ADHD Flashcards

Question

Dexmethylphenidate / Serdexmethylphenidate

Answer 1

2h onset of effect 10-12 hour duration of effect Usual dosage 52.3mg for ser-dex and 10.4mg for dex-MPH • Serdexmethylphenidate pro-drug of dexmethylphenidate • Risk suicidal ideation

Answer 2

Jornay PM Multiple Layer Beads - Unique Product Onset of Effect >/10 hours Duration of Effect 24-36h Usual dosage 25-100mg QD • No more than 5% of total drug absorbed in first 10 hours • Administer between 6:30-9:30 PM Sprinkle-able *Not recommended to convert mg to mg from other methylphenidate products*

Answer 3

Pharmacokinetics -Selectively inhibits presynaptic reuptake of DA & NE → increased neurotransmitter activity in the CNS -DA >> NE -Time to peak concentrations can be delayed by high fat meals Dosing -Titrate weekly until clinical response observed -IR products dosed at least BID *Preferred for patients <16 kg* -Afternoon IR dose should not be given <6 hours before bedtime

Answer 4

Methylphenidate! Even though it doesn’t have the FDA approval

Answer 5

• Ramp effect: behavioral effects are proportional to the rate of methylphenidate absorption into CNS • Use in caution in patients with glaucoma, tics, psychosis, and concurrent monoamine oxidase inhibitor (MAOI) use • Safe/effective in patients with epilepsy • Priapism reported in pediatrics and adults after prolonged exposure, dose increases, or drug withdrawal

Answer 6

Adderrall 5-8h duration of effect Usual dosage 5-20 mg BID MDD 40 mg **FDA approved in children 3 yo and older**

Answer 7

Evekeo 4-6h duration of effect Usual dosage 5-40 mg Qday to BID (start@2.5 mg in 3-5 y/o) **FDA approved in children 3 yo and older**

Answer 8

Evekeo ODT 4-6h duration of effect Usual dosage 10-40mg QD

Answer 9

Adderall XR Duration of effect 10 hours Usual dosage 5-30 mg QAM MDD 30 mg • **50% IR & 50% ER** • May be opened and sprinkled on applesauce

Answer 10

Dayanavel XR Duration of effect 8-10h Usual dosage 2.5-5 mg Qday MDD 20 mg • **Dose conversion NOT 1:1 – must retitrate** Side effects: epistaxis (nose bleed), upper abdominal pain, allergic rhinitis

Answer 11

Adzenys XR-ODT Duration of effect 10-12 hours Usual dosage 6.3-12.5 mg QD DO NOT CHEW - ODT must be dissolved

Answer 12

Adzenys ER Duration of effect 10-12h Usual dosage 6.3-12.5 mg QD

Answer 13

Mydayis Duration of Effect *16h* (longest of amphetamine agents) Usual dosage 12-50 mg QD **FDA approval ONLY for >/13 years old** MDD 50 mg adults / 25 mg adolescents **Cannot convert mg-to-mg with other amphetamines** Triple time release beads within capsule to reduce medication wearing off

Answer 14

Dexedrine, Zenzedi Duration of effect 4-6h Usual dosage 2.5 mg – 40 mg per day

Answer 15

ProCentra Duration of effect 4-6h Usual dosage 2.5 mg – 40 mg per day

Answer 16

Dexedrine Spansule Duration of effect 6-10h Usual dosage 5-40 mg QD

Answer 17

Vyvanse Duration of effect 8-14h Usual dosage 10-30 mg QAM MDD 70 mg • **Designed for less abuse potential**

Answer 18

Xelstrym FDA approved for **>/6 years & adults** Dosage ranges 4.5-18mg Usual dosage 4.5 mg/9h Qday MDD 18 mg/9H Apply 2h before effect is needed Can apply to Hip, upper arm, chest, upper back, flank Max wear time of 9 hours 3h of effect after removal <10% dextroamphetamine remains in patch Application Site Reactions: Pain, itchiness (resolves with wear)

Answer 19

-Increase the release of DA and NE into the synapse from pre-synaptic nerve terminal (different from MPH which inhibits presynaptic reuptake) -Enhance release of NE in periphery -High doses – stimulate serotonin release and acts as serotonin agonist -High fat meals delay time to peak concentration

Answer 20

Preferred stimulant in *adults* Dosing -Titrate weekly until clinical response -IR formulations given at least BID -Preferred for <5 years old -Afternoon dose should not be given <6 hours before bedtime Contraindications -**Not** the preferred agent if patient has **history of cardiovascular disease (moderate to severe HTN, arrhythmias, heart failure, recent MI)**

Answer 21

**MPH recommended first line** medication -Strongest safety/efficacy in this population, but available evidence NOT strong enough for FDA approval AMP only medication with FDA approval because FDA approval was less stringent at time of drug development **Non-stimulants NOT recommended for treatment in ages 4-5 years** Pharmacologic treatment reserved for: -Moderate-to-severe dysfunction, persisting for at least 9 months, manifesting at home and at school, not responding adequately to PTBM

Answer 22

Strattera Norepinephrine Reuptake Inhibitor Dosed QD-BID, BID to improve tolerability in children **Onset of effect 1-2 WEEKS** Duration of effect 10-12 hours Usual dosage range 5-20mg BID ; MDD 40mg Potential for **liver toxicity** with long term use Increased concentrations by paroxetine & fluoxetine Behavior may worsen initially

Answer 23

Qelbree Norepinephrine Reuptake Inhibitor 1 dose per day **Onset of Effect 1-2 WEEKS** Duration of effect 24h Usual dosage range: 100 – 600 mg Qday <17 y/o: MDD 400 mg Adults: MDD 600 mg **Renal dose adjustment required** Lots of DDIs: Viloxazine (strong CYP1A2 inhibitor, weak CYP2D6 & CYP3A4 inhibitor): • Antidepressants – duloxetine, fluoxetine, paroxetine, venlafaxine, TCA’s • Antipsychotics – aripiprazole, asenapine, chlorpromazine, clozapine, olanzapine, perphenazine, risperidone, thioridazine • Benzodiazepines • Buprenorphine, hydrocodone, methadone, oxycodone (Can’t use Viloxazine in pt getting methadone from clinic)

Answer 24

Atomoxetine and Viloxazine ER • Inhibits pre-synaptic reuptake of norepinephrine • Safe and effective in children, teenagers and adults • Head-to-head trials show *stimulants have greater efficacy than atomoxetine* • Full benefit may not be seen for 6-8 weeks Adverse effects: • Upset stomach, psychiatric, and **cardiovascular effects (QTc prolongation)** • **Not recommended in those with structural heart defects or serious heart problems** • Greater risk fatigue, sedation, and dizziness • Only FDA approved ADHD medication with a **BBW for new-onset suicidality** Drug interactions: (agent specific not included) • Do not use in combination with one another • QTc prolonging medications (antipsychotics, TCA’s)

Answer 25

Kapvay Alpha-Adrenergic Receptor Agonists Dosed 1-2 times a day **Onset of Effect 1-2 WEEKS** Duration of effect 10-12h Usual dosage range: 0.1 mg QHS or BID MDD 0.4 mg Commonly added adjunct to stimulants See general class card for more info

Answer 26

Intuniv Alpha-Adrenergic Receptor Agonists Dosed QD **Onset of Effect 1-2 WEEKS** Duration of effect 18 hours Usual dosage range: 1-4 mg QD MDD 7 mg See class card for more info

Answer 27

Clonidine ER and Guanfacine ER • Increase blood flow to pre-frontal cortex (enhances working memory and executive functioning) and inhibits norepinephrine release • Not as effective as stimulants for monotherapy (nothing is) Adverse effects: • Sedation/dizziness • Hypotension • Constipation • **Heart block** Extended release *should not be taken with a high fat meal*

Answer 28

50-300 mg/day (3-6 mg/kg/day for all formulations) Weak dopamine and norepinephrine reuptake inhibitor Found beneficial in adolescents with ADHD and depression Metabolized faster in prepubertal children → BID dosing optimal for dosing (even in SR formulations) Adverse effects: -Less appetite suppression and weight loss compared to stimulants -**Seizures - lowers seizure threshold, don’t use in pt who have seizures**

Answer 29

Dr. Burns skipped past, doesn’t like these as an option Imipramine: 50-150 mg/day Desipramine: MDD 300 mg/day Nortriptyline: MDD 300 mg/day Up to 4 weeks to see maximum effects Adverse effects -Sedation/dizziness -Constipation -Heart block -Weight gain -Overdose toxicity* -Rapid heart beat

Answer 30

Lithium, valproate, carbamazepine Effective for: -Aggression -Explosive behavior -Impulsivity -Childhood-onset bipolar disorder or combined ADHD-bipolar disorder

Answer 31

Usually used with stimulants in patients with ADHD We normally stay away from FGA because EPS risk Chlorpromazine & haloperidol -Hyperactivity -Impulsivity -Negative effects on learning, cognitive function, and can cause extrapyramidal side effects Second generation: risperidone, olanzapine, quetiapine, ziprasidone, & aripiprazole -Severe aggression (comorbid conduct or bipolar disorder) -Risk of metabolic syndrome

Answer 32

-Methylphenidate formulations less likely to have drug interactions than amphetamine salts -Males have increased bioavailability of methylphenidate compared to females -Monitoring all agents: Height, weight, eating, sleeping patterns – baseline and every 3 months Atomoxetine/viloxazine/bupropion: adequate trial = 6 weeks at maximum tolerated dose Guanfacine/clonidine: monitor blood pressure and pulse; adequate trial = 1-2 months -EKG not mandatory, but often completed

Answer 33

Non-stimulants Patches ER formulations

ADHD Flashcards

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