Attention deficit hyperactivity disorder

Question 1

First line treatment for ADHD?

Answer 1

Methyphenidate, can be given for over 5 years

Question 2

Second and third line treatments for ADHD ?

Answer 2

Lisdexamphetamine. Alternative would be atomoxetine, guanfacine

Question 3

Methylphenidate mechanism of action ?

Answer 3

increases dopamine and noradrenaline levels in the brain

Question 4

Methylphenidate side effects ?

Answer 4

appetite loss, insomnia, weight loss
increased HR and BP, tachycardia
Tic’s and Tourettes syndrome
Growth restriction in children

Question 5

Contraindications of methylphenidate ?

Answer 5

cardiovascular disease, hyperthyroidism, severe hypertension, uncontrolled bipolar disorder, severe depression

Question 6

How should methylphenidate be prescribed ?

Answer 6

MR preparations must be prescribed by brand

Question 7

What monitoring should be in place for methylphenidate ?

Answer 7

• pulse, BP, appetite, weight and height on starting, after dose change and every six months
• Monitor for psychiatric symptoms such as depression, psychosis and suicidal ideation

Question 8

How does dexamphetamine and lisdexamfetamine work ?

Answer 8

increases noradrenaline and dopamine levels in the brain

Question 9

What are the side effects of amphetamines ( dexamphetamine and lisdexamfetamine ) ?

Answer 9

• Appetite loss, anorexia
• increased HR and BP
• Tic’s and Tourettes syndrome
• Growth restriction in children

Question 10

What are the sings of overdose with dexamphetamine and lisdexamfetamine ?

Answer 10

Wakefulness, hyperactivity, paranoia, hallucinations and hypertension, followed by exhaustion, convulsions, hyperthermia and coma.

Question 11

Monitoring requirements for amphetamines ?

Answer 11

• Pulse, BP, appetite, weight and height on starting, after a dose change and every six months
• Psychiatric symptoms such as aggressive behaviour and hostility, depression, psychosis

Question 12

Amfetamines contraindications ?

Answer 12

Cardiovascular disease, hyperthyroidism, moderate/severe hypertension, agitated states

Question 13

Atomoxetine: MOA ?

Answer 13

noradrenaline reuptake inhibitor causes increased levels of noradrenaline at synaptic cleft

Question 14

What are the side effects of atomoxetine ?

Answer 14

Suicidal ideation
hepatoxicity
QT prolongation

Question 15

What should be monitored when patient is taking atomoxetine ?

Answer 15

pulse, BP, psychiatric symptoms, appetite, weight and height at the start of treatment and every six months or following dose change