Segars: ADHD drugs Flashcards
What are the Stimulants in ADHD medication
- Amphetamine, Dextroamphetamine,
- Lisdexamfetamine (pro drug)
- Methylphenidate and dexmethylphenidate
What are the non stimulants?
- Atomoxetine
- Guanfacine
- Clonidine
What isomer of amphetamine or methylphenidate has more CNS activity
D
What is methylphenidate’s main activity?
- inhibition of DA reuptake and inhibition of neurotransmitter pre-synaptic reuptake
- Doesn’t stimulate release of neurotransmitter like amphetamine
what are the non IR amphetamine formulations?
- Adzenys XR
- Dyanavel XR
- Dexedrine spansules (dextroamphetamine)
- Vyvanse (lisdexamfetamine, prodrug of dextroamphetamine)
- Adderall (amphetamine/dextroamphetamine)
ROA of Adzenys
oral disintegrating tablet
% for Adzenys
50 IR 50 XR
ROA for Dyanavel
liquid
ROA Dexedrine Spansules
sprinkle on food
ROA of Vyvanse
may empty capsule contents into glass of water, juice or pudding/yogurt . . . working on chewable tablet
ROA for Adderall XR
can sprinkle capsule on food
% for Adderall XR
50% IR 50% XR
What are the Non IR forms of Methylphenidate
- Concerta
- Ritalin LA
- Metadate CD
- Aptensio
- Daytrana
- QuilliChew ER
- Quillivant
- Focalin
% for Concerta
22% IR and 78% ER
% for Ritalin LA
50% IR and 50% LA
% for Metadate
30% IR and 70% CD
% for Aptensio XR
40% IR and 60% XR
ROA for Daytrana
patch
% for QuilliChew ER
30% IR and 70% XR
ROA for QuilliChew ER
chewable tablet
% for Quillivant XR
20% IR and 80% XR
ROA for Quillivant XR
liquid
% for Focalin
50% IR and 50% XR
What are the rare side effects of stimulants needed to watch out for
- Sudden cardiac death
- structural cardiac abnormalities
- Always assess for cardiac structural abnormalities
MOA of Atomoxetine
inhibition of NE pre synaptic reuptake . . .NET blocker
MOA of Guanfacine and Clonidine
Agonist of CNS alpha-2a receptors
onset of activity for non stimulants
1-4 Weeks
brand name for Atomoxetine
Strattera
Difference in side effects of Atomoxetine from stimulants
- No motor/vocal tics
- No seizures
- Yes suicidal ideations
- Yes severe liver injury/jaundice
What are the cautions for using Atomoxetine?
- Narrow angle Glaucoma
- MAO inhibitors
- CYP2D6 inhibitors
Brand name for Guanfacine
Intuniv
Brand name for Clonidine
Dapvay
What is the comment for both Guanfacine and Clonidine?
Downward dose titration over 1+ week
-risk of rebound Hypertension
Side effects of Guanfacine and Clonidine
- Dyspepsia/GI distress
- Somnolence/Sedation/Fatigue
- Hypotension/Bradycardia: orthostatic hypotension
- Rare: Exacerbation of cardiac conduction abnormalities (QT prolongation, AV block)
use caution with Guanfacine and Clonidine when?
- Symptomatic CV disease (intolerant of decrease in BP): hypotension/Bradycardia
- Cardiac conduction Abnormalities
