Pharm - ADHD

Question 1

list the amphetamines

Answer 1

• adderall
• adderall XR
• dexedrine
• dexedrine spansule
• vyvanse

Question 2

list the methylphenidates

Answer 2

• concerta
• daytrana
• focalin (and XR)
• metadate (ER and CD)
• methylin
• quillivant XR
• ritalin
• ritalin LA and SR

Question 3

norepinephrine uptake inhibitor

Answer 3

strattera

Question 4

list the alpha adrenergic agents

Answer 4

• intuniv

- kapvay

Question 5

what sx are significantly reduced by stimulants?

Answer 5

• inattention
• impulsivity
• hyperactivity

Question 6

ADRs of the Daytrana patch

Answer 6

• contact sensitization

- chemical leukoderma

Question 7

ADRs of Strattera (atomoxetine)

Answer 7

• weight loss
• GI: abdominal pain, decreased appetite, N/V, dyspepsia
• CNS: HA, dizziness, somnolence/fatigue, irritability
• Cardio: stimulatory effects and rarely death
• priapism
• suicidal thinking** black box
• liver injury

Question 8

ADRs of extended release Kapvay (clonidine)

Answer 8

• sedation
• depression
• bradycardia
• HA
• possible hypotension
• generalized rash, urticaria, angioedema

Question 9

when would a drug holiday be needed from a stimulant med?

Answer 9

if they can be tolerated w/o impairment of functioning, drug holidays are good for kids who stimulant therapy is associated w/ aberrant growth trajectory

Question 10

how to manage decreased appetite

Answer 10

• administer med after a meal
• encourage child to eat nutrient dense foods
• offer foods the child likes for the noon meal
• meals with higher fat may delay onset and increase peak concentrations

Question 11

how to manage poor growth

Answer 11

• drug holidays
• change in tx
• nutritional consultation

Question 12

how to manage dizziness

Answer 12

• monitor BP and pulse
• ensure adequate fluid intake
• if only associated w/ peak effect, try longer acting med

Question 13

how to manage insomnia/nightmares

Answer 13

• establish bedtime routine and good sleep hygiene
• omit / reduce last dose of the day
• if using long acting, change to short acting
• administer earlier in the day

Question 14

how to manage mood lability

Answer 14

• if at peak concentration, reduce dose or switch to long acting
• try adding afternoon dose

Question 15

how to manage rebound

Answer 15

• increase dose of long acting med in morning

- add a smaller dose of short acting med at end of day

Question 16

how to manage tics

Answer 16

-lower dose or brief trial off the med

Question 17

how to manage psychosis

Answer 17

• verify that the dose is appropriate and the med is being administered as prescribed
• if so, dc the stimulant

Question 18

monitoring parameters to assess ADHD medication efficacy

Answer 18

• during titration, assess core sx and ADRs weekly and adjust dose as needed
• can monitor sore sx and ADRs through parent and teacher feedback
• see pts once / mo.
• monitor weight, height, HR, BP
• teacher feedback is essential!

Question 19

what steps can be taken to prevent or decrease drug diversion or misuse of stimulant meds

Answer 19

• monitor sx and script refills for evidence of misuse or diversion
• prescribe long acting stimulants and keep track of dates
• have open discussion about diversion and misuse