ADHD

Question 1

CNS Stimulants

Answer 1

Most effective. Diminish after 2-3 years. Controlled substances
IND: ADHD
MOA: Stimulate release of NE and Dopamine, block reuptake, stimulates the cerebral cortex. Increase alertness and confidence. Long term; physical dependence.
BOX: Abuse and dependence, high potential
CON:
ADR: Insomnia. Loss of appetite/weight loss especially in pediatrics so counsel parents for a big breakfast. Hypertension/tachycardia. Psychosis

Question 2

Dextroamphetamine

Answer 2

IND: ADHD
MOA: Enantiomer of CNS stimulant. 3:1 dextro:levo
BOX: Sudden death from CV events
CON: Arteriosclerosis, CV dz, HTN, hyperthyroidism, glaucoma, agitation, Hx of drug abuse, use with MAOIs
ADR: HTN, tachycardia, palpitations, appetite suppression, insomnia

Question 3

Lisdexamfetamine

Answer 3

IND: ADHD, binge eating
MOA: CNS stimulant. Prodrug of dextroamphetamine with L-lysine. Lower abuse potential
BOX: n/a
CON: MAOIs
ADR: HTN, tachycardia, Appetite suppression

Question 4

Methylphenidate

Answer 4

IND: ADHD, narcolepsy
MOA: CNS Stimulant. 50/50 dexmethylphenidate and levo
BOX:
CON: MAOIs, anxiety, tension, agitation, Tourette’s
ADR: LESS CV risk. Insomnia and weight loss still present
Patch type available for pts who need it

Question 5

Dexmethylphenidate

Answer 5

IND: ADHD
MOA: CNS stimulant. More potent
BOX:
CON: MAOIs
ADR: Insomnia, jitters, Appetite suppression

Question 6

Serdexmethylphenidate/Dexmethylphenidate

Answer 6

IND: ADHD
MOA: CNS Stimulant 30:70. “Ser” is the prodrug
BOX:
CON: MAOIs
ADR: Insomnia, jitters, appetite suppression

Question 7

Non-stimulants

Answer 7

Less effective
Monotherapy or adjunct
NOT controlled substances

Question 8

Atomoxetine

Answer 8

IND: ADHD
MOA: Selectively inhibits reuptake of NE. Initial response takes 1-3 days, peak at 1-3 weeks
BOX: Suicidal ideation in kids/YA
CON: MAOIs, NAG, CV dz, or Pheochromocytoma
ADR: HA, insomnia, GI/appetite suppression, hyperhydrosis

Question 9

Viloxazine

Answer 9

IND: ADHD
MOA: Inhibits reuptake of NE. 1-3 days, 1-3 weeks
BOX: Suicidal ideation in kids/YA
CON: MAOIs, CYP substrates
ADR: HTN/tachycardia, drowsy

Question 10

Guanfacine

Answer 10

IND: ADHD, autism, HTN, Tics
MOA: Alpha 2 adrenoreceptor agonist. CNS; improves prefrontal cortex neurons (memory and behavior)
PNS; reduce sympathetic nerve impulses = decreased vasomotor tone and heart rate
BOX:
CON:
ADR: Drowsy, HA, fatigue. App suppression, ab pain. Hypotension

Question 11

Clonidine

Answer 11

IND: ADHD, HTN, menopause
MOA: Alpha 2a adrenoreceptor agonist
BOX: 
CON: 
ADR: Hypotension
Comes as patches for HTN treatment