CNS ADD

Question 1

why is MR prep preferred

Answer 1

Because of their..
pharmacokinetic profile
convenience
improved adherence

PRESCRIBE AS BRAND ONLY

Question 2

ADHD

> /= 5years, 1st and 2nd line treatment?

Answer 2

1) Methylphenidate

2) If 6 week trial of methylphenidate at max. tolerated dose NOT reduce symptoms? switch to Lisdexamfetamine (Dexamfetamine, unlicensed, used if patients cannot tolerate longer duration of action of Lisdexamfetamine)

Question 3

ADHD

Children intolerant of both methylphenidate & lisdexamfetamine?

Answer 3

Atomoxetine or
Guanfacine (unlicensed)

Question 4

ADHD- ADULT TREATMENT

1st LINE?

2nd LINE?

Answer 4

1st LINE?
methylphenidate/lisdexamfetamine (dexamfetamine if patient can’t tolerate long duration of action)

2nd LINE?
Atomoxetine (causes QT prolongation, hepatotoxicity & suicidal ideation)

Question 5

METHYLPHENIDATE is a centrally acting sympathomimetic, CNS stimulant

SIDE-EFFECTS?

Answer 5

Hypertension/Tachycardia/Arrythmias
Mood change/Drowsiness/Sleep disorders
Decreased appetite/Weight loss
Growth retardation (children)

Question 6

METHYLPHENIDATE

MONITOR? BPPAWH

Answer 6

At initiation/after dose adjustments/6 monthly

Pulse
BP
Psychiatric symptoms
Appetite
Weight
Height

Question 7

LISDEXAMFETAMINE & DEXAMFETAMINE
similar effects to methylphenidate

OVERDOSE signs?

Answer 7

Amfetamines cause: wakefulnness/excessive activity/paranoia/hallucinations/hypertension

Followed by: exhaustion/convulsions/hyperthermia/coma

(up then down)

Question 8

LISDEXAMFETAMINE & DEXAMFETAMINE

OVERDOSE TREATMENT?

Answer 8

diazepam/lorazepam

Question 9

ADHD non drug tx?

Answer 9

specific to the person’s circumstances, and may involve changes to seating arrangements, lighting and noise, reducing distractions, optimising work or education by having shorter periods of focus with movement breaks, and reinforcing verbal requests with written instructions

Question 10

ADHD psychological interventions

Answer 10

cognitive behavioural therapy (CBT) may be effective in patients who have refused drug treatment, have difficulty with adherence, are intolerant of, or unresponsive to drug treatment. In patients who have benefited from drug treatment, but whose symptoms are still causing significant impairment in at least one area of function (such as interpersonal relationships, education and occupational attainment, and risk awareness), consider a combination of non-drug treatment with drug treatment.