out food

34
Q

lisdexamfetamine dosing

A

Vyvanse
30,50,70mg caps QAM w/ or w/out food

35
Q

atomoxetine dosing

A

Strattera
40-80mg caps, occasionally up to 100mg daily or can divide BID

36
Q

guanfacine extended release dosing

A

Intuniv
1-4mg tabs daily. Start at 1mg

37
Q

clonidine extended release dosing

A

Kapvay
0.1-0.2mg tabs. Start at 0.1mg HS, titrate weekly, using BID dosing

38
Q

modafinil dosing

A

Provigil 200mg daily

39
Q

armodafinil dosing

A

Nuvigil 150-250mg daily

40
Q

Moa aromodafinil dosing

A

R isomer of modafinil

41
Q

BBW warnings for stimulants:

A
  1. heart-related problems: increased BP and HR, stroke and heart attack in adults, sudden death in those who have existing heart problems/defects
  2. psychiatric problems: new or worse behavior and thought problems, bipolar illness, aggressive behavior or hostility
  3. Children and teens: new psychotic symptoms (hearing voices, believing this that are not real, suspicious)
42
Q

Stimulants possible MoA

A

inhibit norepi and dopamine reuptake

43
Q

Contraindications to stimulants use

A

glaucoma, history of tics, current MAOI use

44
Q

Monitoring for stimulants

A

BP & HR (at least monthly), height/weight of children, symptom improvement, mood changes/worsening

45
Q

Side effects of stimulants: GI, Eye, CV, Mood, etc

A
  1. nausea, loss of appetite (lose wt, anorexia), insomnia, dizzy, HA, lightheaded (if child faints, SOB, chest pain - call doctor), irritable, blurry vision, difficulty with visual accomodation
  2. Increase BP 2-4 mmHg, HR 3-8 bpm - monitor, caution in CV disease
  3. Worsening of mixed/mania episodes if bipolar disorder
  4. Withdrawal symptoms (hyper): must titrate UP and DOWN
  5. Risk of seizures - caution in seizure history
46
Q

What is unique about lisdexamfetamine?

A

Prodrug. Needs first pass metabolism to dextroamphetamine. Thus, may have decreased risk of abuse because cannot be injected or snorted

47
Q

If Vyvanse caps are too big to swallow, what can be done?

A

Mix contents with some water, drink immediately (or else the coating with dissolve)

48
Q

Should stimulants be taken with food?

A

W/ or w/out food. Although, advise eating good bfast since stimulants can cause loss of appetite

49
Q

If a child on stimulant has trouble sleeping, what can be done?

A
  1. Stop the evening dose
  2. Give a long acting once daily formulation instead
  3. diphenhydramine
  4. sedating antidepressant
  5. clonidine
50
Q

Counseling for Daytrana patch

A
  1. Apply new patch to hip area in AM 2hrs before desired effect
  2. Avoid waistline on pants so it doesn’t rub off.
  3. Replace each AM.
  4. Alternate L and R hip.
  5. Hold patch on skin for 30sec and smooth down edges
  6. If applied correctly, it will stay on during bathing/swimming.
  7. When peeling off to discard, fold in half, throw in lidded trash can.
51
Q

Strattera BBW

A

atomoxetine:
1. Risk of suicidal ideation in children
2. Monitor for possible liver injury, CV problems
3. MAOI use within 14days, narrow-angle glaucoma, Hx of pheochromocytoma, Hx of CV disorders where condition would deteriorate with BP or HR increases

52
Q

Strattera contraindications

A

glaucoma, pheochromocytoma, MAOI use within 14 days

53
Q

Strattera SEs

A

stomach upset, nausea, loss of appetite, trouble sleeping (same as stimulants)
fatigue (Main) , dry mouth, dizzy, menstrual cycle changes, mood changes, decrease libido, erectile dysfunction, orthostasis
rare: liver damage, priapism

54
Q

If Strattera capsules cannot be swallowed, what can be done?

A

DO NOT open capsules - product is an ocular irritant. Must swallow capsules whole. If opened, wash hands immediately and do not touch eyes.

55
Q

Does Strattera require tapering UP or DOWN?

A

No, ok to d/c abruptly.

56
Q

Take Strattera w/ or w/out food?

A

Does not matter

57
Q

Strattera DDIs

A
  1. Decrease dose if on strong 2D6 inhibitors (eg Paxil, fluoxetine, quinidine) or if pt is known 2D6 poor metabolizer
  2. 14day wash out period after MAOI use
58
Q

What is the indication for generic guanfacine? Brand name?

A

hypertension; Tenex

59
Q

Strattera MoA

A

selective NE reuptake inhibitor

60
Q

Intuniv SEs

A

guanfacine:
overall well-tolerated
somnolence, hypoTN, bradycardia, HA, fatigue, upper GI pain, nausea, increase lethargy, fainting

61
Q

Intuniv DDI

A

3A4 substrate; avoid use with 3A4 inducers/inhibitors

62
Q

Is Intuniv ok with food?

A

As long not taken with high-fat meal (will increase absorption)

63
Q

Kapvay SEs

A

clonidine extended-rel:
somnolence (higher incidence than Intuniv), bradycardia, dry mouth, fatigue, lethargy, depression, psychotic reactions, nasal stuffiness, impotence, exacerbate Parkinson’s,
(IMP) rebound HTN (with sweating, anxiety, tremors) if stopped abruptly - do not become dehydrated
XR formulation supposed to have less SEs

64
Q

MoA of Intuniv and Kapvay

A

central acting alpha2 adrenergic R agonists -> decrease sympathetic outflow from CNS -> decrease BP, HR, peripheral resistance
unknown MoA in ADHD

65
Q

Provigil and Nuvigil require MedGuide due to..

A

risk of severe rash incl SJS/TEN (this is why Provigil was denied for use in ADHD in children). Stop use if rash occurs.

66
Q

Provigil and Nuvigil SEs

A

HA, dizz, anxiety, agitation
nausea, diarrhea, insomnia, dry moth

67
Q

Which medications require MedGuide

A

Stimulants incl Provigil, Nuvigil, Strattera non-stimulant (all have BBW)

68
Q

Which do not need MedGuide

A

Intuniv, Kapvay - not controlled
(Stimulants CII, Provigil/Nuvigil are C IV)

69
Q

Natural Products used in ADHD

A

Fish oil omega-3 (“possibly effective”) at 6capsules daily with or without evening primrose oil omega-6.
Others: SAMe, St.John’s wort, ginkgo

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