Pharm Final: ADHD Flashcards
What are sx of ADHD?
poor attention, physical restlessness, excessive impulsivity, difficult getting started and completing tasks
What are four modes of treatment for ADHD?
- pt education about diagnosis and tx
- behavior mgmt techniques
- stimulant meds
- education and support groups
What is first line medication for ADHD?
stimulants such as methylphenidate and dextroamphetamine
available as IR or long acting
What other common stimulants are used?
- mixed amphetamine salts- Adderal
2. Lisdexamfetamine Dimesylate- prodrug of dextroamphetamine
What is MOA of stimulants?
affect dopaminergic and noradrenergic says causing release of catecholamines in storage sites in CNS synapses this is said to improve attention span and concentration
What drug was recently withdrawn from market due to hepatotoxicity?
pemoline
What is Atomoxetine?
a selective norepinephrine reuptake inhibitor
used in pts 6 and older who can not tolerate regular stimulators
What are main SE of meds?
- anorexia or appetite disturbance (80 percent)
- sleep disturbances (3-85%)
- weight loss (10-15%)- more in adderal
What are less common SE?
increases HR and BP, HA, social withdrawal, stomach pain, irritability
What type of pt should not take stimulants?
children or adolescents with known heart issues- can cause sudden death
also don’t use with children who have developed recent pychosis issues with stimulants or suicidal behavior with atomoxetine
What are positive clinical symptoms of SCZ?
hallucinations, delusions, thought disorders, disorganized speech
What are negative clinical sx of SCZ?
amotivation, social withdrawal, blunted affect, poor hygiene
As PT what should we watch out for in pts with SCZ?
suicide
What is pathogenesis of SCZ?
not well known possibly overactivity of dopamine pathways
What is first choice for treatment of SCZ?
atypical (newer) agents- improve both negative and positive sx and are better tolerated with less EPS SE
however more metabolic toxicities
What are some examples of atypical agents?
clozapine, risperidone
What is 2nd choice of treatment of SCZ?
typical or conventional- control mostly positive sx but are poorly tolerated and largely cause EPS sx
What is MOA for antipsychotic drugs?
block central dopamine receptors, binding to them but not activating them
What dopamine receptor is most important?
D2
What are long release formulations?
Depot; administered IM, recently available for atypical antipsychotics:
- fluphenazine (decanoate and enanthane)
- haloperidol decanoate
What is dosing schedule for depot formulations?
IM injections every 2-4 weeks, takes 2-4 to reach steady state which means continue to use oral meds for 2-4 weeks
What are anticholinergic SE of antipsychotics?
dry mouth, blurred vision, constipation, urinary retention, confusion, tachycardia
What are cardiovascular SE of antipsychotics?
postural and OTN
QT prolongations with thioridazine, do not use unless absolutely necessary
When do EPS sx occur?
early onset, typically within first 4 weeks or late onset 6-12 months after tx was started
