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PT2 Psyche 1-6 > ADHD pharmacology and therapeutics > Flashcards

ADHD pharmacology and therapeutics Flashcards

1
Q

two general types of ADHD symptoms

A
  • inattention

- hyperactivity and impulsivity

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2
Q

factors that contribute to ADHD

A
  • genetics
  • maternal smoking
  • preterm birth or low birth weight
  • deficits in monoamine NT system
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3
Q

childhood diagnosis criteria

A
  • at least 6 symptoms
  • before age 12
  • at least 6 months in duration
  • symptoms present in two or more settings
  • symptoms interfere with life
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4
Q

adult diagnosis criteria

A
  • at least 5 symptoms
  • present before age 12
  • last at least 6 months
  • in two or more settings
  • symptoms interfere with lifeS
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5
Q

inattention symptoms

A
  • fails to give attention to detail
  • careless mistakes
  • trouble holding attention
  • does not seem to listen
  • does not follow through on instructions
  • fails to finish work
  • avoids or is reluctant to do tasks that take a long period of time
  • loses things needed for tasks
  • easily distracted
  • forgetful
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6
Q

hyperactivity and impulsivity symptoms

A
  • difficulty organizing tasks
  • excessive talking, fidgeting
  • runs about or climbs when not appropriate
  • unable to play or have leisure quietly
  • often on the go
  • talks excessively
  • blurts out answers
  • has trouble waiting for their turn
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7
Q

3 types of presentation

A
  • combined
  • mostly inattentive
  • mostly hyperactive-impulsive
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8
Q

most common presentation in adults

A

inattentive

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9
Q

common comorbid conditions

A
  • anxiety
  • mood disorders
  • learning disabilities
  • medical conditions
  • substance abuse
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10
Q

non-stimulant ADHD medications

A 
clonidine
guanfacine
atomoxetine
modafinil
armodafinil
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11
Q

target of stimulant drugs

A

monamine transporters

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12
Q

primary NE pathway

A

dorsal noradrenergic bundle

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13
Q

role of the NE pathway

A

mediates orienting response, selective attention, and vigilance (helps response to sensory stimulation and filtering)

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14
Q

cocaine CNS MoA

A

prevents reuptake of dopamine, serotonin and norepinephrine

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15
Q

cocaine anesthesia MoA

A

inactivates sodium channels and stops depolarization

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16
Q

cocaine uses

A

local anesthesia, usually EENT

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17
Q

amphetamines general MoA

A
  • taken up via NET and inhibits VMAT
  • increases release of dopamine, NE, and serotonin
  • not dependent on firing rate of neuron
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18
Q

general structure of amphetamines

A

phenyl ethyl amine

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19
Q

pharmacological effect of amphetamines

A
  • increase mood
  • improved attention span and alertness
  • euphoria at high doses
  • reduced appetite
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20
Q

amphetamines adverse effects

A
  • euphoria
  • restlessness
  • tremor
  • anxiety
  • dizziness
  • insomnia
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21
Q

dextroamphetamine

A

enantiomer of amphetamine that is more potent and centrally active

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22
Q

adderall

A

combination of dextroamphetamine and amphetamine

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23
Q

methylphenidate MoA

A
  • blocks reuptake transporter in the synapse

- dependent on firing rate of neuron

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24
Q

stimulants adverse effects

A
  • reduced appetite
  • stomachache
  • insomnia
  • headache
  • rebound symptoms
  • irritability/jitteriness
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25
Q

atomoxetine MoA

A

selective presynaptic NE reuptake inhibitor

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26
Q

atomoxetine side effects

A
  • nausea
  • anorexia
  • increased BP
  • insomnia
  • fatigue
  • sedation
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27
Q

clonidine MoA

A

alpha 2 adrenergic agonist, inhibits NE release presynaptically

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28
Q

clonidine adverse effects

A
  • sedation
  • hypotension
  • constipation
  • bradycardia
  • syncope
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29
Q

guanfacine MoA

A

alpha 2 adrenergic agonist that is more selective than clonidine

30
Q

guanfacine adverse effects

A
  • sedation
  • hypotension
  • constipation
  • bradycardia
  • syncope
31
Q

guanfacine PK

A
  • longer half life and duration than clonidine

- more selective alpha 2 means less sedation and dizziness

32
Q

treatment goals for ADHD

A

specific for the patient involving reduced symptoms

33
Q

ADHD in ages 6-11

A
  • usually combined inattentive and hyperactive/impulsive
  • crucial time for development of self
  • accurate diagnosis/treatment is crucial
  • most studied group
34
Q

nonpharm therapy for ADHD

A
  • parent training
  • education on ADHD
  • coordinate care between parents, teachers, clinicians
  • behavior interventions
35
Q

behavior interventions

A
  • positive rewards for good behavior
  • break up homework into shorter segments
  • individualized educate programs
  • cognitive behavioral therapy
  • external organizer
36
Q

selection of drugs for ADHD

A
  • methylphenidate OR amphetamines
  • if inadequate response try the other drug
  • if still inadequate response try non-stimulants
  • if still inadequate try a combination or TCA
37
Q

patients to avoid stimulants in

A
  • bipolar
  • psychosis
  • substance abuse
  • anxiety
38
Q

general dosing for stimulants

A
  • start at lower dose and titrate to find max efficacy with min side effects
  • food can delay absorption
39
Q

symptoms that should improve with stimulants

A
  • hyperactivity
  • attention span
  • impulsivity
  • compliance
  • aggression
  • social interactions
  • academic productivity
40
Q

IR dosing

A

BID or TID

41
Q

dextroamphetamine onset

A

30-60 mins

42
Q

dextroamphetamine duration

A

IR 4-6 hours

43
Q

adderall onset

A

20-60 mins

44
Q

adderall IR duration

A

6 hours

45
Q

adderall XR duration

A

10-12 hours

46
Q

lisdexamfetamine (vyvanse) onset

A

1 hour

47
Q

lisdexamfetamine duration

A

over 12 hours

48
Q

methylphenidate onset

A

30-60 mins

49
Q

drug with ghost tablet

A

methylphenidate ER (Concerta)

50
Q

daytrana patch onset

A

2 hours

51
Q

daytrana patch duration

A

up to 3 hours after taking patch off for total of 12 hours

52
Q

daytrana patch application

A

in hip area for 9 hours at a time

53
Q

quillivant XR

A

oral suspension

54
Q

quillivant onset

A

4-5 hours

55
Q

quillivant duration

A

12 hours

56
Q

dexmethylphenidate onset

A

20-60 mins

57
Q

dexmethylphenidate duration

A

IR-5 hours

XR-12 hours

58
Q

risks when using stimulants

A
  • BBW for CV risk so avoid if known cardiac abnormalities
  • growth may be decreased
  • potential for psychosis or mania
59
Q

contraindications of stimulants

A
  • hypersensitivity
  • MAO-I use in last 14 days
  • anxiety, active psychosis
  • untreated hyperthyroidism or HTN
  • structural or symptomatic CV disease
60
Q

what are some things that are not contraindications

A
  • Hx drug abouse
  • seizure disorders
  • Tourettes
61
Q

stimulants drug interactions

A
  • MAO-I

- antihypertensives (still ok to use though)

62
Q

atomoxetine place in therapy

A

used alone or in combination with stimulants

63
Q

atomoxetine dosing

A

QAM or BId

takes up to 2-4 weeks for benefit

64
Q

clonidine place in therapy

A
  • alone or in combination with stimulants

- useful for disruptive behavior, aggression, or improving sleep

65
Q

guanfacine place in therapy

A
  • alone or in combo with stimulants
  • useful for disruptive behavior, aggression, and sleep
  • longer half life than clonidine
  • less sedation and dizziness
66
Q

bupropion MoA

A

weak dopamine and NE reuptake inhibitor

67
Q

bupropion place in therapy

A
  • more benefit seen in children
  • less effective than stimulants
  • less appetite suppression
  • onset in 2-4 weeks
68
Q

bupropion adverse effects

A

nausea
rash
seizures
tics

69
Q

TCA MoA

A

serotonin-NE reuptake inhibitor

70
Q

most studied TCAs

A

imipramine and desipramine

71
Q

TCA place in therapy

A
  • last line

- onset 2-4 weeks

PT2 Psyche 1-6 (6 decks)

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