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Flashcards in ADHD Deck (33):
1

Metadote CD, Ritalin LA, Quillivant XR/Quillichew ER, Concerta are all?

Long acting methylphenidates

10-12 hours

 

2

Ritalin SR, Metadote ER, Methylin ER are all?

3-8 hours intermidiate 

Methylphenidates 

 

3

Dexedrine Spansule what is it and what is its DOA?

Dextroamphetamine 

6-8 hours 

4

Adverse effects of stimulants?

- Anorexia - GI distress - Insomnia - Rebound symptoms - Irritability - Dysphoria - Zombie state

5

What is the delay with Daytrana?

2 hour delay 

6

DSM-5 6 or more of the following

  •  Careless
  • Difficultly sustaining attention in activity
  •  Unable to listen
  •  Fails to finish school work, doesnt follow through with instructions
  •  Difficulty organizing tasks
  •  Loses important things
  •  Easily distracted
  • Forgetful in daily activities

7

Adderall XR (50/50)

is a? what is its DOA?

Levoamphetamine and dextroamphetamine

8-12 hours 

8

Ritalin, Methylin, Methylin Oral Liquid are all?

Short acting methylphenidates

3-5 hours 

9

What are the advantages of long acting stimulants?

  • Once daily dosing
  • Extra coverage for extracurricular activities
  • Privacy issues
  • Store them at home so you know theyre taking it. 

 

10

What are the disadvantages of methylphenidate?

  • Intermediate acting are too short acting for most patients
  • – Erratic peaks and troughs w/ intermediate acting
  • – Concerta- risk of obstruction in patients with GI narrowing
  • – Transdermal – slow onset (2 hours)
  • – Redness from the patch

11

Nonpharm treatment for ADHD

  •  Behavioral interventions
  • Individualized education program
  • Shorter homework Adults
  • Organizers and regular schedules

12

Daytrana transdermal is?

Long acting 10-12 hours Methylphenidate

13

Non-stimulant medications?

  • Atomoxetine
  • Bupropion
  • TCA
  • Clonidine ER (Kapvay)
  • Guanfacine XR (Intuniv)
  • Atomoxetine, Clonidine, Guanfacine are FDA approved 

14

Dosing principles for psychostimulants?

  • Start low
  • Increase every 3-4 days or weekly until there is a response
  • Initial response is typically rapid
  • Drug holidays
  • If one fails you can switch to another 
  • If there isnt a response reconsider diagnosis 

15

Adderall is a? what is its DOA?

5-7 its a levoamphetamine or Dextroamphetamine

 

16

Subtypes of ADHD?

Inattention Hyperactivity or impulsivity.

17

Counseling tips for patients

  • How to take the meds/ what its for
  • What ADHD is, risk of untreated ADHD
  • When to expect results
  • SEs
  • Risk of abuse
  • growth delay 

18

Lisdexamphetamines?

Vyvanse 10 hour duration, 

19

Dexmethylphenidate 

Brand names? 

Durations?

Focalin- 6 hours 

Focalin XR- 10-12

20

TCAs

  • Response in the first 2 weeks 
  • Effective in adult ADHD
  • Imipramine, Desipramine
  • Disadvantages: Increase SEs, Risk of death in OD, Monitor EKG

21

ADHD and abuse

Basically patients with ADHD are more likely to have substance abuse 

22

AEs of stimulants?

  • Anorexia
  • GI distress
  • Insomnia
  • Rebound symptoms
  • Irritability 
  • Dysphoria
  • Zombie state

Tics, HTN, Hallucinations, and cardiovascular events, rare

23

Medications for aggression and explosive behavior?

Refractory ADHD cases with severe aggression?

  • Lithium
  • Valproate
  • Carbamazepine

 

Antipsychotics

24

What are the advantages of methylphenidate?

  • Most Studied
  • – Least effects on worsening tics, appetite and mood
  • – Potential for less abuse?
  • – Less regulatory requirements? –
  • Transdermal - alter the duration of its effects (wear time)
  • – Potentially less BP changes

25

Clonidine XR and Guanfacine 

Adjuncts for?

Monitor?

SEs?

Do what when stopping? 

 

  • For sleep and aggression
  • Monitor EKG
  • Sedation, Hypotension, Constipation 
  • Taper 

26

Pharm treatment for ADHD?

  • Stimulants
  • Atomoxetine
  • Clonidine/ Guanfacine
  •  Antidepressants
  • Cognitive treatment

27

Atomoxetine

Onset of action, what line of treatment?

metabolized by?

SEs?

Black box

  • 2nd line ofr treatment 
  • Onset is 2-4 weeks 
  • full in 6-8 week s
  • 2D6
  • Increase LFT, BP and P, Nausea, decreased appetite
  • Suicide in children 

28

Stimulants should be avoided in patients with?

  • Serious structural cardiac abnormalities
  • Cardiomyopathy
  • Serious heart rhythm abnormalitites

29

Symptoms need to be present in multiple?

Stimulant medications are?

Non-stimulant medication benefits include?

  • Settings
  • First line
  • No abuse potential, less growth effects and less sleep disturbances 

30

Bupropion what line? Advantages for who? 

Contraindications?

  • 2nd line
  • Less toxicity than TCA, less appetite suppression than stimulants 
  • For adults
  • No seizures

31

Phychostimulants

  • - Methylphenidate
  • - Dexmethylphenidate
  • - Dextroamphetamine
  • - Mixed amphetamine
  • - Lisdexamfetamine

32

How is ADHD diagnosed?

  • Symptom onset prior to age 12
  • Symptoms must be present in multiple settings for at least 6 months 
  • Need to rule out other causes like a learning disability

33

Dexedrine and Dextrostat are both? And what is their DOA?

Dextroamphetamines 

3-5 hours