CNS Stimulants - Iszard

Question 1

what ADHD medications are derivatives of amphetamine?

Answer 1

• dextroamphetamine (methamphetamine)
• lisdexamfetamine (vivance, pro-drug)
• methylphenidate, dexmethylphenidate

Question 2

what ADHD medications are considered non-stimulants?

Answer 2

• atomoxetine
• guanfacine
• clonidine

Question 3

these drugs enhance NT by serving as direct and indirect non-catecholamine sympathomimetics
- block presynaptic reuptake, interfere with vesicular monoamine transporter (VMAT), and increase NT release (NE, then DA, then 5HT each at increasing doses)

Answer 3

stimulants

Question 4

• dyspepsia/GI distress/abd pain
• headache
• decreased appetite
• insomnia
• anxiety/jitteriness
• irritability/aggression/agitation
• elevated BP/HR

Answer 4

side effects of stimulants

Question 5

• priapism
• seizures
• sudden cardiac death
• stroke, MI
• chemical leukoderma

Answer 5

rare side effects of stimulants

Question 6

who should use caution with stimulants?

Answer 6

• anxiety and agitation
• symptomatic CV disease (intolerant of increased BP)
• moderate-severe HTN
• glaucome
• motor tics, family hx of tourette’s
• ineffectively-treated bipolar/psychoses
• poorly-controlled seizures
• hx of drug abuse

Question 7

onset of activity usually 24 hours

- a controlled substance, but MO allows future-dating Rx

Answer 7

stimulants

Question 8

what is the form of dextroamphetamine (adderall) IR?

Answer 8

tablet

Question 9

what is the form of dextroamphetamine sulfate IR?

Answer 9

liquid

Question 10

what is the form of amphetamine sulfate IR?

Answer 10

capsule

SA: mood changes, new/worse bipolar illness, aggressive behavior

Question 11

what is the form of dextroamphetamine (zensidi) IR?

Answer 11

tablet

SA: runny nose, dry mouth, high potential for misuse and abuse

Question 12

what is the form of dextroamphetamine XR?

Answer 12

capsule

Question 13

what is the form of amphetamine XR?

Answer 13

liquid

Question 14

what is the form of lisdexamfetamine (vyvance) XR?

Answer 14

capsule

Question 15

what is the form of amphetamine (mixed salts) XR?

Answer 15

capsule

Question 16

what is the percentage of IR vs XR in an extended release capsule of amphetamine?

Answer 16

50:50

Question 17

what is the form of dexmethylphenidate IR?

Answer 17

tablet

Question 18

what is the form of methylphenidate (methylin) IR?

Answer 18

liquid

Question 19

what is the form of methylphenidate (ritalin) IR?

Answer 19

tablet

Question 20

what is the form of methylphenidate/ritalin-SR?

Answer 20

tablet

Question 21

what is the form methamphetamine/desoxyn-SR?

Answer 21

tablet

Question 22

what is the form of methylphenidate HCl-XR?

Answer 22

chewable tablet

Question 23

what is the form of methylphenidate/quillivant-XR?

Answer 23

liquid

Question 24

• onset of activity is 1-4+ weeks
• useful for pts intolerant of stimulant effects, or resistant of using stimulant class
• non-scheduled, refills and samples permitted up to 1 year time-frame

Answer 24

non-stimulants

Question 25

the main effect of non-stimulants for ADHD is to enhance NT transmission via which two mechanisms?

Answer 25

• inhibition of NE pre-synaptic reuptake (atomoxetine)

- agonists of CNS a-2a adrenergic receptors (guanfacine/clonidine)

Question 26

what is the form of atomoxetine?

Answer 26

capsule

Question 27

what is the form of clonidine/kapvay?

Answer 27

tablet

Question 28

what is the form of guanfacine/intuniv?

Answer 28

tablet

Question 29

which two drugs have a recommendation of downward dose titration over 1+ weeks upon discontinuation?

Answer 29

guanfacine and clonidine

- d/t risk of rebound hypertension (both are antihypertensives)