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Chapter 3
ADHD
13
Medical
Professional
08/21/2011

Additional Medical Flashcards

 


 

Cards

Term
What is first line for ADHD ?

Name the 4 drugs considered first line

What period of no response warrants trial of a new drug ?
Definition
Psychostimulants are first line for ADHD

The 4 first line psychostimulants: Dextroamphetamine, lisdexamfetamine, & mixed salt amphetamines.

3-4 weeks of no response warrants switching to an alternate stimulant
Term
Which stimulants are long acting formulations (include brand names)?

What is the benefit of long acting stimulants ?

How are SR stimulants regularly dosed?

Which drugs are SR stimulants?

When should a drug holiday be taken?
Definition
long acting Methylphenidate (Adderall XR, Biphentin, Concerta) & Lisdexamfetamine (Vyvanse) are long acting formulations

Long acting only require once daily dosing

SR are usually dosed more than once per day.

Methylphenidate SR (Ritalin SR), and dextroamphetamine (dexedrine) are sustained release

Drug holidays should be taken when weight is reduced by 10% of initial weight
Term
What concern is there about using stimulants and atomoxetine in patients with underlying cardian anomilies ?
Definition
Cardiac events can occur such as sudden cardiac death.
Term
Atomoxetine

Is it a stimulant ?

Is it approved for ADHD ?

Is it a controlled substance ?

What is the minimum age requirement for use?

Efficacy comprable to psychostimulants?

Who is a good candidate for therapy with atomoxetine ?
Definition
Atomoxetine

It is NOT a stimulant

It IS approved for ADHD

It is NOT a controlled substance

Atomoxetine should be used in anyone 6 or older

Efficacy IS comparable to psychostimulants

Those with ADHD, and are unresponsive to stimulants, or those who have substance abuse, or depression.
Term
Antidepressants

Are they as effective as stimulants?

What comorbid conditions would make a patient a good candidate for therapy with antidepressants for ADHD ?

What 'line' is bupropion ?

When should TCAs be used ?
Definition
Antidepressants

NOT as effective as stimulants

Comorbid conditions such as depression, tic disorders, anxiety or enuresis

Bupropion is 2nd line to stimulants, along with atomoxetine

TCAs can be used when stimulants, bupropion and atomoxetine have failed or are contraindicated.
Term
Clonidine

When should it be used?

What does it primarily do? what does it NOT do for ADHD pts?
Definition
Clonidine

2nd or 3rd line

Reduces symptoms of aggression and hyperactivity, but does NOT improve attention span
Term
SGAs

When should they be used?

What does it primarily do? what does it NOT do for ADHD pts?
Definition
2nd or 3rd line

Reduces symptoms of aggression and hyperactivity, but does NOT improve attention span actually can WORSEN attention
Term
What drugs CAN be used for ADHD ?
Definition
ADHD drugs

Stimulants, Antidepressants, clonidine, SGAs
Term
Stimulants

Side effects (common, transient, significant)

Drug interactions

Counseling points
Definition
Stimulants

Side effects
COMMON: Anorexia, insomnia, irritability, HA, abdominal pain

TRANSIENT: zombie like effects, agitation, growth failure, rebound hyperactivity, leukopenia

SIGNIFICANT: Cardiac death, seizures, exacerbation of tics, hyperthyroidism

OVERDOSE: Glassy eyes, insomnia, hyperactivity
Drug interactions
MAOIs, P450 inhibitor and subtrate

Counseling points: no later dose than 4pm to avoid insomnia.
Term
Atomoxetine

Adverse events

Drug interactions
Definition
Atomoxetine

Adverse events: HA, insomnia, abdominal pain, decreased of decreased appetite vs stimulants,
SIGNIFICANT: suicide ideation, liver toxicity, sudden cardiac death

Drug interactions
Metabolized by 2D6
Term
Bupropion

Side effects

Drug Interactions
Definition
Bupropion

Side effects - similar to those of stimulants, anticholinergic effects, increased risk of seizure AVOID in patients with seizure disorders

Interactions
2D6, 3A4
Avoid use with MAOIs
Term
Clonidine

Adverse effects

Interactions
Definition
Clonidine

Adverse effects:
HoTN, sedation, worsen depression, dry mouth

Interactions:
AVOID CNS depressants & TCAs
Term
What medications are used to treat ADHD or some of its symptoms ?
Definition
Meds that can be used for ADHD

stimulants, atomoxetine, bupropion, TCAs, Clonidine, SGAs
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