Segar: ADHD Medications: Stimulants and Non-Stimulants Flashcards
What Neurotransmitters are involved in ADHD?
- DA
- NE (and 5HT)
What are the stimulant ADHD meds we have to know (amphetamine derivatives)?
- Amphetamine
- dextroamphetamine (meth)
- Lisdexamfetamine (pro drug)
- Methylphenidate
- Dexmethylphenidate
What are the non stimulant meds?
- Atomexetine
- Guanfacine
- Clonidine
How do the stimulants work?
- they enhance neurotransmitter transmission by serving as direct and indirect non catecholamine sympathomimetics
- block presynaptic reuptake, interference with VMAT, increase in NT release
Which kind of isomers have more activity for stimulants?
-the D-isomers
What is Methylphenidates main activity?
-inhibition of DA reuptake and inhibition of NT pre synaptic reuptake
What does amphetamine come in?
-adzenys XR-ODT (oral disintegrating tablet), Dyanavel XR (oral suspension), Eveko (IR.. immediate release)
What does Dextroamphetamine come in?
- Dexedrine (IR and XR)
- ProCentra (IR oral sln)
What is Lisdexamfetamine?
-pro-drug of detroamphetamine
What are the mixed amphetamine salts?
-Adderall (IR), Adderall XR,
What are the methylphenidate drugs?
- Aptensio XR
- Ritalin (IR), Ritalin LA
- Concerta
- Methylin (IR oral sln and IR chewable tablet)
- Metadate CD
- Quillivant XR (oral suspension)
- Quillichew ER (chewable tablet)
- Daytrana (patch)
What is the Dexmethylphenidate drug?
-Focalin IR or XR
When is the onset of activity for stimulants?
- 24 hrs in most pts
- they are controlled substances, so no refills or samples, no future dating which sucks
Non IR forms of amphetamine
- Adzenys XR-ODT
- 3:1 ratio of d and L amphetamine isomers
- 50% IR, 50% XR
- no water necessary because it dissolves on the tongue
- QD dosing
What is Dyanavel XR liquid?
- 3.2:1 ratio of d and L amphetamine isomers
- LiquiXR technology
- 6 and older
- QD dosing
What is Vyvanse?
lisdexamfetamine; prodrug of dextroamphetamine
- CYP450’s will convert it
- can empty capsule contents into glas of water
- 6 and older ADHD tx
- QD dosing
What is Adderall XR
- 3:1 ratio of d to L isomers
- 50:50 IR and XR beads
- can sprinkle on things
- 3 and older
- Qd dosing
What is concerta?
- Phase 1: 22% IF
- phase 2: 78% ER
- 6 and older
- QD dosing
- we are now in formulations of methyphenidate
Ritalin LA
- 50% IR beads and 50% LA beads
- sprinkle
- 6 and older
- QD dosing
Metadate CD
- 30% IR and 70% CD
- may empty capsule contents onto food
- approved for ages 6 and older
- QD dosing
Aptensio XR
- 40% IR and 60% XR
- multilayer bead releasing system
- 6 and older
- empty onto food
- QD
Daytrana
- this is the patch for of methylphenidate
- MPH in acrylic adhesive dipersed in silicone adhesive
- Wear time individualizaeable
- 6 or older
- QD dosing
Quillichew ER
- only extended release chewable methylphenidate tablet
- 30% IR and 70%XR
- 6 or older
- QD
Quillivant XR
- only extended release oral methylphenidate suspension
- shake well
- 20% IF and 80% XR
- 6 and older
- QD
Focalin XR
- 50:50 IR:XR
- sprinkle
What are some side effects of stimulants?
- GI stuff
- headache
- decreased appetite
- insomnia
- anxiety
- irritability/aggression/agitation
- elevated BP/HR
What do we always have to make sure we keep track of when giving stimulants?
- cardiac stuff
- always assess for cardiac structural abnormalities
What are the three non stimulant ADHD meds again?
- Atomoxetine
- Guanfacine
- clonidine
What is the main effect of non stimulants?
- to enhance NT transmission via:
- ihibition of NE pre synaptic reuptake (atomoxetine)
- Agonists of CNS alpha adrenergic receptors (guanfacine/clonidine)
What is the onset of activity for non stimulants?
- 1-4 weeks or even more
- refills and samples are permitted, which is nice
Atomoxetine (Strattera)
- do not open capsules (ocular irritant)
- metbaolized by CYP2D6
- just singular, not dual,
- non stimulant
- NET blocker
What was the important side effect of non stimulants what wasn’t with the stimulants?
- Suicidal ideations
- severe liver injury/jaundice was in there too
When taking someone off of Guanfacine or clonidine, what do we have to make sure we do?
- downward dose titration…. no cold turkey
- risk of rebound htn because both of these drugs are anti-hypertensives
What are the side effects of alpha 2 agonists?
-Hypotension/bradycardia…. orthostatic hypotension
