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Drugs and ADHD
Pharmacotherapy Exam 4
43
Pharmacology
Professional
04/24/2013

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Cards

Term
selective NE reuptake inhibitor
Definition
strattera (atomoxetine)
Term
alpha-2 agonist
Definition
clonidine and guanifacine ER
Term
others drugs used in ADHD
Definition
anticonvulsants, lithium and bupropion
Term
atypical antipsychotics (dopamine antagonists)
Definition
rispiridone, Geodon (ziprasodone), Zyprexa (olanzapine), Abilify (aripiprazol)
Term
first and second line for ADHD
Definition
methylphenidate or dexmethylphenidate switched with dextroamphetamine or mexed amphet salts
Term
third line for ADHD
Definition
atomoxetine (Strattera), guanfacine ER, clonidine or bupropion
Term
fourth line for ADHD
Definition
consider combo of first-third line agents or TCA
Term
First line for Tourrette's disorder comorbidity
Definition
atypical antipsychotic, lithium, anticonvulsant
Term
response to first line but ADHD persists for Tourrette's disorder comorbidity
Definition
add stimulant
Term
inadequate response for Tourrette's disorder comorbidity
Definition
alternative or additional mood stabilizer
Term
First line for anxiety/depression disorder comorbidity
Definition
psychotherapy and antidepressant
Term
response to first line but for anxiety/depression disorder comorbidity
Definition
add stimulant
Term
inadequate response for anxiety/depression disorder comorbidity
Definition
alternative antidepressant
Term
first line for bipolar/ severe aggression comorbidity
Definition
atypical antipsychoits, lithium or anticonvulsant
Term
Response by ADHD persists for bipolar/ severe aggression comorbidity
Definition
add stimulant
Term
inadequate response for bipolar/ severe aggression comorbidity
Definition
alternative or additional mood stabilizer
Term
short acting (BID, TID)
Definition
ritalin, methylin, focalin, dexadrine, dextrostat
Term
intermediate (BID)
Definition
ritalin SR, methylin ER, metadate ER, methylphenidate ER, dexadrine spansule, adderall
Term
long acting once daily
Definition
ritalin LA, metadate CD, methylphenidate transdermal, daytrana, adderall, concerta
Term
concerta
Definition
uses oral osmotic CR delivery, other preps use IR and ER beads
Term
daytran
Definition
provides 12 hours of symptom control when worn for 9 hours, apply patch 2 hours before desired effect
Term
older wax matrix (ritalin)
Definition
less effective and not used as much
Term
strattera (atomoxetine)
Definition
selective NE reuptake inhibitor, the first to be approved for ADHD
Term
no potential for abuse, but slower onset
Definition
strattera (atomoxetine)
Term
alpha-2 antagonists (guanfacine/clonidine)
Definition
less effective alternatives to stimulant, atomoxetine and bupropion monotherapy (good for adjunct to reduce disruptive behavior, control aggression and improve sleep)
Term
lithium/ anticonvulsants
Definition
used increasingly to control aggression and explosive behavior
Term
antipsychotics
Definition
controls severe aggression in refractory cases of ADHD, especially if conduct disorder or bipolar disorder comorbidity is present
Term
conventional antipsychotics
Definition
not used that frequently now that we have atypical antipsychotics
Term
BBW of new onset suicidality
Definition
strattera and TCA (children/adolescents)
Term
BBW of psychosis/mania, aggression/violent behavior, severe anxiety or panic attacks
Definition
strattera and stimulants
Term
growth suppression
Definition
stimulants > strattera
Term
severe liver dysfunction
Definition
atomoxetine carries warning for this
Term
cardiac sudden death in children and adults
Definition
stimulants
Term
stimulants SE mitigation: reduced appetite/ wt loss
Definition
high calorie meal when stimulant effects are low (breakfast and bedtime)
Term
stimulants SE mitigation: stomach ache
Definition
give on full stomach and lower dose if possible
Term
stimulants SE mitigation: insomnia
Definition
give dose earlier in day; lower the first dose of day or give it earlier; consider a sedating medication at bedtime
Term
stimulants SE mitigation: HA
Definition
divide dose, give with food or give analgesic (tyleno, advil)
Term
stimulants SE mitigation: rebound symptoms
Definition
consider long-acting stimulant trial, atomoxetine or antidepressant
Term
sedating meds at bedtime if needed for stimulant effects
Definition
guanfacine, clonidine, melatonin, or cyproheptadine
Term
stimulants SE mitigation: irritability/jitteriness
Definition
assess for comorbid condition (bipolar disorder), reduce dose, consider mood stabilizer (lithium, valproate) or atypical antipsychotic
Term
stimulants SE mitigation: zombie-like
Definition
reduce dose and consider alt therapy
Term
stimulants SE mitigation: hypertension, pulse fluctuations or dysphoria
Definition
reduce dose or change med
Term
stimulants SE mitigation: hallucinations
Definition
discontinue stimulant, reassess diagnosis, mood stabilizer and/ or atypical antipsychotic may be needed
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