ADHD Flashcards by Saaliha R

What is ADHD?

A neurodevelopmental disorder characterized by difficulties with attention, hyperactivity, and impulsivity.

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Treatment in children 5+

Methyphenidate
If not tolerated after 6 weeks = lisdexamfetamine
o This causes prolonged duration of sfx
If this is an issue for pt = dexamfetamine

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Treatment in children 5+ if both methylphenidate and lisdexamfetamine CI

atomoxetine or guanfacine

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Treatment in adults

Methyphenidate or lisdexamfetamine
o Lisdexamfetamine causes prolonged duration of sfx
o If this is an issue for pt = dexamfetamine
Atomoxetine

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Methyphenidate or lisdexamfetamine

o Lisdexamfetamine causes prolonged duration of sfx
o If this is an issue for pt = dexamfetamine

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Methylphenidate - MOA

Potent CNS stimulant.
Increased dopamine and noradrenaline levels in the brain.

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Methylphenidate is a CNS stimulant: Side effects

Causes sympathetic pathways to be excited
* High bp, Tachycardia, Arrythmias
* Behaviour and mood changes, Drowsiness and sleep disorder
* Decreased appetite, Growth retardation, Weight loss

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Methylphenidate monitoring

Monitoring = following dose adjustments then 6 monthly
* Pulse
* Bp
* Psychiatric symptoms
* Appetite
* Weight
* Height at initiation

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Methylphenidate - contraindications

CVD
Hyperthyroidism
Severe hypertension
Uncontrolled BPD
Severe depression

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Methylphenidate - MHRA (2022)

Caution when switching between MR preparations.
Prescribe by brand.

MR preparations contian immediate release and modified release components. Different preparations contain different proportions of immediate-release and modified-release components = different release profiles.

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MR preps preferred due to

Pharmacokinetic profile
Convenience – take less a day
Improved adherence

Should be prescribed as brand only

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methylphenidate - if effect wears off in evening with rebound hypersensitivity, the following may be appropriate

dose at bed time may be appropriate - establish need with trial bedtime dose

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generic methylphenidate is used for ADHD, and also for this indication (unlicensed) (using IR meds)

narcolepsy

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Take in morning with breakfast for these two brands of methylphenidate

Medikinet, Equasym

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A patient has arrhythmias - are they suitable for treatment with methylphenidate

No it is contraindicated in arrhythmias

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If a patient has dysphagia, the following three brands of methylphenidate do not have appropriate dose form due to restricted GI lumen

concerta xl, demlosart PR tabs, xaggitin xl

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Methylphenidate causes growth retardation in children -T or F

True

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Why should alcohol be avoided with methylphenidate

it might increase conc of methylphenidate

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TCAs interaction with methylphenidate

methylphenidate may increase conc of TCAs e.g. amitriptyline, imipramine, doxepin, dosulepin etc
use with caution and adjust dose

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interaction - MAOB inhibitor and methylphenidate

selegiline, rasagiline
these are predicted to increase risk of hypertensive crisis when given with methylphenidate - avoid

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interaction between methylphenidate and MAOIs

Methylphenidate causes a hypertensive crisis when given with Tranylcypromine, isocarboxazid, phenelzine

Manufacturer advises avoid and for 14 days after stopping the MAOI.

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avoid this high risk abx because methylphenidate may increase risk of elevates BP when given with it

linezolid

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Lisdexamfetamine and dexamfetamine MOA

Potent CNS stimulant.
Increases dopamine and noradrenaline levels in the brain.

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Lisdexamfetamine and dexamfetamine side effects

Study These Flashcards

Similar SFx to methylphenidate

Lisdexamfetamine and dexamfetamine overdose

* Wakefulness, excessive acitivity, paranoia, hallucinations * Hypertension * Followed by: exhaustion, convulsion, hypothermia, coma

dexamfetamine can be used (unlicensed) for refractory ADHD, initiated under specialist supervision. If the following syndrome occurs, discontinue

tics

Monitor these two parameters as growth restriction can occur during prolonged therapy with dexamfetamine

height and weight

What can you do to reduce risk of growth restriction with prolonged therapy with dexamfetamine

Drug free periods may allow catch up in growth by withdraw slowly to avoid inducing depression or renewed hyperactivity

Dexamfetamine interaction with MAOIs (2)

Predicted to increase the risk of a hypertensive crisis when given with MAOIs. Manufacturer advises avoid and for 14 days after stopping the MAOI. Also increased risk of serotonin syndrome

Dexamfetamine interactions with MAO-B inhibitors. (2)

Rasagiline, selegiline is predicted to increase the risk of severe hypertension when given with Dexamfetamine. Manufacturer advises avoid. Also increased risk of serotonin syndrome

Dexamfetamine and -perazine antipsychotics interaction

They are predicted to decrease the effects of dexamfetamine and dexamfetamine is predicted to decrease their effects

Dexamfetamine and SSRIs, SNRIs (dulox, venlfax), bupropion, TCAs, ondansetron, lithium, methadone, triptams, pethidine, vortioxetine etc

can increase the risk of serotonin syndrome

A patient presents to A&E. You are told that initially, they were very hyperactive and had hallucinations. They now seem to be very exhausted, dizzy and hyperthermic. You look at their medication list: sertraline 50mg OD, dexamfetamine 10mg OD, salamol 2 puffs up to QDS prn. What do you suspect?

Amfetamine overdose - cause akefulness, excessive activity, paranoia, hallucinations, and hypertension followed by exhaustion, convulsions, hyperthermia, and coma.

Lisdexamfetamine relationship with dexamfetamine

Lisdexamfetamine is a prodrug of dexamfetamine.

Lisdexamfetamine is contraindicated in hypo or hyperthyroidism

HYPER

Discontinue amphetamines if the following occurs

seizures

Lisdexamfetamine warning labels

This medicine may make you sleepy. If this happens, do not drive or use tools or machines. Swallow this medicine whole. Do not chew or crush.

Atomoxetine MOA

Noradrenaline reuptake inhibitor Causes increased levels of noradrenaline at the synaptic cleft

When should atomoxetine dose be taken?

morning if given as divided dose, last dose should be no later than early evening

Atomoxetine - children max licensed dose

100mg daily

Atomoxetine - adults max licensed dose

dose max of 120mg not licensed

Atomoxetine - CI

phaeochromocytoma severe CVD severe cerebrovascular disease

Avoid this drug class, and for 2 weeks after stopping it, because it is predicted to increase the risk of adverse effects when given with atomoxetine

MAOIs - tranylcypromine, phenelzine, isocarboxazid

Atomoxetine side effects

o Causes QT prolongation - Avoid concomitant drugs that prolong QT interval o Hepatotoxicity - counsel pt to report signs of toxicity e.g. N + V, malaise, dark urine, abdominal pain, jaundice o Suicidal ideations - counsel pt to report suicidal thoughts, self-harming behaviour, irritability, anxiety or depression.

Atomoxetine - monitoring

Monitor on initiation, every 6 months and after a dose change. Pulse BP Appetite Weight Height

Atomoxetine - dose adjustments in HI

1/2 dose in moderate impairment 1/4 dose in severe

Atomoxetine is …toxic so patients and carers should be advised of the rare risk and be told how to recognise symptoms; prompt medical attention should be sought in the case of ….

Hepatotoxic Jaundice, unexplained n/v, malaise, dark urine, abdominal pain

Atomoxetine - label

This medicine may make you sleepy. If this happens, do not drive or use tools or machines

Atomoxetine is associated with sexual dysfunction - T or F

True

Guanfacine - cautions

Bradycardia (risk TDP) Heart block (risk TDP) History CVD History QT interval prolongation Hypokalaemia (risk TDP)

Guanfacine - Signs of overdose

hypotension, initial hypertension, bradycardia, lethargy, and respiratory depression patients who develop lethargy should be observed for development of more serious toxicity for up to 24 hours

Guanfacine - contraception

Contraception needed? effective contraception in females of childbearing potential

True of false - you need to measure BMI after treatment for Guanfacine

false take BMI before, then every 3 months for 1 year, then every 6 months

True or false - you need to monitor BP and pulse regularly in pt taking guanfacine

False - monitor these during dose downward titration and following discontinuation of treatment

True or false - unlike the amphetamines and atomoxetine, you can abruptly withdraw guanfacine

False - avoid abrupt withdrawal; consider dose tapering to minimise potential withdrawal effects.

Is there any special directions for administration for guanfacine?

Manufacturer advises avoid administration with high fat meals (may increase absorption).

Guanfacine labels

Warning: This medicine may make you sleepy. If this happens, do not drive or use tools or machines. Do not drink alcohol. Swallow this medicine whole. Do not chew or crush.

Do ADHD drugs cause weight GAIN or weight LOSS

weight loss

ADHD Flashcards

(58 cards)