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BPS > Segar: ADHD Medications: Stimulants and Non-Stimulants > Flashcards

Segar: ADHD Medications: Stimulants and Non-Stimulants Flashcards

1
Q

What Neurotransmitters are involved in ADHD?

A
  • DA

- NE (and 5HT)

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2
Q

What are the stimulant ADHD meds we have to know (amphetamine derivatives)?

A
  • Amphetamine
  • dextroamphetamine (meth)
  • Lisdexamfetamine (pro drug)
  • Methylphenidate
  • Dexmethylphenidate
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3
Q

What are the non stimulant meds?

A
  • Atomexetine
  • Guanfacine
  • Clonidine
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4
Q

How do the stimulants work?

A
  • they enhance neurotransmitter transmission by serving as direct and indirect non catecholamine sympathomimetics
  • block presynaptic reuptake, interference with VMAT, increase in NT release
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5
Q

Which kind of isomers have more activity for stimulants?

A

-the D-isomers

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6
Q

What is Methylphenidates main activity?

A

-inhibition of DA reuptake and inhibition of NT pre synaptic reuptake

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7
Q

What does amphetamine come in?

A

-adzenys XR-ODT (oral disintegrating tablet), Dyanavel XR (oral suspension), Eveko (IR.. immediate release)

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8
Q

What does Dextroamphetamine come in?

A
  • Dexedrine (IR and XR)

- ProCentra (IR oral sln)

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9
Q

What is Lisdexamfetamine?

A

-pro-drug of detroamphetamine

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10
Q

What are the mixed amphetamine salts?

A

-Adderall (IR), Adderall XR,

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11
Q

What are the methylphenidate drugs?

A
  • 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)
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12
Q

What is the Dexmethylphenidate drug?

A

-Focalin IR or XR

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13
Q

When is the onset of activity for stimulants?

A
  • 24 hrs in most pts

- they are controlled substances, so no refills or samples, no future dating which sucks

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14
Q

Non IR forms of amphetamine

A
  • 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
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15
Q

What is Dyanavel XR liquid?

A
  • 3.2:1 ratio of d and L amphetamine isomers
  • LiquiXR technology
  • 6 and older
  • QD dosing
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16
Q

What is Vyvanse?

A

lisdexamfetamine; prodrug of dextroamphetamine

  • CYP450’s will convert it
  • can empty capsule contents into glas of water
  • 6 and older ADHD tx
  • QD dosing
17
Q

What is Adderall XR

A
  • 3:1 ratio of d to L isomers
  • 50:50 IR and XR beads
  • can sprinkle on things
  • 3 and older
  • Qd dosing
18
Q

What is concerta?

A
  • Phase 1: 22% IF
  • phase 2: 78% ER
  • 6 and older
  • QD dosing
  • we are now in formulations of methyphenidate
19
Q

Ritalin LA

A
  • 50% IR beads and 50% LA beads
  • sprinkle
  • 6 and older
  • QD dosing
20
Q

Metadate CD

A
  • 30% IR and 70% CD
  • may empty capsule contents onto food
  • approved for ages 6 and older
  • QD dosing
21
Q

Aptensio XR

A
  • 40% IR and 60% XR
  • multilayer bead releasing system
  • 6 and older
  • empty onto food
  • QD
22
Q

Daytrana

A
  • this is the patch for of methylphenidate
  • MPH in acrylic adhesive dipersed in silicone adhesive
  • Wear time individualizaeable
  • 6 or older
  • QD dosing
23
Q

Quillichew ER

A
  • only extended release chewable methylphenidate tablet
  • 30% IR and 70%XR
  • 6 or older
  • QD
24
Q

Quillivant XR

A
  • only extended release oral methylphenidate suspension
  • shake well
  • 20% IF and 80% XR
  • 6 and older
  • QD
25
Q

Focalin XR

A
  • 50:50 IR:XR

- sprinkle

26
Q

What are some side effects of stimulants?

A
  • GI stuff
  • headache
  • decreased appetite
  • insomnia
  • anxiety
  • irritability/aggression/agitation
  • elevated BP/HR
27
Q

What do we always have to make sure we keep track of when giving stimulants?

A
  • cardiac stuff

- always assess for cardiac structural abnormalities

28
Q

What are the three non stimulant ADHD meds again?

A
  • Atomoxetine
  • Guanfacine
  • clonidine
29
Q

What is the main effect of non stimulants?

A
  • to enhance NT transmission via:
  • ihibition of NE pre synaptic reuptake (atomoxetine)
  • Agonists of CNS alpha adrenergic receptors (guanfacine/clonidine)
30
Q

What is the onset of activity for non stimulants?

A
  • 1-4 weeks or even more

- refills and samples are permitted, which is nice

31
Q

Atomoxetine (Strattera)

A
  • do not open capsules (ocular irritant)
  • metbaolized by CYP2D6
  • just singular, not dual,
  • non stimulant
  • NET blocker
32
Q

What was the important side effect of non stimulants what wasn’t with the stimulants?

A
  • Suicidal ideations

- severe liver injury/jaundice was in there too

33
Q

When taking someone off of Guanfacine or clonidine, what do we have to make sure we do?

A
  • downward dose titration…. no cold turkey

- risk of rebound htn because both of these drugs are anti-hypertensives

34
Q

What are the side effects of alpha 2 agonists?

A

-Hypotension/bradycardia…. orthostatic hypotension

BPS (15 decks)

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