Pharm Final: ADHD

Question 1

What are sx of ADHD?

Answer 1

poor attention, physical restlessness, excessive impulsivity, difficult getting started and completing tasks

Question 2

What are four modes of treatment for ADHD?

Answer 2

1. pt education about diagnosis and tx
2. behavior mgmt techniques
3. stimulant meds
4. education and support groups

Question 3

What is first line medication for ADHD?

Answer 3

stimulants such as methylphenidate and dextroamphetamine

available as IR or long acting

Question 4

What other common stimulants are used?

Answer 4

1. mixed amphetamine salts- Adderal

2. Lisdexamfetamine Dimesylate- prodrug of dextroamphetamine

Question 5

What is MOA of stimulants?

Answer 5

affect dopaminergic and noradrenergic says causing release of catecholamines in storage sites in CNS synapses this is said to improve attention span and concentration

Question 6

What drug was recently withdrawn from market due to hepatotoxicity?

Answer 6

pemoline

Question 7

What is Atomoxetine?

Answer 7

a selective norepinephrine reuptake inhibitor

used in pts 6 and older who can not tolerate regular stimulators

Question 8

What are main SE of meds?

Answer 8

1. anorexia or appetite disturbance (80 percent)
2. sleep disturbances (3-85%)
3. weight loss (10-15%)- more in adderal

Question 9

What are less common SE?

Answer 9

increases HR and BP, HA, social withdrawal, stomach pain, irritability

Question 10

What type of pt should not take stimulants?

Answer 10

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

Question 11

What are positive clinical symptoms of SCZ?

Answer 11

hallucinations, delusions, thought disorders, disorganized speech

Question 12

What are negative clinical sx of SCZ?

Answer 12

amotivation, social withdrawal, blunted affect, poor hygiene

Question 13

As PT what should we watch out for in pts with SCZ?

Answer 13

suicide

Question 14

What is pathogenesis of SCZ?

Answer 14

not well known possibly overactivity of dopamine pathways

Question 15

What is first choice for treatment of SCZ?

Answer 15

atypical (newer) agents- improve both negative and positive sx and are better tolerated with less EPS SE

however more metabolic toxicities

Question 16

What are some examples of atypical agents?

Answer 16

clozapine, risperidone

Question 17

What is 2nd choice of treatment of SCZ?

Answer 17

typical or conventional- control mostly positive sx but are poorly tolerated and largely cause EPS sx

Question 18

What is MOA for antipsychotic drugs?

Answer 18

block central dopamine receptors, binding to them but not activating them

Question 19

What dopamine receptor is most important?

Answer 19

D2

Question 20

What are long release formulations?

Answer 20

Depot; administered IM, recently available for atypical antipsychotics:

1. fluphenazine (decanoate and enanthane)
2. haloperidol decanoate

Question 21

What is dosing schedule for depot formulations?

Answer 21

IM injections every 2-4 weeks, takes 2-4 to reach steady state which means continue to use oral meds for 2-4 weeks

Question 22

What are anticholinergic SE of antipsychotics?

Answer 22

dry mouth, blurred vision, constipation, urinary retention, confusion, tachycardia

Question 23

What are cardiovascular SE of antipsychotics?

Answer 23

postural and OTN

QT prolongations with thioridazine, do not use unless absolutely necessary

Question 24

When do EPS sx occur?

Answer 24

early onset, typically within first 4 weeks or late onset 6-12 months after tx was started

Question 25

What are the four main late EPS sx?

Answer 25

1. tardive dyskinesia- most feared
2. tardive dystonia
3. tardive akathisia

Question 26

What are early sx?

Answer 26

dystonia, akathisia, pseudoparkinson’s

Question 27

What is management of early dystonia?

Answer 27

self resolving with IM benadryl or benztropine, resolves with 20-30 mins if used atlas 7-10 days

Question 28

What is tx for early akathisia?

Answer 28

propanolol usually drug of choice, anticholinergic agents, need to treat continuously and hard to manage

Question 29

What is tx for tardive dyskinesia?

Answer 29

non reversible and progressive, no tx really

discontinue agent and switch to clozapine

Question 30

What drugs are more effective with positive sx?

Answer 30

typical but atypical can also do negative sx w/ less SE

Question 31

What is difference between atypical drugs paliperidone and risperidone?

Answer 31

P: is a long acting ER tablet which allows for once a day dosing

also available as Invega sustenna which is a depot formulation allowing for once a month administration

Question 32

What drug are you likely to see in acute care psychosis mgmt?

Answer 32

Olanzapine- available in rapid onset disintegrating tablets, IV injection and IM

Question 33

What are usual SE with atypical meds?

Answer 33

1. agranulocytosis- w/ clozapine
2. weight gain- highest in first 3 months
3. glucose disregulation- hyperglycemia, new onset diabetes- switch to other agent
4. Elevated TG levels
5. QT prolongation

Question 34

What is neuroleptic malignant syndrome?

Answer 34

caused by all different kinds of antipsychotics but extremely rare

Question 35

What are signs and SX?

Answer 35

hyperthermia, severe muscle rigidity, tremor, altered mental status, elevated CPK, elevated WBC

Question 36

What puts pts at greater risk for NMS?

Answer 36

higher potency, higher doses and fast rising doses

develops rapidly within 1st month of tx

Question 37

What is tx for NMS?

Answer 37

dantrolene and bromocriptine

most recover in 2-14 days

reintroduction to antipsychotics must be 2 weeks after its resolved