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afsha - ADHD and anxiety > CNS stimulants > Flashcards

CNS stimulants Flashcards

1
Q

What is 1st line drug treamtnet for ADHD - 2 options

A

lisdexamfetamine methylphenidate

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2
Q

methylphenidate - if effect wears off in evening with rebound hypersensitivity, the following may be appropriate

A

dose at bed time may be appropriate - establish need with trial bedtime dose

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3
Q

generic methylphenidate is used for ADHD, and also for this indication (unlicensed) (using IR meds)

A

narcolepsy

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4
Q

MHRA safety info re methylphenidate PR preps - caution if switching between products due to differences in formulation

A

All LA preps contain an IM component and a MR component
biphasic release profiles of diff preparations are NOT all equivalent and contain different proportions of IR and MR components

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5
Q

A patient has arrhythmias - are they suitable for treatment with methylphenidate

A

No it is contraindicated in arrhythmias

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6
Q

Methylphenidate causes growth retardation in children -T or F

A

true

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7
Q

Monitoring for methylphenidate

A
  • psychiatric disorders
  • pulse, BP, psychiatric symptoms, appetite, weight and height - initiation, dose adjustment, at least every 6 months thereafter
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8
Q

Why should alcohol be avoided with methylphenidate

A

it might increase conc of methylphenidate

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9
Q

TCAs interaction with methylphenidate

A

methylphenidate may increase conc of TCAs e.g. amitriptyline, imipramine, doxepin, dosulepin etc
use with caution and adjust dose

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10
Q

interaction - MAOB inhibitor and methylphenidate

A

selegiline, rasagiline
these are predicted to increase risk of hypertensive crisis when given with methylphenidate - avoid

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11
Q

interaction between methylphenidate and MAOIs

A

Methylphenidate causes a hypertensive crisis when given with Tranylcypromine, isocarboxazid, phenelzine Manufacturer advises avoid and for 14 days after stopping the MAOI.

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12
Q

avoid this high risk abx because methylphenidate may increase risk of elevates BP when given with it

A

linezolid

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13
Q

dexamfetamine can be used (unlicensed) for refractory ADHD, initiated under specialist supervision. If the following syndrome occurs, discontinue

A

tics

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14
Q

Monitor these two parameters as growth restriction can occur during prolonged therapy with dexamfetamine

A

height and weight

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15
Q

What can you do to reduce risk of growth restriction with prolonged therapy with dexamfetamine

A

Drug free periods may allow catch up in growth by withdraw slowly to avoid inducing depression or renewed hyperactivity

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16
Q

Which drug for ADHD has interactions with serotinergic drugs leading to risk of serotonin syndrome?

A

Dexamfetamine & lisdexamfetamine

17
Q

Dexamfetamine interaction with MAOIs (2)

A

Predicted to increase the risk of a hypertensive crisis when given with MAOIs. Manufacturer advises avoid and for 14 days after stopping the MAOI. Also increased risk of serotonin syndrome

18
Q

Dexamfetamine interactions with MAO-B inhibitors. (2)

A

Rasagiline, selegiline is predicted to increase the risk of severe hypertension when given with Dexamfetamine. Manufacturer advises avoid. Also increased risk of serotonin syndrome

19
Q

Dexamfetamine and -perazine antipsychotics interaction

A

They are predicted to decrease the effects of dexamfetamine and dexamfetamine is predicted to decrease their effects

20
Q

Dexamfetamine and SSRIs, SNRIs (dulox, venlfax), bupropion, TCAs, ondansetron, lithium, methadone, triptams, pethidine, vortioxetine etc

A

can increase the risk of serotonin syndrome

21
Q

Amfetamines in overdose - what are the symptoms (initial and after)

A

wakefulness
excessive activity
paranoia
hallucinations
hypertension
followed by exhaustion, convulsions, hyperthermia and coma

22
Q

A patient presents to A&E. You are told that initially, they were very hyperactive and had hallucinations. They now seem to be very exhausted, dizzy and hyperthermic. You look at their medication list: sertraline 50mg OD, dexamfetamine 10mg OD, salamol 2 puffs up to QDS prn. What do you suspect?

A

Amfetamine overdose - cause akefulness, excessive activity, paranoia, hallucinations, and hypertension followed by exhaustion, convulsions, hyperthermia, and coma.

23
Q

Treatment of early Staes of amfetamine overdosage

A

diazepam or lorazepam

24
Q

dexamfetamine monitoring requirements

A
  • monitor growth in chilsren
  • monitor for aggressive behaviour or hostility during initial treatment
  • pulse, BP, psychiatric symptoms, appetite, weight and height at initiation, each dose adjustment, and at least every 6 months thereafter
25
Q

Do ADHD drugs cause weight GAIN or weight LOSS

A

weight loss

26
Q

Lisdexamfetamine relationship with dexamfetamine

A

Lisdexamfetamine is a prodrug of dexamfetamine.

27
Q

Lisdexamfetamine is contraindicated in hypo or hyperthyroidism

A

HYPER

28
Q

Discontinue amphetamines if the following occurs

A

seizures

29
Q

All amphetamines to be used with caution in …

A

psychiatric disorders e.g. Bipolar disorder

30
Q

Bupropion MHRA advice with all amphetamines

A

B might increase risk of serotonin syndrome when given with amphetamines - monitor

31
Q

Moclobemide interaction with lis/dexamfetamine

A

predicted to increase the risk of a hypertensive crisis when given with Moclobemide. Manufacturer advises avoid.
also increased risk of serotonin syndrome

32
Q

RI - max dose of lisdexamfetmine in severe impairment

A

max dose 50mg daily

33
Q

Should amphetamines be stopped

A

avoid abrupt withdrawal

34
Q

Depression, drowsiness, fever, psychiatric disorders and skin reactions are very common in children taking lisdexamfetamine - true or false

A

true

35
Q

Lisdexamfetamine warning labels

A

This medicine may make you sleepy. If this happens, do not drive or use tools or machines.
Swallow this medicine whole. Do not chew or crush.

36
Q

A patient has moderate hypertension. Can you give lisdexamfetamine

A

No - contraindicated

37
Q

Monitoring - lisdexamfetamine

A
  • aggressive behaviour or hostility during initial treatment
  • pulse, BP, psychiatric symptoms before initiation, following dose adjustment, every 6 months thereafter
  • monitor weight in adults before treatment initiation and during treatment
  • children: height and weight before initiation, and then height, weight and appetite at least every 6 months during

afsha - ADHD and anxiety (7 decks)

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