CNS- ADHD

Question 1

psychostimulants for adhd include

Answer 1

Dextroamphetamine & amphetamine- Adderall
Methylphenidate-Ritalin
Methampthetamine- Desoxyn
Dextroamphetamine -Dexedrine
Dexmethylphenidate -Focalin
lisdexamphetamine (newest) -Vyvanse

Question 2

MOA psychostimulants

Answer 2

dopamine reuptake inhibition

-work through slightly different mechanisms

Question 3

average age of diagnosis of ADHD is

Answer 3

7 y/o

Question 4

ADRs of pychostimulants

Answer 4

norepi or dopamine like effect
-sweaty, HR
- anxiety, hallucinations, etc
-GI prob
insomnia
decreased appetite
cardiovascular "effect"

Question 5

FDA alert for psychostimulants

Answer 5

In children (~w/ heart probs?)
Sudden cardiac death- amphetamines, MPH
sudden unexplained death-atomoxetine, amphetamine, methylphenidate

psych probs, manic behavior, hearing voices

Question 6

To dx ADHD-inattention

Answer 6

symptoms of inattention present for atleast 6m; inappropriate for developmental level
5 or more sym of inattention for 17y/o and up
6 or more symp of inattention for children up to 16

Question 7

2 neurotransmitters linked to ADHD

Answer 7

Dopamine

Norepinephrine

Question 8

Do blood levels of psychostimulants = clinical effect?

Answer 8

NO

titrate to effect

Question 9

If one psychostimulant fails to tx what should you do?

Answer 9

Pick another one

probably work through 3 diff ones before giving up

Question 10

Is screening EEG required for children to start psychostimulant?

Answer 10

Not mandated

better do good cardiac exam if starting for peds

Question 11

Daytrana

Answer 11

methylphenidate patch
avoids first pass effect
apply 2hrs before needed, effects last 3hrs after removal
once daily application

Question 12

Vyvanse

Answer 12

lisdexampthetamine
low DLE “drug liking effect”
prodrug
no snorting, shooting etc

Question 13

do psycostimulants affect growth?

Answer 13

right at start maybe
minimal or insignificant effect in long run
-measure ht & wt semiannually

Question 14

Are “drug holidays” good for psychostimulants?

Answer 14

Stopping meds, can help any negative effect on growth

Question 15

Dose a psychostimulant for ADHD

Answer 15

Vyvanse 30mg once a day in the morning

Question 16

Non-stimulants include

Answer 16

Clonidine ext rel (Kapvay)
Guafacine ext. rel (Intuniv)
Atomoxetine (Strattera)

Question 17

Dose a non-stimulant

Answer 17

Strattera 80mg Once a day

Question 18

ADRs of Strattera

Answer 18

Cardiovascular, tachycardia, hypertension

Reversible liver failure?

Question 19

How is atomoxetine/Strattera dosed

Answer 19

weight-based dosing

Question 20

Major substrate of Strattera

Answer 20

2D6

Question 21

MOA of guanfacine (Intuniv)

Answer 21

binds postsynapthic alpha2a-adrenoreceptors in prefrontal cortex

Question 22

ADRs of fuanfacine/intuniv

Answer 22

less sedation that clonidine

less dizziness than clonidine

Question 23

MOA of clonidine/kapvay

Answer 23

binds postsynaptic alpha2a-adrenoreceptors in prefrontal cortex

Question 24

ADRS of clonidine/kapvay

Answer 24

sedation, dizziness, bradycardia

Question 25

MOA of atomoxetine (Strattera)

Answer 25

affects norepinephrine
takes 2-3wks to start working
(like TCAs)

Question 26

What other meds that have been tried for ADHD

Answer 26

TCA (kids don’t tolerate, cardiac probs, suicide risk, lethal)
Modafinil/Provigil- (not approved)
bupropion/wellbutrin (insomnia, anorexia, szs)
divalporate/Depakote (no studies)
and more…