Pharmacology: ADHD Flashcards
1st line therapy for ADHD:
Stimulants: Methylphenidate and “-amphetamine”. If it doesn’t work with one class, switch to the other class before trying other meds.
Medications helps improve ____ and _____
attention and hyperactivity/impulsivity. But not social or academic function directly.
2nd and 3rd line therapy for ADHD
Atomoxetine is 2nd line, Buproprion is 3rd line.
MOA of Stimulants: Methylphenidate and “-amphetamine”
- Inhibition of Norepinephrine and Dopamine reuptake
- Weak MAOI effects (Therefore avoid MAOIs: Drug interaction)
Boxed Warning for Stimulants: Methylphenidate and “-amphetamine”
- Controlled substances: watch out for dependency
MOA of Atomoxetine
- Norepinephrine reuptake inhibition
- May take about 2-4 weeks to work.
Drug Interactions for Atomoxetine
Try not to combine with strong 2D6 inhibitor
MOA of Bupropion
- Inhibition of Norepinephrine and Dopamine reuptake
- May take 4+ weeks to work (compared to 2-4 weeks of Atomoxetine)
Use of MAOIs
Avoid in general due to various drug interactions with stimulants, Atomoxetine, Bupropion, etc.
Bupropion: Important adverse effects
- Tic exacerbation and decreased seizure threshold
Bupropion: Important Concept
Pediatric metabolism may be faster than adults, therefore possible that dose is higher than expected + decrease dose as child ages.
TCAs: imipramine = Important concept
Obtain a baseline EKG prior to initiation + lots of Adverse Effects. Primarily used for depression
Alpha-2 agonists: ______ and ______ + Therapeutic Use
Clonidine and Guanfacine: ADHD + HTN
Clonidine and Guanfacine: Important Adverse Effects
Sedation, hypotension and rebound hypertension (need to taper slowly)
ADHD Tx Algorithm
NOTE: Treat predominant disorder FIRST! (Tourette’s Syndrome, Bipolar disorder/severe aggression, Anxiety/depression) then treat ADHD.
First: One type of Stimulant Class (Methylphendiate/dexmethylphenidate OR dextroamphetamine/mixed amphetamine salts)
Second: If inadequate, try the other stimulant class
Third: Try atomoxetine (+/- bupropion)
Fourth: Try bupropion, Alpha-2 agonists, or TCA (LAST)
