Stimulants + Non stimulant ADHD meds Flashcards
note–a bunch of stimulant review is in the ADHD section (CADDRA guidelines)
list the 3 formulations of amphetamines
dexedrine (dextroamphetamine)–> tablets (IR) or spansules (XR)
vyvanse (lisdexamphetamine)
adderall XR (dextropamphetamine)
list the formulations of methylphenidate available
Ritalin (IR or SR)
Biphentin
Concerta (OROS)
what assessments should be done before starting ANY stimulant
BP, HR
height, weight
(ECG only if cardiac history or other clinical concern)
how quickly should you be adjusting stimulant doses
can do every 7 days
side effects of stimulant medications
insomnia
irritability (?more with amphetamine rather than methylphenidate)
headache
anxiety
appetite suppression
weight loss
N/V/D
?worsened tics
tachycardia
HTN
growth delay (?1 inch with sustained stimulant use)
**in OSCE, mention cardiac risks/black box warning for monitoring for cardiac risks
**in OSCE, mention risk for diversion and misuse of stimulants
max dose of adderall
30mg po daily
max dose of vyvanse
60mg po daily
max dose for dexedrine
30mg/day for kids
40mg/day for adults
how long does vyvanse last
13-14 hours
how long does dexedrine last
4 hours for tablets
6-8 hours for spansules
how long does adderall XR last
12 hours
how long does ritalin last
3-4 hours
what is the max dose of ritalin
60mg /day
CADDRA says up to 100mg for adults
how long does biphentin last
10-12 hours
how long does concerta last
12 hours
must be swallowed whole
how long does foquest last
up to 16 hours
max dose of biphentin
60mg/day for kids
80mg/day for adults
max dose of concerta
54mg/day for kids
72mg/day for adults
other than ADHD, what is an indication for ritalin
depression in the medically unwell
what is a black box warning/concern with atomoxetine
warn of risk of SI with atomoxetine
you should use caution with atomoxetine in the setting of which medical comorbidity
asthma
side effects of atomoxetine
tachycardia
HTN
anxiety
N/V/D
irritability
headache
weight loss
doesnt worsen tics
in which population might atomoxetine be particularly useful
those with SUD history
cant be diverted/abused
max dose of atomoxetine
1.4mg/kg/day
or 100mg/day
what is the mechanism of atomoxetine
selective norepinephrine reuptake inhibitor
max dose of guanfacine
4mg/day in kids
7mg/day in adults
max dose of clonidine
1.2mg/day
guanfacine is first line for what disorder
tics
side effects of guanfacine, clonidine
drowsiness
dizziness
fatigue
bradycardia
syncope
hypotension
dry mouth/eyes
nausea
constipation
list indications for modafinil
1st line for hypersomnolence disorder and narcolepsy
2nd line for MDD adjunct
3rd line for ADHD
used for fatigue caused by cancer, MS, OSA
is modafinil recommended in peds
no
