Psych Pharmacology Flashcards
1
Q
SSRI
Fluoxetine (Prozac)
A
- Dose - 10mg - 60mg, weekly form 90mg
- FDA indications- MDD (age 8+), OCD (age 7+), panic disorder, bulimia, PMDD
- Monitoring-none
- Side Effects- most likely to cause insomnia, anxiety, reduced appetite
Misc Info
* Has longest half live (active metabolite T1/2 is 2+ weeks) of any SSRI which can make it self-tapering (no discontinuation syndrome)
* stimulating med
2
Q
SSRI
Paroxetine (Paxil)
A
- Dose: 10mg - 40mg
- Indications- MDD, OCD, panic disorder, social anxiety, GAD, PTSD, PMDD, menopausal hot flashes
- Monitoring- none
- Side Effects- weight gain, sexual side effects, sedation
- Pregnancy category D, so avoid if possible in women of child-bearing age
- Half life of less than 24 hours, bad rebounds symptoms if stopped abruptly
3
Q
SSRI
Sertaline (Zoloft)
A
- Dose: 50mg - 300mg
- Indications- MDD, OCD (age 6+), panic disorder, PTSD, PMDD, social anxiety
- Monitoring- none
- Side Effects- n/v/d (called squirt-raline due to GI sx)
4
Q
SSRIs
Citalopram (Celexa)
A
- Dose: 10mg - 40mg
- Indications- MDD
- Monitoring- none
- Side Effects- QTc prolongation (do not exceed 40mg/day)
5
Q
SSRIs
Escitalopram (Lexapro)
A
- Dose: 10mg - 20mg
- Indications- MDD (age 12+), GAD
- Monitoring- none
- Side Effects- Considered the cleanest SSRI meaning it has the fewest SE
- Enantiomer of citalopram (S enantiomer is the pure active form and R enantiomer has anticholinergic properties which causes more side effects)
6
Q
SSRI
Fluvoxamine (Luvox)
A
- Dose: 50mg - 300mg
- Indications- OCD, MDD, panic disorder, GAD, PTSD
- Monitoring- none
- Side Effects: general SSRI side effects
- Less commonly used, many drug-to-drug interactions
7
Q
SNRI
A
Blocks serotonin and norepinephrine reuptake transports to increase both in synaptic cleft
8
Q
SNRIs
Venlafaxine (Effexor)
A
- Dose: 37.5mg - 225mg
- Indications- MDD, social anxiety disorder, GAD, panic disorder
- Monitoring- periodic BP
- Side Effects- anorexia, dizziness, dry mouth, sweating, sexual side effects, nervousness, hypertension, hyponatremia (in volume depleted)
- Has significant discontinuation syndrome even with the XR formulation, titrate off very slowly or consider using fluoxetine taper
9
Q
SNRIs
Desvenlafaxine (Pristiq)
A
- Dose: 50mg - 200mg
- Indications- MDD (fibromyalgia off label)
- Monitoring- periodic BP
- Side Effects- hypertension, nausea, dizziness, insomnia, excessive sweating, sexual side effects
10
Q
SNRIs
Duloxetine (Cymbalta)
A
- Dose: 20mg - 120mg (typically BID)
- Indications- MDD, GAD (ages 7+), diabetic peripheral neuropathic pain, fibromyalgia, chronic MSK pain
- Monitoring- LFTs is suspect liver disease, periodic BP
- Side Effects- liver disorders, nausea, dry mouth, insomnia, fatigue, HA, sexual side effects, urinary hesitation, urinary retention
- Very useful in patients with comorbid pain syndromes or with stress urinary incontinence
11
Q
SNRIs
Levomilnacipran (Fetzima)
A
- Dose: 20mg - 120mg
- Indications- MDD
- Monitoring- periodic BP and pulse
- Side Effects- nausea, vomiting, constipation, sweating, increased HR, urinary hesitation, urinary retention
- second line due to elevated cost & high occurrence of side effects
12
Q
NRDI
Bupropion (Wellbutrin)
A
- Dose: comes in IR and XL version. 75mg - 450mg
- Indications- MDD, seasonal affective disorder, smoking cessation (Zyban)
- Side effects- seizure, agitation, insomnia (take in morning to reduce), HA, nausea, vomiting, tremor, tachycardia, NE effects make this med stimulating making it particularly useful in patients with fatigue and poor concentration associated with depression
- Lack of sexual side effects and weight gain make it very useful in patients suffering these SE from other meds or are worried about this SE
- Can reduce seizure threshold so don’t give in bulimic patients and be very careful in patients with alcohol use disorder and electrolyte disorders
13
Q
Mirtazapine (Remeron)
A
- MOA- serotonin antagonist and alpha-2 adrenergic antagonist
- Dose: 7.5mg to 45mg
- Indications- MDD
- Monitoring- weight
- Side Effects- somnolence, increased appetite, weight gain, agranulocytosis or severe neutropenia (rare)
- Its tendency to cause stimulant appetite and sedation makes it a great choice for some patients (insomnia, cachexia, etc) but a terrible option for others (eating disorders, body dysphoric disorder)
- If patient has too much sedation at starting dose, consider increasing dose as it has more noradrenergic activity relative to antihistaminergic activity at higher doses
14
Q
Trazodone
A
- MOA- serotonin reuptake inhibitor, alpha-1 adrenergic antagonist, serotonin receptor antagonist
- Dose: 25mg to 300mg
- Indications- MDD (insomnia, anxiety off label)
- Monitoring- no routine monitoring
- Side Effects- drowsiness, dry mouth, lightheadedness, orthostatic hypotension, priapism (TrazoBone)
- Mostly used for insomnia due to its sedating qualities
15
Q
Vilazodone (Viibryd)
A
- MOA- serotonin reuptake inhibitor and serotonin partial agonist
- Dose: 10mg to 40mg
- Indications- MDD
- Monitoring- no routine monitoring
- Side Effects- diarrhea, nausea, vomiting, insomnia, hyponatremia
- Must be taken with food
Fewer Sexual side effects
16
Q
Vortioxetine (Trintellix)
A
- MOA- multimodal antidepressant: antagonist, partial agonist, and agonist of different serotonin receptors
- Dose: 5-20mg
- Indications- MDD
- Monitoring- no routine monitoring
- Side Effects- GI side effects, sexual side effects
- Helps with cognitive functioning in depression
17
Q
Brexpiprazole (Rexulti)
A
- MOA- dopamine D2 and serotonin partial agonist and antagonist
- Dose: 0.5mg to 4mg
- Indications- schizophrenia, depression adjunct (never monotherapy for depression)
- Monitoring- fasting glucose, lipids
- Side Effects- weight gain, akathisia, somnolence, tardive dyskinesia, impulse control problems, pathologic gambling
18
Q
Esketamine (Spravato)
A
- MOA- NMDA receptor antagonist
- Indications- treatment resistant major depression (in conjunction with an oral antidepressant)
- Monitoring- must be monitored after dose for 2 hours (cannot be taken at home)
- Side Effects- sedation, dissociation, elevated BP, cognitive impairment, hypertensive crisis
- Recently approved for treatment resistant major depression, even more recently approved for use in emergency room for urgent depressive episode or suicidal ideation
19
Q
TCAs
A
- Meds: nortryptiline, amitryptiline
- MOA- serotonin and NE reuptake inhibitor which causes its therapeutic effects, but it also blocks histamine and muscarinic receptors and effects Na and Ca channels which account for its side effects and toxicity
- Indications- MDD
- Monitoring- ECG if history of cardiac disease, requires plasma levels
- Side Effects- sedation, dry mouth, constipation, weight gain, sexual side effects, urinary hesitation, blurred vision, arrhythmias, QT prolongation
- monitor for overdose/toxicity
20
Q
Cognitive Behavior Therapy
A
- recognizing thoughts/triggers and challenging those thoughts
- CBT monotherapy is just as effective as antidepressants monotherapy
- for best results: combine CBT + meds!
21
Q
Light Box Therapy
A
- Indications- indicated for seasonal affective disorder and non-seasonal depression
- Side effects- eye strain, HA, mania in bipolar patients (uncommon)
MOA
* Light boxes emit full spectrum light with the standard minimum intensity of 10,000 lux (similar to light experienced if standing outside for 30 minutes
* Decreases melatonin production (so don’t use before bedtime)
22
Q
Electroconvulsive Therapy (ECT)
A
- Indications- treatment resistant or severe depression (either unipolar or bipolar), catatonia
- Side effects- acute confusion, memory loss, tension HA (30%), nausea, jaw pain
- Induces a generalized seizure which has antidepressant/antipsychotic effects via unknown mechanism
- Treatments given 3x/wk, response usually within 3-6 treatments, average number of treatments = 7-10 (inpatient treatment); High remission rate however relapse is common with out maintenance treatment
- Most effective treatment for depression
23
Q
Transcranial Magnetic Stimulation (TMS)
A
- Indications- depression that has not responded to 1 prior antidepressant, OCD, migraine pain
- Side effects- scalp discomfort, seizures (uncommon), hearing loss (uncommon
MOA
* Modulates activity in cortical regions
* In theory, left dorsolateral prefrontal cortex in underactive in depression
* Treatments are given 5x/wk with response usually beginning after 20 treatment
24
Q
Antipsychotics- Typicals
Chlorpromazine (Thorazine)
A
- First antipsychotic developed, not commonly used
- Dose: 60mg - 800mg PO
- Indications- Psychosis, mania, nausea and vomiting, intractable hiccups
- Monitoring- ECG if cardiac disease
- Side Effects- sedation, orthostasis, tachycardia, drowsiness, dry mouth, constipation, blurred vision, prolactin elevation, skin pigmentation, ocular changes, jaundice, photosensitivity
25
# Antipsychotic- Typicals
Fluphenzine (Prolixin)
* **Dose**: 3 - 45mg PO
* **Indications**- psychosis, schizophrenia
* **Side** **Effects**- EPS, headache, drowsiness, dry mouth
26
# Antipsychotics- Typicals
Haloperidol (Haldol)
* **Dose**: 1-40mg PO
* **Indications**- psychosis, Tourette’s disorder
* **Side** **Effects**- EPS, headache, drowsiness, dry mouth, prolactin elevation
27
# Antipsychotics- Atypicals
Quetiapine (Seroquel)
* **Dose**: 300 - 800mg
* Indications- Schizophrenia (13+yo), bipolar manic/mixed (10+), bipolar depression, maintenance for bipolar, major depression (as adjunct)
* **Monitoring**- fasting glucose, lipids
* **Side** **Effects**- somnolence (!), hypotension, dry mouth, dizziness, constipation, weight gain, fatigue, orthostatic hypotension
28
# Antipsychotics- Atypicals
Ziprasidone (Geodon)
* **Dose**: 120 - 160mg PO or IM
* **Indications**- Schizophrenia, bipolar disorder (acute tx of mania/mixed episodes, Bipolar maintenance as adjunct, acute agitation in schizophrenia (IM only)
* **Monitoring**- fasting glucose, lipids, ECG if cardiac disease
* **Side** **Effects**- somnolence, dizziness, akathisia, rash, QT prolongation, DRESS
Misc Info
* Need to take with **500 cals**
* Less weight gain than clozapine, olanzapine, quetiapine, and risperidone
* More **QT prolongation** than any other atypical antipsychotic
29
# Antipsychotics- Atypicals
Lurasidone (Latuda)
* **Dose**: 40mg to 120mg
* **Indications**- Schizophrenia (adults and adolescents 13-17), bipolar depression (as monotherapy and adjunct in adults and children 10-17)
* **Monitoring**- fasting glucose, lipids
* **Side** **Effects**- sedation, akathisia, nausea, parkinsonism, agitation, orthostatic hypotension, syncope
Misc Info
* Administer with at least **350** **calories** to increase absorption
* Appears relatively weight neutral
30
# Antipsychotics- Atypicals
Aripiprazole (Abilify)
* **Dose**: 10 - 30mg
* **Indications**- schizophrenia (13-17, adults), bipolar disorder (acute mania: adults and 13-17, maintenance: adults), major depression as adjunct (adults), irritability in autism (children 6-17), Tourette's disorder (children 6-17)
* **Monitoring**- fasting glucose, lipids
* **Side** **Effects**- akathisia, anxiety, insomnia, sedation, tremors
Misc Info
* Minimal weight and metabolic side effects but risk of akathisia
31
# Antipsychotics- Atypicals
Olanzapine (Zyprexa)
* **Dose**: 5 - 20mg
* **Indications**- schizophrenia (13+), acute or mixed bipolar 1 manic episodes (13+), maintenance tx of bipolar, bipolar depression (as Symbyax, 13+), treatment resistant depression (as Symbyax), acute agitation in schizophrenia and bipolar mania (injectable form)
* **Monitoring**- fasting glucose, lipids
* **Side** **Effects**- somnolence, dry mouth, constipation, weight gain (10-30lb is common), increased appetite, EPS
Misc Info
* High prevalence of weight gain and metabolic side effects
* Symbyax is an expensive combination of olanzapine and fluoxetine (just write as separate generic medications)
32
# Antipsychotics- Atypicals
Paliperidone (Invega)
* **MOA**- dopamine D2 and serotonin 5-HT2A receptor antagonist
* **Indications**- Schizophrenia (13+), schizoaffective disorder
* **Monitoring**- fasting glucose, lipids, prolactin if symptoms
* **Side** **Effects**- akathisia, EPS, tremor, tachycardia, insomnia, somnolence, weight gain, orthostatic hypotension, headache, elevated prolactin
Misc Info
* ”Ghost pills” osmotic delivery system
* Not highly effective in acute mania
* Along with risperidone, causes the most EPS and hyperprolactinemia of all atypicals
33
# Antipsychotics- Atypicals
Risperidone (Risperdal)
* **Dose**: 4 - 16mg
* **Indications**- schizophrenia (13+), bipolar disorder (manic/mixed 10+), irritability in autism (children 5+)
* Monitoring- fasting glucose, lipids, prolactin if symptoms
* **Side** **Effects**- EPS, somnolence, anxiety, constipation, nausea, dyspepsia, dizziness, prolactin elevation, weight gain, orthostatic hypotension
Misc Info
* Along with paliperidone, causes most EPS and hyperprolactinemia of all atypicals
34
# Antipsychotics- Atypicals
Asenapine (Saphris)
* **Dose**: 10 - 20mg
* **Indications**- Schizophrenia, bipolar disorder (acute and maintenance of manic/mixed episodes in adults and kids 10-17)
* **Monitoring**- fasting glucose, lipids
* **Side** **Effects**- akathisia, oral hypoesthesia, somnolence, dizziness, EPS, weight gain
Misc Info
* Sublingual and patch formulation, good if swallowing pills is an issue
35
# Antipsychotics- Atypicals
Cariprazine (Vraylar)
* **Dose**: 3 - 6mg
* **Indications**- Schizophrenia, bipolar I depression, Major depressive disorder
* **Monitoring**- fasting glucose, lipids
* **Side** **Effects**- GI upset, dizziness, insomnia, increased appetite. Typically very well tolerated and effective
36
# Antipsychotics
Clozapine (Clozaril)
* **Dose**: 300 - 600mg
* **Indications**- treatment resistant schizophrenia, reduction in risk of suicide in schizophrenia and schizoaffective disorders
* **Monitoring**- fasting glucose, lipids, baseline ANC (>1000) then weekly for 6 months, then biweekly for another 6-12 months, then monthly after 12 months
* **Side** **Effects**- sedation (!), orthostatic hypotension, hypersalivation, weight gain, constipation, tachycardia, potentially life-threatening neutropenia (1-2%)
Misc Info
* Must be in risk evaluation and mitigation strategy program (REMS) in order to prescribe
37
# Bipolar Disorder
meds for bipolar maintenance
| 8
* Quetiapine (Seroqual)- SGA
* Ziprasidone (Geodon)- SGA
* Risperidone (Riperdal Consta)- SGA LAI
* Asenapine (Saphris)- SGA
* Lamotrigine (Lamictal)- Anticonvulsant
* Lithium- Mood Stabilizer
* Olanzapine (Zyprexa)- SGA
* Aripiprazole (Abilify)- SGA
38
# Bipolar Disorder
meds for bipolar depression
| 4
* Quetiapine (Seroquel)- SGA
* Olanzapine/Fluoxetine (Symbyax)- SSRI/SGA
* Lurasidone (Latuda)- SGA
* Cariprazine (Vraylar)- SGA
39
# Bipolar Disorder
Meds for Mania Management
| 10
* Quetiapine (Seroquel)- SGA
* Asenapine (Saphris)- SGA
* Ziprasidone (Geodon)- SGA
* Lithium- Mood Stabilizer
* Divalproex (Depakote/Depakote ER)- anti-convulsant
* Carbemazepine (Equetro)- anti-convulsant
* Risperidone (Risperdal)- SGA
* Aripiprazole (Abilify)- SGA
* Olanzapine (Zyprexa)- SGA
* Cariprazine (Vraylar)- SGA
40
# Mood Stabilizer
Lithium
* **MOA**: not completely known but is thought alter the sodium transport across membranes of nerve and muscle cells.
* Thought to modulate dopamine, glutamate and GABA.
* **Gold** **standard** **for** **bipolar** **disorder** (indicated for mania and maintenance)
* Can reduce risk of suicide completion (8x less)
* VERY effective, 80% of patients respond well
* can take 1-2 weeks to become effective (augment with valproate or atypical antipsychotics)
* **Contraindications**: renal impairment, myasthenia gravis, 1st trimester/breastfeeding (teratogenic due to Ebsetin Anomaly)
* **Caution/Avoid**: NSAIDs, ACE inhibitors, HCTZ; excess sweating, low Na diet, dehydration (all increase Li levels)
41
# Mood Stabilizers
Lithium Side Effects
| 9
* nausea/diarrhea (take w/meals, split dosing, ER)
* Tremor (propranolol)
* polyuria/polydipsia (dose at bedtime)
* Hypothyroidism (7-9%, 9x more likely in women, tx: levothyroxine)
* nephrotoxicity (diabetes insipidus)
* Weight gain
* Memory problems
* Edema
* Rarely - EKG abnormalities
42
# Mood Stabilizers
Lithium Level
* Level should be between 0.6 and 1.2 (aim for 1)
* Starting dose: 300-600mg QHS, can be BID
* Typical dose is 900 to 1200mg/day but can vary. Max: 2400mg/day
Lithium Toxicity
* Occurs when plasma levels raise above 1.2
* Nausea, cogwheeling tremor, vomiting, somnolence, confusion, muscle weakness
* Plasma levels over 3 = seizures, coma, and death
43
# Mood Stabilizers
Lithium Monitoring
When Beginning
* Check Li level, BUN/creatinine, electrolytes, TSH/T3/T4, EKG (over 50), Preg test
* Recheck 1 week + 1 month after initiation. Maintenance q 6-12 months
When Changing Doses
* Check Li level 1 week after changing doses - 12 hours after last Li dose
* Once level achieved, check q 3 months for 6 months
* Once stable, check q 6-12 months
Misc Monitoring Notes
* Monitor for metabolic effects (BMI, lipids, etc)
* Compliance/access to labs can be an issue
44
# Anti-Convulsant
Lamotrigine (Lamictal)
* **MOA**: Sodium channel blocker, Anticonvulsant
* **Indications**: bipolar maintenance
* **Starting** **dose**: 25mg x 14 days. “Max”: 200mg; best if split BID (100mg BID), takes about 8 weeks to get to target dose
* **Side** **effects**: dizziness, headaches, benign rash (7%) diplopia, blood dyscrasias, withdrawal seizures if abruptly d/c,
* **If miss 5+ doses in a row, must start back at 25mg q daily**
* **Complication**: Stevens Johnsons Syndrome (SJS) - 1 in 1000 patients, but can be lethal; Valproate can DOUBLE lamotrigine levels
* Levels are lowered by oral contraceptives, so may need higher dose in women taking OCP. Levels can be higher during “placebo” week
45
# Anti-Convulsant
Valproic Acid/Valproate (Depakote)
* Anticonvulsant indicated for bipolar mania (off label good for rapid cycling)
* **Dose**: 250-500mg/day, rapidly titrate up to max of 4000mg/day
* **Monitoring**: serum level 50-125 ug/mL (aim for 100); check 5 days after increase and q 6 months
* **Side** **effects**: somnolence, nausea, fatigue, dizziness, hair loss, tremor, thrombocytopenia, hyperammonemia (confusion)
* ER formulation absorbs 20% less valproate
* **Complications**: Pancreatitis, Hepatic necrosis, EXTREMELY TERATOGENIC (NTD/spina-bifida and low IQ scores, decreases folate)
46
# Anti-Convulsants
Carbmazepine (Equetro)
* **MOA**: sodium channel blocker (anticonvulsant)
* **Indications**: acute mania, maintenance
* **Dose**: 200mg BID with max of 800mg BID
* **Side** **Effects**: dizziness, somnolence, nausea, headache; rare include agranulocytosis, aplastic anemia, hepatic failure, SIADH, SJS/TEN
* **Will decrease OCP effectiveness**
* NOT APPROVED FOR PSYCH (Tegretol)
47
# Anti-Convulsants
Oxycarbazepine (Trileptal)
* “Gentle” carbamazepine
* Off label use only for bipolar disorder, NOT first line
* **Dose**: 300mg BID up to 2400mg/day
* **Side** **Effects**: dizziness, somnolence, headache, ataxia, nausea and vomiting
* **Complications**: SJS/TEN, angioedema, anaphylaxis
* **NOT FDA APPROVED FOR PSYCH USE; OFF LABEL USE ONLY**
48
# Alcohol Use Disorder
Acamprosate (Campral)
* **MOA**: Glutamate neurotransmission modulation at metabotropic-5 glutamate receptor sites
* **Dose**: 666mg 3x daily
* **Monitoring**: No labs required, but should be avoided in patients with severe renal impairment
* **Side** **Effects**: diarrhea, nervousness, and fatigue
* Can take with naltrexone and disulfiram and in pts who continue to drink
49
# Alcohol Use Disorder/Opioid Use Disorder
Naltrexone
* **MOA**: mu opioid receptor blocker; naltrexone also modifies the HPA axis to suppress ethanol consumption (~25% in studies); opioid antagonist
* **Dose**: 50mg PO QD or 380mg IM q4 wks
* **Monitoring**: LFTs Q6 mo
* **Side Effects**: nausea, HA, dizziness, fatigue, liver damage
* **Contraindicated**: hepatic failure
* must be free from opioids or will enter precipitated withdrawal
* d/c 72 hrs before scheduled surgery if opioid use is anticipated (if IM d/c 30d prior)
50
# Alcohol Use Disorder
Disulfiram (Antabuse)
* **MOA**: discourages drinking by causing an unpleasant physiologic reaction when alcohol is consumed; Inhibits aldehyde dehydrogenase and prevents the metabolism of alcohol's primary metabolite, acetaldehyde
* **Dose**: initially dosed at 500 mg/day for 1-2 weeks, followed by an avg maintenance dose of 250 mg/day with a range from 125-500 mg based on the severity of adverse effect
* **When EtOH is Consumed**: causes sweating, headache, dyspnea, lowered blood pressure, flushing, sympathetic overactivity, palpitations, nausea, and vomiting
* **Side** **Effects**; rash, drowsiness, HA, metallic taste, hepatitis
* **Contraindications**: severe myocardial disease and/or coronary occlusion, psychosis, or known hypersensitivity to the medication or other thiuram derivatives. Also avoid in pregnancy and during breastfeeding
51
# Opioid Use Disorder
Methadone
* Pure opioid agonist → greater OD risk than buprenorphine
* Function: works to prevent cravings and withdrawal sx for 24+ hrs; reduces the euphoric effects of subsequent illicit opioid use by maintaining high levels of opioid tolerance
* Best studied and longest used medication for treatment of opioid addiction
* Methadone maintenance therapy is associated with overall lower mortality rates, including 70% lower than untreated heroin abusers
* Methadone is first line for pregnant patients with OUD
* Must be administered by certified center, typically dosed daily
52
# Opioid Use Disorder
Buprenorphine
* Opioid partial agonist (Some pain relief, potential for diversion)
* Oral form combined with naloxone to decrease diversion to injection (Suboxone/Bunavail/Zubsolv)
* Long-acting injection available (Sublocade) and implant (Probuphine)
* Patient should be experiencing withdrawal symptoms prior to starting (depends on half-life of drug)
* Safe in pregnancy, but less research than methadone, so this is not first line
* Patients are at higher risk of death if concurrently taking benzodiazepines, alcohol or using IV opiates in combination with Buprenorphine
* Does not show up on standard drug screen
* Contraindicated: severe hepatic impairment
53
# Opioid Use Disorder
Naloxone
* **MOA**: Opioid antagonist that blocks effects of opioid analgesics and reverses the effects of overdose
* No abuse potential
* Can be administered in both healthcare settings and in community
* Project DAWN (Deaths Avoided with Naloxone)
* Demonstrated to decrease mortality, not cause opioid dose escalation and improve eventual entry into treatment
54
# ADHD
Amphetamies
* **Meds**: *adderal*, *vyvanse*, mydayis, dexedrine, evekeo, dyanavel, adzenys
* **MOA**: releases and blocks reuptake of norepinephrine and dopamine; can be too strong and lead to anxiety
* **Side Effects**: HA, insomnia, anorexia, anxiety, irritability, HTN, aggression
* **Contraindications**: glaucoma, tics, MAOI use, agitation, structural cardiac abnormalities, uncontrolled hypertension, +/- hyperthyroidism
Potential abuse
**ABUSE POTENTIAL**
55
# ADHD
Stimulant- Methylphenidate
* **Meds**: *ritalin*, focalin, daytrana, concerta, metadate, quilivant, cotempla, aptensio, jornay, azstarys
* **MOA**: : blocks reuptake of norepinephrine and dopamine
* **Side Effects**: HA, insomnia, anorexia, anxiety, irritability, HTN, aggression
* **Contraindications**: glaucoma, tics, MAOI use, agitation, structural cardiac abnormalities, uncontrolled hypertension, +/- hyperthyroidism
Potential abuse
**ABUSE POTENTIAL**
