Stimulants Flashcards
What is the overall MOA for stimulants for ADHD?
Enhance NT transmission by serving as direct and indirect non-catecholamine sympatheticomimetics.
Blocks presynaptic reuptake, interference with VMAT and increase NT release.
What is the “main activity” of Methylphenidate?
Inhibition of DA reuptake and inhibition of NT presynaptic reuptake.
Common S/E of stimulants:
Dyspepsia/GI distress HA Decreased appetite Insomnia Anxiety Irritability Elevated BP/HR
Rare S/E of stimulants:
Priapism Seizures Sudden cardiac death Stroke/MI Chemical leukoderma**
Which patients should you be cautious of when prescribing stimulants?
Pts. w/ anxiety/agitation CVD Mod-severe HTN Glaucoma Motor tics or Tourette's Mania/psychoses Seizures H/O drug abuse
What is the usual onset of stimulants?
They are __________. This means what?
Usually 24 hrs.
Controlled substances (1 mo. supply, no refills, no samples).
What are the 4 immediate release stimulants? What is the form?
Dextroamphetamine/AMP (Adderall) - tab
Dextroamphetamine sulfate (ProCentra) - liquid
Amphetamine sulfate (Evekeo) - capsule
Dextroamphetamine (Zenzidi) - tab
What are the 5 extended release stimulants? What is their form?
Dextroamphetamine (Adderall XR) - capsule
Dextroamphetamine (Dexedrine) - capsule
Amphetamine (Dyanavel XR) - liquid
Lisdexamfetamine (Vyvanse) - capsule
Amphetamine mixed salts (Mydayis) - capsule
What kind of stimulant is Adzenys?
Who is it indicated for?
What is the dosing?
XR-oral dissociative tablet (no water needed).
Approved for > 6 y/o
QD dosing
What are the 3 immediate release Methylphenidate-based stimulants? What is their form?
Dexmethylphenidate (Focalin) - tab
Methylphenidate (Methylin oral solution) - liquid
Methylphenidate (Ritalin) - tab
What are the 2 sustained release Methylphenidate-based stimulants? What is their form?
Methylphenidate (Ritalin SR) - tab
Methamphetamine (Desoxyn) - tab
What is the onset of activity for non-stimulants?
What is the best for these drugs?
What is the scheduling?
1-4+ weeks
Useful in pts. intolerant of stimulant effects or pts. resistant to using stimulants.
Non-scheduled; refills and samples permitted up to 1 year.
What is the main non-stimulants med?
How long of a duration?
What form is it in?
Who is it approved for?
What’s the dosing?
What metabolizes it?
What must you not do to the capsule?
Atomoxetine (Strattera ER)
24 hrs.
Capsule
Ages >6 y/o
QD dosing
CYP2D6
Don’t open it! It can irritate the eyes.
What are the 2 anti-hypertensives used to treat ADHD? What is their form?
What is the duration?
What are the side-effects?
What is the dosing?
What must be done when discontinued? What is the major risk if not done?
Clonidine (Kapvay ER) - tab
Guanfacine (Intuniv ER) - tab
12-24 hrs.
Fatigue, drowsiness, dizziness, dry mouth, irritability, low BP, etc.
QD dosing
Downward dose titration over 1+ weeks (depending on dose. Risk of rebound HTN!
