CNS Stimulants Flashcards
What are the 2 general class options for ADHD treatment?
Stimulants
Non-stimulants
IR
Immediate Release
ER or XR
Extended Release
LA
Long Acting
CD
Controlled Delivery
ODT
Oral Disintegrating Tablet
What are the 2 types of Stimulants?
Amphetamine based
Methylphenidate based
What are the 2 types of Stimulants?
Amphetamine based
Methylphenidate based
What are the 3 Non-Stimulants?
Atomoxetine
Guanfacine
Clonidine
What are the 3 Non-stimulants?
Atomoxetine
Guanfacine
Clonidine
What is the MOA for Stimulants?
Enhance neurotransmitter transmission by serving as direct/indirect non-catecholamine sympathomimetics
Stimulants can block neurotransmitter reuptake, interfere with VMAT and increase release. As the dose increases, what neurotransmitter effects will occur?
As dose increases:
- NE
- Then DA
- – Then 5-HT
What are some general side effects of the Stimulants? (4)
GI distress
Decreased appetite and growth
Insomnia
Jittery
What are some rare side effects of the Stimulants? (4)
Priapism – extended erection
Seizures
Chemical Leukoderma
Cardiac deaths
How long does it take for the onset of activity for Stimulants?
24 hours
Stimulants are controlled substances - yes or no?
YES
- 1-3 month supply, no refills, no samples
Amphetamine based IR forms?
Tablet
Capsule
Liquid
Amphetamine based IR forms?
Tablet
Capsule
Liquid
Amphetamine based ER forms?
Capsule
Liquid
Amphetamine based ER forms?
Capsule
Liquid
Amphetamine based also has an XR-ODT form. Describe it.
Extended release oral disintegrating tablet
– NO water necessary!
The XR-ODT form of Amphetamine has what ratio of d:l amphetamine?
3:1
Methylphenidate based IR forms?
Tablet
Liquid
Methylphenidate based IR forms?
Tablet
Liquid
Methylphenidate based SUSTAINED release forms?
Tablet
Methylphenidate based SUSTAINED release forms?
Tablet
Methylphenidate based ER forms?
Tablet Capsule Liquid Chewable tablet Transdermal patch
Methylphenidate based ER forms?
Tablet Capsule Liquid Chewable tablet Transdermal patch
What is the Methylphenidate based stimulant that is ER and can be worn as a transdermal patch?
Methylphenidate transdermal
What side effect can occur with the Methylphenidate based ER transdermal patch form?
Chemical Leukoderma
What is the Methylphenidate ER form that is a chewable tablet?
Methylphenidate HCI
What is the MOA for Atomoxetine?
(-) NE reuptake
What form is Atomoxetine given in?
Capsule
What are the possible side effects of Atomoxetine?
Ocular irritant if capsule opened
Suicidal thoughts
What is the MOA for Guanfacine and Clonidine?
CNS Alpha2a receptor Agonists
What form is Guanfacine and Clonidine given in?
Tablet
Guanfacine and Clonidine are actually _____
Antihypertensives
What are there risks or/warning to not do with Guanfacine and Clonidine?
Risk of Rebound HTN
Do not crush, chew, break tablets
With Guanfacine and Clonidine there is a risk of Rebound HTN, how should you discontinue the meds?
Downward dose titration for 1+ weeks
How long does the onset of activity take to occur with Non-Stimulants?
1-4+ weeks
Non-stimulants are controlled substances - yes or no?
NO
– refills and samples permitted
In what patients are Non-stimulants useful?
Patients/parents intolerant of stimulant effects
Compare the effect-size of Non-stimulants to Stimulants?
Non-stimulants effect-size NOT as large as seen with Stimulants
Compare the effect-size of Non-Stimulants to Stimulants?
Non-Stimulants effect-size NOT as large as seen with Stimulants
