ADHD Flashcards
Stimulant drugs for ADHD should be trialed for ___ and continued for ____ if responding.
Stimulant drugs for ADHD should be trialed for 3-4wks, and continued for 6-12mths if responding, with follow ups every 3 mths.
long acting stimulants are first line because
they last 8-14h which decreases abuse and rebound sx and also improves adherence
intermediate acting stimulants should be used
as adjuncts and dosed no later than 4pm as they last up to 8 hours
what are contraindications to stimulants?
hypersensitivity, symptomatic CVD (including moderate to severe HTN), uncontrolled hyperthyroidism, history of drug abuse or MAOI use
What is Modafinil’s place in therapy?
It’s a less effective CNS stimulant that isn’t approved or used for ADHD
What safety parameters should be monitored in patients starting stimulants?
increased HR & BP - monitor week 1 then q3m
GI upset decreased appetite - monitor weight Q2W F6M then Q6M
neuro (anxiety, dizziness, irritability, insomnia, headache) - monitor week 1 then monthly F3M then Q6M
What are signs of stimulant overdose?
glassy eyes, insomnia, hyperactivity
What are rare side effects of stimulants?
leukopenia, insomnia, hyperactivity
What should be recommended for patients with a history of psychosis?
Try non stimulant options like atomoxetine or guanfacine first since stimulants can increase the risk of psychosis
what is the onset of stimulants?
1 week
what are second and third line options?
2nd: atomoxetine (NRI), guanfacine (a2 adrenergic)
3rd: clonidine, antidepressants (bupropion, venlafaxine, TCAs)
when should stimulant meds be reassessed?
usually once a year during the summer months, a drug holiday is trialed to reassess need for tx.
can stimulants be abruptly discontinued?
abrupt discontinuation may cause withdrawal symptoms in some, so consider tapering over weeks in patients who have been on tx for over 3 months
What are the 4 intermediate acting stimulants?
Dexedrine (dextroamphetamine) IR (don’t crush) BID, SR (can sprinkle) QAM
Ritalin (methylphenidate) IR TID, SR BID (may combine w IR)
What are the 5 long acting stimulants?
Vyvanse (lisdexamfetamine) Adderal XR (mixed salts amphetamine ER) Biphentin (methylphenidate CR) Foquest (methylphenidate CR) Concerta (methylphenidate bilayer CR) All except Concerta can be sprinkled on food & Vyvanse can be mixed in water
