CNS Stimulants - Iszard Flashcards
what ADHD medications are derivatives of amphetamine?
- dextroamphetamine (methamphetamine)
- lisdexamfetamine (vivance, pro-drug)
- methylphenidate, dexmethylphenidate
what ADHD medications are considered non-stimulants?
- atomoxetine
- guanfacine
- clonidine
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)
stimulants
- dyspepsia/GI distress/abd pain
- headache
- decreased appetite
- insomnia
- anxiety/jitteriness
- irritability/aggression/agitation
- elevated BP/HR
side effects of stimulants
- priapism
- seizures
- sudden cardiac death
- stroke, MI
- chemical leukoderma
rare side effects of stimulants
who should use caution with stimulants?
- 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
onset of activity usually 24 hours
- a controlled substance, but MO allows future-dating Rx
stimulants
what is the form of dextroamphetamine (adderall) IR?
tablet
what is the form of dextroamphetamine sulfate IR?
liquid
what is the form of amphetamine sulfate IR?
capsule
SA: mood changes, new/worse bipolar illness, aggressive behavior
what is the form of dextroamphetamine (zensidi) IR?
tablet
SA: runny nose, dry mouth, high potential for misuse and abuse
what is the form of dextroamphetamine XR?
capsule
what is the form of amphetamine XR?
liquid
what is the form of lisdexamfetamine (vyvance) XR?
capsule
what is the form of amphetamine (mixed salts) XR?
capsule
what is the percentage of IR vs XR in an extended release capsule of amphetamine?
50:50
what is the form of dexmethylphenidate IR?
tablet
what is the form of methylphenidate (methylin) IR?
liquid
what is the form of methylphenidate (ritalin) IR?
tablet
what is the form of methylphenidate/ritalin-SR?
tablet
what is the form methamphetamine/desoxyn-SR?
tablet
what is the form of methylphenidate HCl-XR?
chewable tablet
what is the form of methylphenidate/quillivant-XR?
liquid
- 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
non-stimulants
the main effect of non-stimulants for ADHD is to enhance NT transmission via which two mechanisms?
- inhibition of NE pre-synaptic reuptake (atomoxetine)
- agonists of CNS a-2a adrenergic receptors (guanfacine/clonidine)
what is the form of atomoxetine?
capsule
what is the form of clonidine/kapvay?
tablet
what is the form of guanfacine/intuniv?
tablet
which two drugs have a recommendation of downward dose titration over 1+ weeks upon discontinuation?
guanfacine and clonidine
- d/t risk of rebound hypertension (both are antihypertensives)
