CNS- ADHD Flashcards
psychostimulants for adhd include
Dextroamphetamine & amphetamine- Adderall Methylphenidate-Ritalin Methampthetamine- Desoxyn Dextroamphetamine -Dexedrine Dexmethylphenidate -Focalin lisdexamphetamine (newest) -Vyvanse
MOA psychostimulants
dopamine reuptake inhibition
-work through slightly different mechanisms
average age of diagnosis of ADHD is
7 y/o
ADRs of pychostimulants
norepi or dopamine like effect -sweaty, HR - anxiety, hallucinations, etc -GI prob insomnia decreased appetite cardiovascular "effect"
FDA alert for psychostimulants
In children (~w/ heart probs?)
Sudden cardiac death- amphetamines, MPH
sudden unexplained death-atomoxetine, amphetamine, methylphenidate
psych probs, manic behavior, hearing voices
To dx ADHD-inattention
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
2 neurotransmitters linked to ADHD
Dopamine
Norepinephrine
Do blood levels of psychostimulants = clinical effect?
NO
titrate to effect
If one psychostimulant fails to tx what should you do?
Pick another one
probably work through 3 diff ones before giving up
Is screening EEG required for children to start psychostimulant?
Not mandated
better do good cardiac exam if starting for peds
Daytrana
methylphenidate patch
avoids first pass effect
apply 2hrs before needed, effects last 3hrs after removal
once daily application
Vyvanse
lisdexampthetamine
low DLE “drug liking effect”
prodrug
no snorting, shooting etc
do psycostimulants affect growth?
right at start maybe
minimal or insignificant effect in long run
-measure ht & wt semiannually
Are “drug holidays” good for psychostimulants?
Stopping meds, can help any negative effect on growth
Dose a psychostimulant for ADHD
Vyvanse 30mg once a day in the morning
Non-stimulants include
Clonidine ext rel (Kapvay)
Guafacine ext. rel (Intuniv)
Atomoxetine (Strattera)
Dose a non-stimulant
Strattera 80mg Once a day
ADRs of Strattera
Cardiovascular, tachycardia, hypertension
Reversible liver failure?
How is atomoxetine/Strattera dosed
weight-based dosing
Major substrate of Strattera
2D6
MOA of guanfacine (Intuniv)
binds postsynapthic alpha2a-adrenoreceptors in prefrontal cortex
ADRs of fuanfacine/intuniv
less sedation that clonidine
less dizziness than clonidine
MOA of clonidine/kapvay
binds postsynaptic alpha2a-adrenoreceptors in prefrontal cortex
ADRS of clonidine/kapvay
sedation, dizziness, bradycardia
MOA of atomoxetine (Strattera)
affects norepinephrine
takes 2-3wks to start working
(like TCAs)
What other meds that have been tried for ADHD
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…
